PAS三联疗法对急性脑梗死患者血清相关蛋白及颈动脉易损斑块的影响  

Effect of PAS therapy on serum related protein levels and carotid vulnerable plaque in patientswith acute cerebral infarction

作　　者：李强 凌芳 聂德云 胡琴 胡仁琳 

机构地区：[1]武汉市第五人民医院神经内科,430050

出　　处：《中华神经医学杂志》2013年第1期44-49,共6页Chinese Journal of Neuromedicine

基　　金：武汉市卫生局科研基金（WX10C23）

摘　　要：目的探讨普罗布考＋阿司匹林＋阿托伐他汀（PAS）三联疗法对急性脑梗死患者血清氧化型低密度脂蛋白（ox-LDL）、血清妊娠相关蛋白A（PAPP-A）及基质金属蛋白酶．3（MMP-3）水平的影响，观察其对颈动脉易损斑块的消退作用。方法选择武汉市第五人民医院神经内科自2007年9月至2010年7月收治的135例急性脑梗死患者为研究对象，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）。易损斑块组抽血检查后按随机数字表法分为阿托伐他汀＋阿司匹林（AS）组45例（阿司匹林100mg／d、阿托伐他汀20mg／d，口服）和PAS组45例（阿司匹林100mg／d、阿托伐他汀20mg／d、普罗布考0．25／次，2次／d，口服）。比较治疗前和治疗4周后各组患者血清ox-LDL、PAPP-A和MMP-3水平，观察治疗前及治疗12月后颈动脉内中膜厚度（IMT）、斑块面积及斑块回声变化。结果治疗前，易损斑块组中两亚组（AS组和PAS组）血清ox-LDL、PAPP-A和MMP-3水平均明显高于稳定斑块组，差异有统计学意义（P〈0．05），但两亚组间该3项指标比较差异无统计学意义（P〉0．05）。治疗4周后，PAS组患者血清ox-LDL、PAPP-A和MMP-3水平均明显低于AS组和稳定斑块组，距治疗前下降幅度均大于AS组和对照组，差异有统计学意义（P〈0．05）。治疗12月后，易损斑块组中两亚组（AS组和PAS组）IMT值和斑块面积均较治疗前减少，且PAS组该2项指标低于AS组，差异均有统计学意义（P〈0．05）；PAS组低回声斑块数量较AS组明显减少，斑块消失数量增加，差异有统计学意义（P〈0．05）。结论PAS三联疗法具有更强的抗氧化降脂作用，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 serum oxidized low-density lipoproteins （ox-LDL）, pregnancy-associated plasma protein A（PAPP-A） and marix metalloproteinase-3（MMP-3） and resolution of carotid vulnerable plaque in patients with acute cerebral infarction （ACI）. Methods One hundred and thirty-five patients with ACI, admitted to our hospital from September 2007 to July 2010, were chosen in our study; according to the results of carotid artery ultrasound, these patients 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 patients with carotid vulnerable plaque were randomly subdivided into aspirin and statins drugs （AS） group （n=45, aspirin 100 mg/d, atorvastatin 20 mg/d, orally） and PAS group （n=45, aspirin 100 mg/d, atorvastatin 20 mg/d, probucol 0.25 g/time, 2 times/day, orally）. Levels of Ox-LDL, PAPP-A and MMP-3 were detected in all patients before treatment and four weeks after drug therapy. The intima-media thickness, plaque area and echogenicity of carotid plaques were evaluated by Dopplerultrasonography during a 12-month follow-up period. Results Before treatment, serum ox-LDL, PAPP-A and MMP-3 levels in AS group and PAS group were significantly higher than those in the control group （P〈0.05）; no significant differences ofox-LDL, PAPP-A and MMP-3 levels were noted between AS and PAS groups （P〉0.05）. Four weeks after treatment, levels of serum ox-LDL, PAPP-A and MMP-3 in PAS group were significantly lower than those in AS and control groups （P〈0.05）; the decrease of levels of ox-LDL, PAPP-A and MMP-3 in PAS group was obviously higher than that in AS and control groups （P〈0.05）. Twelve months after treatment, significant decrease of plaque area and intima-media thickness （IMT） was noted in the AS and PAS groups （P〈0.05）; the IMT and plaque area in PAS group

关 键 词：脑梗死 阿托伐他汀 普罗布考 阿司匹林 氧化型低密度脂蛋白 妊娠 相关蛋白A 基质金属蛋白酶-3 斑块 

分 类 号：R743.3[医药卫生—神经病学与精神病学]