PAS三联疗法对急性脑梗死患者血脂、血清sCD40L及MMP-9水平及颈动脉易损斑块稳定性的影响  

Effect of PAS therapy on blood lipoprotein,serum soluble CD40 ligand and marix metalloproteinase-9(MMP-9) in patients with acute cerebral infarction and the stability of carotid vulnerable plaque

作　　者：李强 凌芳 肖家平 唐智敏 黄天志 

机构地区：[1]武汉市第五医院神经内科,湖北武汉430050

出　　处：《中风与神经疾病杂志》2011年第12期1090-1093,共4页Journal of Apoplexy and Nervous Diseases

基　　金：武汉市卫生局科研资助项目(编号:WX10C23)

摘　　要：目的探讨普罗布考、阿司匹林、他汀类药物(PAS)三联疗法对急性脑梗死患者血脂、血清超敏C-反应蛋白(hs-CRP)、可溶性CD40配体(sCD40L)及基质金属蛋白酶-9(MMP-9)水平的影响,观察其对颈动脉易损斑块稳定性的影响。方法根据颈动脉超声检查结果分为颈动脉稳定斑块组(n=45)和颈动脉易损斑块组(n=90)。将稳定斑块组作为对照组,按随机数字法将易损斑块组分为AS组(n=45,阿司匹林100mg/d,阿托伐他汀20mg/d,口服)和PAS组(n=45,AS基础上加用普罗布考片,0.25/次,2次/日,口服)。比较治疗前后血脂、血清hs-CRP、sCD40L和MMP-9水平;观察治疗前后颈动脉内-中膜厚度(IMT值)、斑块Crous积分及斑块回声变化。结果治疗后4w,两组中TG、TC、LDL-C、血清hs-CRP、sCD40L和MMP-9水平均下降,PAS组中各项指标下降幅度均大于AS组,差异具有显著性(P均<0.01);治疗后12个月,两组IMT值和斑块Crous积分较治疗前减少,且PAS组两项指标低于AS组,PAS组低回声斑块回声增强例数高于AS组(P均<0.01)。结论 PAS三联疗法是一种安全有效的治疗方法,具有更强的降脂抗炎作用,可逆转和稳定斑块。Objective To observe the influence of combination therapy of probucol,aspirin and statins drugs（PAS） on levels of blood lipoprotein,high sensitivity C-reactive protein（hs-CRP）,soluble CD40 ligand（sCD40L） and marix metalloproteinase-9（MMP-9） in patients with acute cerebral infarction（ACI） and its effect on the stability of carotid artery plaque.Methods According to the results of carotid artery ultrasound,135 cases of patients with ACI were divided into carotid stable plaque group（n=45） and carotid vulnerable plaque group（n=90）.Stable plaque group was considered as control group.90 cases with carotid vulnerable plaque were randomly divided into aspirin and statins drugs（AS） group（n=45,aspirin 100mg/d,atorvastatin 20mg/d,oral）and PAS group（n=45,aspirin 100mg/d,atorvastatin 20mg/d,probucol 0.25/time,2 times/day,oral）.Blood lipoprotein,Hs-CRP,sCD40L and MMP-9 were detected in all patients before treatment and four weeks after drug therapy.The intima-media thickness,Crouse integrals and echogenicity of carotid plaques were evaluated by Doppler ultrasonography during a 12 month follow up period.Results After treatment for four weeks,levels of TG,TC,LDL-C,serum hs-CRP,sCD40L and MMP-9 were significantly decreased in patients who treated with aspirin and statins drugs（AS） for 4 weeks,as well as in patients who treated with probucol,aspirin and statins drugs（PAS）（P0.01）.When compared with the treatment drop scope,the decreases in levels of of TC,LDL-C,hs-CRP,sCD40L and MMP-9 in PAS group were obviously higher than that in AS group（P0.01）.Whether AS or PAS group,significant increases in echogenicity of carotid plaques and decreases in Crouse integrals of carotid plaques and intima-media thickness were noted after therapy.However,the value of IMT and crouse integrals of carotid plaques in PAS group were significantly lower than that in AS group（P0.01）.Compared with the treatment,the number of echogenic cases of hypoechoic plaques in PAS group were increased signifi

关 键 词：脑梗死 阿托伐他汀 普罗布考 可溶性CD40配体 基质金属蛋白酶-9 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]