大剂量辛伐他汀联合阿替普酶对急性脑梗死患者神经功能的影响  

Effect of large-dose simvastatin combined with alteplase on neurological function in patients with acute cerebral infarction

作　　者：焦继峰 龙治华 JIAO Jifeng;LONG Zhihua(Department of Neurology,Gongyi People′s Hospital of He′nan Province,Gongyi 451200,China;Department of Neurology,Zhumadian Central Hospital,Zhumadian 463000,China)

机构地区：[1]河南省巩义市人民医院神经内科,巩义451200 [2]驻马店市中心医院神经内科,驻马店463000

出　　处：《西北药学杂志》2020年第2期277-282,共6页Northwest Pharmaceutical Journal

基　　金：河南省科技攻关计划项目(编号:182102310153)。

摘　　要：目的分析大剂量辛伐他汀联合阿替普酶静脉溶栓对急性脑梗死(ACI)患者神经功能及血清血管细胞黏附分子-1(VCAM-1)和神经元特异性烯醇化酶(NSE)水平的影响。方法选取收治的111例ACI患者,采取简单随机化法均分为3组,对照组给予阿替普酶静脉溶栓治疗,小剂量组给予20 mg辛伐他汀联合阿替普酶静脉溶栓,大剂量组给予40 mg辛伐他汀联合阿替普酶静脉溶栓,比较3组治疗6周后的总有效率、美国国立卫生研究院卒中量表评分(NIHSS)、日常生活能力量表评分(ADL)、Fas/Fas蛋白配体(FasL)信号通路变化[可溶血Fas(sFas)、可溶性肿瘤坏死因子相关凋亡诱导配体(sTRAIL)和可溶血Fas配体(sFasL)]、NSE、泛素羧基末端水解酶L1(UCH-L1)、髓鞘碱性蛋白(MBP)、胶质纤维酸性蛋白(GFAP)、中枢神经特异性蛋白(S-100β)、P-选择素、VCAM-1水平及不良反应发生情况。结果大剂量组(94.59%)和小剂量组(91.89%)治疗6周后的总有效率均高于对照组(67.57%)(P<0.05),但大、小剂量组间比较差异无统计学意义;大、小剂量组治疗6周后NIHSS评分均低于对照组,ADL评分均高于对照组(P<0.05);大剂量组治疗6周后NIHSS和ADL评分高于小剂量组(P<0.05);大、小剂量组治疗6周后sFas、sTRAIL和sFasL均低于对照组(P<0.05);大剂量组治疗6周后sFas、sTRAIL和sFasL均低于小剂量组(P<0.05);大、小剂量组治疗6周后NSE、UCH-L1、MBP、GFAP和S-100β均低于对照组(P<0.05);大剂量组治疗6周后NSE、UCH-L1、MBP、GFAP和S-100β均低于小剂量组(P<0.05);大、小剂量组治疗6周后P-选择素和VCAM-1均低于对照组(P<0.05);大剂量组治疗6周后P-选择素和VCAM-1均低于小剂量组(P<0.05);3组均无明显不良反应发生。结论大剂量辛伐他汀联合阿替普酶静脉溶栓治疗ACI,能促进患者神经功能恢复,改善患者日常生活能力,减少对神经细胞的损伤,抑制动脉粥样硬化,安全可靠,其机制可能与抑制Fas/FasL信号�Objective To analyze the effect of large-dose simvastatin combined with ateplase intravenous thrombolysis on neurologic function,serum vascular cell adhesion molecule-1(VCAM-1)and neuron specific enolase(NSE)in patients with acute cerebral infarction(ACI).Methods A total of 111 ACI patients were selected and divided into 3 groups by simple randomization.The control group was given alteplase intravenous thrombolysis,the small-dose group was given 20 mg simvastatin combined with alteplase intravenous thrombolysis,and the large-dose group was given 40 mg simvastatin combined with alteplase intravenous thrombolysis.The total effective rate,National Institutes of Health Stroke Scale Score(NIHSS),daily life ability scale score(ADL),Fas/Fas protein ligand(FasL)signal pathway changes[soluble Fas(sFas),soluble tumor necrosis factor-related apoptosis-inducing ligand(sTRAIL),soluble Fas ligand(sFasL)],NSE,ubiquitin carboxy-terminal hydrolase L1(UCH-L1),myelin basic protein(MBP),glial fibrillary acidic protein(GFAP),central nerve specific protein(S-100β),P-selectin,VCAM-1 level and the occurrence of adverse reactions of 3 groups were compared after 6 weeks of treatment.Results The total effective rate(94.59%,91.89%)in the large-dose group and the small-dose group was higher than that in the control group(67.57%)after 6 weeks of treatment(P<0.05),but there was no significant difference between the large-dose group and the small-dose group(P>0.05);NIHSS score was lower in the large-dose group and the small-dose group than in the control group after 6 weeks,and the ADL score was higher than that in the control group(P<0.05).The NIHSS and ADL scores in the large-dose group were better than the small-dose group after 6 weeks(P<0.05);the sFas,sTRAIL and sFasL were lower in the large-dose group and the small-dose group than in the control group after 6 weeks(P<0.05);the sFas,sTRAIL and sFasL in the large-dose group were lower than those in the small-dose group after 6 weeks of treatment(P<0.05);NSE,UCH-L1,MBP,GFAP and S-100βwere

关 键 词：辛伐他汀 阿替普酶 急性脑梗死 神经功能及血清血管细胞黏附分子-1 神经元特异性烯醇化酶 静脉溶栓 

分 类 号：R972[医药卫生—药品]