本文關鍵詞： 瑞舒伐他汀 依折麥布 腦梗死 動脈粥樣硬化 血脂 hs-CRP　出處：《蘇州大學》2014年碩士論文　論文類型：學位論文

【摘要】：研究目的越來越多的臨床證據表明，高脂血癥是引起冠狀動脈粥樣硬化性心臟病、腦血管疾病的主要致病危險因素。在本研究中，通過對可定、益適純聯合調脂與可定單藥調脂效果及安全性的比較，探討更適合于腦梗死患者卒中二級預防用藥的調脂方案。 研究對象及方法選擇2012年6月1日至2013年6月30日在蘇州大學附屬第二醫(yī)院神經內科住院的腦梗死患者，均伴有頸動脈粥樣硬化斑塊和高脂血癥（TC5.69mmol/L，LDL-C3.10mmol/L），，其中男性61例，女性37例；年齡48-71歲，平均61.32±7.36歲。所有患者入組前均未應用他汀類與鹽酸類降脂藥物治療，均無肝腎功能異常，無急重癥感染、3個月內無手術和外傷史，無代謝與內分泌系統疾病，無惡性腫瘤病史，預計生存期均超過1年，2組患者的性別、年齡等一般臨床資料比較差異無統計學意義（P0.05），具有一致性。所有研究對象入院后均給予常規(guī)藥物治療，包括給予抗血小板聚集、降血壓(腦梗死急性期除外)類藥物，將所有入組的98例患者采用隨機數字法分為對照組（n=49）和觀察組（n=49）：對照組口服瑞舒伐他�。ㄆ访啥ǎ瑖帨首諮20090091，阿斯利康制藥有限公司）10mg，1次/d，觀察組口服瑞舒伐他汀10mg+依折麥布（品名益適純，進口藥品注冊證號:H20080132，美國先靈葆雅制藥有限公司）10mg，1次/d，隨訪24周，分別在12周、24周于門診抽空腹血監(jiān)測血脂四項血清總膽固醇(TC)、甘油三酯（TG）、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇（HDL-C）、載脂蛋白B（Apo-B）、超敏C反應蛋白（hs-CRP）、肝功能（谷丙轉氨酶ALT、谷草轉氨酶AST）、肌酸激酶（CK）值，并于24周在心超室行頸動脈多普勒超聲檢查，測量頸總動脈內粥樣斑塊橫切面的最大面積（Smax），于距頸總動脈分叉處1.0cm內測量頸動脈內膜中層厚度(IMT)，記錄用藥后主要終點事件（死亡）及次要終點事件（新發(fā)腦卒中）。 結果2組治療后TC、TG、LDL-C和Apo-B水平均較治療前顯著減低（P＜0.05），觀察組LDL-C、TC和Apo-B的減低幅度明顯低于對照組（P＜0.05）。治療后觀察組頸動脈粥樣斑塊最大面積較治療前明顯減�。≒＜0.05），對照組治療前、治療后頸動脈粥樣斑塊面積無明顯變化（P＞0.05）。2組治療后hs-CRP水平均明顯減低（P＜0.05），觀察組與對照組比較無統計學差異（P＞0.05）。2組不良反應發(fā)生率比較差異無統計學意義（P＞0.05）。 結論1.可定10mg或可定10mg+益適純10mg都能顯著降低血脂水平，但可定聯合益適純可更有效降低LDL-C和TC。 2.聯合治療對頸動脈粥樣硬化斑塊可能有一定的逆轉作用。 3.高TC、LDL-C水平對頸動脈斑塊的形成可能有一定的促進作用。 4.觀察組與對照組相比較，不良反應發(fā)生率比較差異無統計學意義（P＞0.05）。
[Abstract]:Objective to study more and more clinical evidence that hyperlipidemia is the main risk factor for coronary atherosclerotic heart disease and cerebrovascular disease. To compare the efficacy and safety of Yishichun combined with orderable drugs in regulating lipid, and to explore a more suitable scheme for secondary prevention of stroke in patients with cerebral infarction. Participants and methods patients with cerebral infarction were selected from June 1st 2012 to June 30th 2013 in Department of Neurology, second affiliated Hospital of Suzhou University. All patients were accompanied with carotid atherosclerotic plaque and hyperlipidemia TC5.69 mmol / L LDL-C3.10 mmol / L, including 61 males and 37 females; The average age was 61.32 鹵7.36 years old. All patients were not treated with statin or hydrochloric acid lipid-lowering drugs before entering the group. There was no abnormal liver and kidney function and no acute severe infection. There was no history of surgery and trauma, no metabolic and endocrine diseases, and no history of malignant tumor within 3 months. There was no significant difference in age and other general clinical data (P 0.05). All the subjects were given routine drug treatment, including anti-platelet aggregation. Drugs for lowering blood pressure (except acute cerebral infarction). All 98 patients in the group were randomly divided into two groups: control group (n = 98) and observation group (n = 49). The control group was treated by oral administration of rosuvastatin (product name can be determined, Chinese medicine accurate character J20090091). AstraZeneca Pharmaceutical Co., Ltd. 10mg / d, the observation group oral Risuvastatin 10mg Ezeimex (product name, import drug registration certificate no.: H20080132). The patients were followed up for 24 weeks and 12 weeks to 24 weeks, respectively, to monitor the blood lipid levels of four serum total cholesterol (TCs) in the abdominal blood of the outpatients. Triglyceride (TGN), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo-Bn). Hypersensitive C-reactive protein (hs-CRP), liver function (alt, AST, CK), and carotid Doppler ultrasound were performed at 24 weeks. The maximum area of atherosclerotic plaques in the common carotid artery was measured and IMT was measured within 1.0 cm from the common carotid artery bifurcation. The main endpoint events (death) and secondary endpoint events (new stroke) were recorded. Results the levels of LDL-C and Apo-B were significantly lower in the two groups than before treatment (P < 0.05). The LDL-C in the observation group was significantly lower than that in the control group (P < 0.05). The decrease of TC and Apo-B was significantly lower than that of control group (P < 0.05). After treatment, the maximum area of carotid atherosclerotic plaque in observation group was significantly lower than that before treatment (P < 0.05), and before treatment in control group. After treatment, the area of carotid atherosclerotic plaque did not change significantly (P > 0.05). The level of hs-CRP decreased significantly after treatment (P < 0.05). There was no statistical difference between the observation group and the control group (P > 0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P > 0.05). Conclusion 1. Both 10 mg and 10 mg of codeine can significantly reduce the level of blood lipid, but the combination of Kedalin and Isochon can effectively reduce LDL-C and TCC. 2. 2. Combined therapy may have a reversal effect on carotid atherosclerotic plaque. 3. High level of TCU LDL-C may promote carotid plaque formation. 4. There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P > 0.05).
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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