调脂治疗对急性脑梗死患者血清hs-CRP、IL-18及MMP-7水平的影响及颈动脉斑块的干预作用  

Effect of lipid-lowering treatment on high sensitivity C-reactive protein,serum interleukin-18 and marix metalloproteinases-7 in patients with acute cerebral infarction and the intervention of atherosclerosis plaque

作　　者：凌芳 李强 聂德云 

机构地区：[1]武汉市第五神经内科,430050

出　　处：《中华脑血管病杂志（电子版）》2012年第3期29-34,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：武汉市卫生局科研资助项目(编号:WX10C23)

摘　　要：目的探讨不同剂量阿托伐他汀调脂治疗对急性脑梗死患者血清高敏C反应蛋白(hs-CRP)、白细胞介素-18(IL-18)及基质金属蛋白酶-7(MMP-7)的影响,观察其对颈动脉斑块的干预作用。方法 144例急性脑梗死患者根据颈动脉超声检查结果分为颈动脉稳定斑块组(n=72)和颈动脉易损斑块组(n=72),抽血检查后分别随机分为小剂量组36例(阿托伐他汀10mg/d,口服)和大剂量组36例(阿托伐他汀40mg/d,口服)。比较治疗前和治疗后4周血清hs-CRP、IL-18和MMP-7水平;观察治疗前及治疗后6个月颈动脉内-中膜厚度(IMT值)、斑块面积及斑块回声变化。结果治疗前,在同一种性质斑块中,两治疗组(小剂量和大剂量组)间血清hs-CRP、IL-18和MMP-7水平比较,差异均无显著性(P均>0.05)。对两种性质斑块间血清hs-CRP、IL-18和MMP-7水平进行比较,无论是小剂量组还是大剂量组,三项指标均以易损斑块组高于稳定斑块组(均P<0.05或P<0.01);在同性质斑块组中,无论是接受小剂量还是大剂量阿托伐他汀治疗,治疗后血清hs-CRP、IL-18和MMP-7水平均明显下降,但大剂量组三项指标下降幅度均大于小剂量组(P均<0.01)。治疗6个月后,小剂量组IMT值及斑块面积稍下降,差异无显著性(P均>0.05),而大剂量组IMT值及斑块面积均明显下降,两项指标均低于小剂量组,差异具有显著性(P均<0.01)。治疗后,小剂量组斑块回声信号无明显改善,而大剂量组低回声斑块回声增强例数高于小剂量组,差异具有显著性(P<0.01)。结论血清hs-CRP、IL-18和MMP-7的水平可作为检测AS易损性的血清学生物指标;大剂量阿托伐他汀调脂治疗能迅速降低脑梗死患者的血清炎性因子水平,具有更强的抗炎作用,在一定程度上可逆转和稳定斑块。Objective To observe the influence of different doses of atorvastatin lipid-lowering treatment on inflammatory factors such as high sensitivity C-reactive protein （hs-CRP）, interleukin-18 （ IL-18 ） and marix metalloproteinase-7 （ MMP-7 ） in patients with acute cerebral infarction （ ACI ） and its effect on the role of carotid artery plaque. Methods According to the results of carotid artery ultrasound, 144 cases of patients with ACI were divided into carotid vulnerable plaque group and carotid stable plaque group. Each group included 72 cases and randomly selected 36 cases were given a small dose （ low-dose group） and high dose atorvastatin （high-dose group ） treatment. Patients in low-dose group received atorvastatin 10 mg daily, whereas patients in high-dose group received atorvastatin 40 mg daily. Levels of serum hs-CRP, IL-18 and MMP-7 were detected in all patients before treatment and four-weeks after drug treatment. The intima-media thickness, plaque area and echogenicity of carotid plaques were evaluated by Doppler uhrasonography during a 6-month follow-up period. Results Before treatment, there were no significant differences on levels of hs-CRP, IL-18 and MMP-7 in patients with the same carotid plaques between low-dose group and high-dose group （ all P 〉 0.05）. No matter what treatment accepted, levels of hs-CRP,IL-18 and MMP-7 were obviously higher in patients withe unstable plaques than those with stable plaques （ all P 〈 0.05 or P 〈 0.01 ）. Compared with the results of treatment before, levels of hs-CRP, IL-18 and MMP-7 were significantly decreased in patients who treated with high-dose atorvastatin for 4 weeks, as well as in patients who treated with low-dose atorvastatin （ all P 〈0.01 ）. Four weeks later, the decreases of levels of hs-CRP, IL-18 and MMP-7 were obviously higher in high-dose group than in low-dose group （all P 〈 0.01 ）. Slight decreases in plaque area and intima-media thickness were noted after statin therapy in low-dose group （ all P

关 键 词：脑梗死 阿托伐他汀 白细胞介素-18 基质金属蛋白酶-7 动脉粥样硬化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]