摘要
目的观察不同剂量辛伐他汀对脑梗死颈动脉粥样硬化斑块患者的超敏C反应蛋白(hs-CRP)和白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)等血清炎性因子的影响,探讨辛伐他汀治疗脑梗死的最佳应用剂量。方法将唐山市开滦总医院在2014年11月至2015年9月期间诊治的156例脑梗死伴颈动脉粥样硬化斑块患者,根据辛伐他汀用量分为小剂量组(20 mg/d)和大剂量组(40 mg/d)各78例,随访6个月,在治疗前、治疗后1个月、3个月和6个月时分别测定hs-CRP、IL-6、TNF-α、MMP-9水平,治疗6个月后对两组疗效进行评价并记录不良反应和复发情况。结果治疗后1个月,大剂量组患者血清hs-CRP[(12.34±3.48)mg/L]、IL-6[(0.72±0.18)ng/L]、TNF-α[(46.28±4.49)μg/L]以及MMP-9[(513.09±71.53)μg/L]均明显低于小剂量组[(14.38±3.46)mg/L、(0.74±0.12)ng/L、(47.83±4.79)μg/L、(613.46±68.28)μg/L],差异均有统计学意义(P<0.05);治疗后3个月,大剂量组患者的血清hs-CRP[(7.94±2.37)mg/L]、IL-6[(0.62±0.17)ng/L]、TNF-α[(32.48±4.57)μg/L]以及MMP-9[(418.62±53.34)μg/L]明显低于小剂量组[(11.34±2.15)mg/L、(0.68±0.15)ng/L、(48.13±4.27)μg/L、(514.85±51.79)μg/L],差异均有统计学意义(P<0.05);治疗后6个月,大剂量组患者的血清hs-CRP[(4.42±1.53)mg/L]、IL-6[(0.49±0.21)ng/L]、TNF-α[(21.27±3.54)μg/L]以及MMP-9[(307.61±35.83)μg/L]明显低于小剂量组[(7.67±1.92)mg/L、(0.63±0.14)ng/L、(34.97±3.56)μg/L、(407.92±42.46)μg/L],差异均有统计学意义(P<0.05);治疗后,大剂量组患者的总有效率为97.44%,与对照组的92.31%比较差异无统计学意义(P>0.05);大剂量组患者6个月内复发率为1.3%,明显低于小剂量组的10.3%,差异有统计学意义(P<0.05)。结论辛伐他汀20 mg和40 mg均是脑梗死伴颈动脉粥样硬化斑块的有效治疗剂量,但是大剂量应用辛伐他汀能够明显减轻炎症水平,改善脑梗死颈动脉粥样硬化斑块治疗效果。
Objective To observe the effects of different doses of simvastatin on serum hypersensitive C reactive protein（hs-CRP） and inflammatory factors including interleukin 6（IL-6）, tumor necrosis factor-α（TNF-α） and matrix metalloproteinase-9（MMP-9） in patients with cerebral infarction and carotid atherosclerosis plaques, and to study the best dose of simvastatin in the treatment of cerebral infarction. Methods A total of 156 patients with cerebral infarction and carotid atherosclerosis plaques was selected in our hospital between November 2014 and September 2015. According to the doses of simvastatin, patients were divided into low dose group（20 mg/d, n=78） and high dose group（40 mg/d, n=78）. They were followed up for 6 months, and hs-CRP, IL-6, TNF-α and MMP-9 levels were detected by enzyme-linked immunosorbent method before and after one-month treatment, and three months and six months after treatment. Then the curative effects were also evaluated after six-month treatment in the two groups. The detailed adverse reactions and relapse were recorded. Results After one-month treatment, serum hs-CRP, IL-6, TNF-α and MMP-9 levels were（12.34±3.48） mg/L,（0.72±0.18） ng/L,（46.28±4.49） μg/L,（513.09±71.53） μg/L in the high dose group, respectively, versus（14.38±3.46） mg/L,（0.74±0.12） ng/L,（47.83±4.79） μg/L,（613.46±68.28） μg/L in the low dose group（all P0.05）. After three-month treatment, serum hs-CRP, IL-6, TNF-α, MMP-9 were（7.94 ± 2.37） mg/L,（0.62 ± 0.17） ng/L,（32.48 ± 4.57） μg/L,（418.62 ±53.34） μg/L] in the high dose group, respectively, versus（11.34 ± 2.15） mg/L,（0.68 ± 0.15） ng/L,（48.13 ± 4.27） μg/L,（514.85±51.79） μg/L in the low dose group（all P0.05）. After six-month treatment, serum levels of hs-CRP, IL-6, TNF-α, MMP-9 were（4.42±1.53） mg/L,（0.49±0.21） ng/L,（21.27±3.54） μg/L,（307.61±35.83） μg/L in the high dose group,versus（7.67±1.92） mg/L,（0.63±0.14） ng/L,（34.97±3.56） μg/L,（407.92±42.46） μg/L in the low dose group（all P0.05）.After the treatment, the total efficiency was 97.44% in the high dose group versus 92.31% in the low dose group（P0.05）.Furthermore, the recurrence rate（1.3%） in the high dose group within six months was significantly lower than that in the low dose group（10.3%）, P0.05. Conclusion The doses of 20 mg and 40 mg of simvastatin are both effective treatment doses for cerebral infarction and carotid atherosclerosis plaque, but high dose of simvastatin can significantly reduce inflammation condition and improve the treatment effect of cerebral infarction and carotid atherosclerosis plaque.
出处
《海南医学》
CAS
2018年第1期18-21,共4页
Hainan Medical Journal
关键词
辛伐他汀
脑梗死
颈动脉粥样硬化斑块
超敏C反应蛋白
炎性因子
Simvastatin
Cerebral infarction
Carotid atherosclerotic plaque
Hypersensitive C reactive protein
Inflammatory factor
