他汀类药物对大脑中动脉梗死的患者肱动脉血流介导的舒张功能的影响  

Effect of Statins on Flow-mediated Dilation in Patients with Cerebral Infarction in the Territory of Middle Cerebral Artery

作　　者：陈雅玲[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海市200040

出　　处：《中国卒中杂志》2009年第10期799-804,共6页Chinese Journal of Stroke

摘　　要：目的观察他汀类药物对大脑中动脉(middle cerebral artery,MCA)供血区梗死的患者肱动脉血流介导的舒张功能(flow-mediated dilation,FMD)的影响。方法入选30例首次发病且发病2周内的MCA供血区梗死的患者,其中服用他汀类药物者20例,未用药者10例,观察发病3个月时FMD与发病2周内的变化,并且研究FMD与通过经颅多普勒(transcranial doppler,TCD)评估的双侧MCA血流速度和PI的相关性,以及FMD与患者预后的关系。结果用药组3个月后的FMD显著改善[(9.10±2.56)%vs(6.13±1.60)%,P<0.01],且FMD的提高与健侧MCA搏动指数(pulse index,PI)值的改变呈显著负相关(rs=-0.432,P=0.031),即患者FMD提高越多,健侧MCA的血管顺应性改善越多;非用药组FMD较基线时的变化无统计学意义;所有患者发病3个月时FMD与患者预后呈正相关(P<0.05),且FMD的变化与血脂的改变之间相关性无统计学意义(P>0.05)。结论他汀类药物可能通过提高肱动脉FMD改善MCA梗死患者的血管内皮功能,且FMD的改善可能与健侧MCA血管顺应性的改善及良好的预后有关,这种作用独立于降脂作用之外。Objective To investigate the effect of statins on flow-mediated dilation in patients with cerebral infarction in the territory of middle cerebral artery. Methods Thirty inpatients with first-ever middle cerebral artery（MCA） territory infarction were enrolled within 2 weeks after symptom onset, among whom twenty cases were in statins group and ten cases were in non-statins group. All patients went through FMD and TCD examination, and were followed up 3 months later. The correlation between FMD and hemodynamics of bilateral MCA was studied, and the correlation with prognosis was also assessed. Results The FMD of patients with continuous statins treatment significantly improved after three months[（9.10±2.56）% vs （6.13±1.60）%, P〈0.01], and the improvement showed a significant inverse correlation with the change of PI of uninjured MCAs（rs=-0.432, P=0.031）. In other words, the more FMD improved, the better compliance the uninjured MCA would get. FMD of non-statins group didn＇t show a significant change. Three month FMD of all patients had a positive correlation with prognosis（P〈0.05）, while the improvement of FMD didn＇t show association with the change of serum lipid（P〉0.05）. Coneluslon Statin treatment may improve endothelial function of patients with MCA territory infacrtion by elevating FMD of brachial artery. The improvement of FMD may have an association with better compliance of uninjured MCAs and thus better outcome, and the effect might be lipidindependent.

关 键 词：他汀 脑梗死 大脑中动脉 血管舒张 内皮 血管 

分 类 号：R743.3[医药卫生—神经病学与精神病学]