發(fā)布時間：2018-05-28 13:00

  本文選題：瑞舒伐他汀 + 急性腦梗死��； 參考：《蘭州大學(xué)》2017年碩士論文

【摘要】：目的:檢測不同劑量他汀類藥物對急性腦梗死(acute cerebral infarction,ACI)患者內(nèi)皮祖細胞(endothelial progenitor cells,EPCs)、超敏C反應(yīng)蛋白(high-sensitivity C-reactie protein,hsCRP)及美國國立衛(wèi)生研究院卒中量表(nation institutes of health stroke scale,NIHSS)評分的影響,探索大劑量他汀類藥物治療ACI患者的益處。方法:選取2015年10月-2016年7月在蘭州大學(xué)附屬第二醫(yī)院神經(jīng)內(nèi)科病房住院的首次發(fā)病72h內(nèi)的ACI患者80例,按照納入標準選擇其中42例患者,隨機分為瑞舒伐他汀10mg治療組和20mg治療組,共治療21天,檢測入院第1天(基線期)和治療后21天的血脂指標;采用流式細胞儀檢測外周血EPCs細胞的數(shù)量,CD34+KDR+CD133+CD45dim作為EPCs的細胞表面標記,分別檢測入院第1天(基線期),治療后7天、14天和21天的外周血EPCs數(shù)量的動態(tài)變化,并用ELISA法檢測分別檢測入院第1天(基線期),治療后7天、14天和21天的hsCRP的水平。并入院第1天(基線期)、治療后7天、14天、21天和30天的美國國立衛(wèi)生研究院卒中量表(NHISS)評分。結(jié)果:1.兩組治療后TC、TG和LDL-C水平與治療前相比均顯著降低,HDL-C水平顯著升高(P0.05),且20mg組的TC和LDL-C水平降低更顯著(P0.05)。2.在治療后兩組患者的EPCs數(shù)量逐漸增高,與10mg組相比,20mg組在治療后第14天、21天時EPCs水平增高更顯著(P0.05),且兩組的EPCs數(shù)量均隨時間變化呈線性相關(guān)。3.在治療后兩組患者的血漿hsCRP水平均不斷下降,與10mg組相比,20mg組在治療后第7d、14d時hsCRP水平下降更顯著(P0.05)。4.治療后NIHSS評分逐漸改善,治療后30天時,與10mg組相比,20mg組NIHSS評分改善更顯著,差異有統(tǒng)計學(xué)意義(P0.05)。5.ACI發(fā)生72h內(nèi),外周血中EPCs數(shù)量與NIHSS評分呈負相關(guān)(r=-0.413,P=0.007);血漿中hsCRP水平與NIHSS評分呈正相關(guān)(r=0.556,P=0.000),外周血中EPCs數(shù)量與血漿中hsCRP水平呈負相關(guān)(r=-0.472,P=0.002)。結(jié)論:與10mg相比,20mg瑞舒伐他汀能更有效地改善ACI患者血脂水平,增加EPCs數(shù)量,降低hsCRP水平并在一定程度上改善神經(jīng)功能缺損。但ACI患者能否長期服用大劑量他汀類藥物治療尚需大樣本隊列研究確定。
[Abstract]:Objective: to investigate the effects of different doses of statins on endothelial progenitor cells (EPCs), high-sensitivity C-reactie protein (hsCRPs) and institutes of health stroke scale (NIHSS) scores in patients with acute cerebral infarction (ACI). To explore the benefits of high-dose statins in the treatment of ACI patients. Methods: 80 patients with ACI were selected from October 2015 to July 2016 in the Department of Neurology, second affiliated Hospital of Lanzhou University, and 42 of them were selected according to the inclusion criteria. The patients were randomly divided into two groups: the 10mg group and the 20mg group. The serum lipids were measured on the first day of admission (baseline period) and 21 days after treatment. Flow cytometry was used to detect the number of EPCs cells in peripheral blood and CD34 KDR CD133 CD45dim was used as the surface marker of EPCs. The dynamic changes of the number of EPCs in peripheral blood were detected on the first day of admission (baseline phase, 7 days, 14 days and 21 days after treatment), respectively. The levels of hsCRP on the first day of admission (baseline period, 7 days, 14 days and 21 days after treatment) were detected by ELISA method. The first day of admission (baseline period, 7 days, 14 days, 21 days and 30 days after treatment) was scored by the National Institutes of Health Stroke scale (NHISS). The result is 1: 1. After treatment, the levels of TG and LDL-C in both groups were significantly lower than those before treatment. The levels of HDL-C in both groups were significantly higher than those before treatment, and the levels of TC and LDL-C in 20mg group were significantly lower than those before treatment. The number of EPCs in the two groups increased gradually after treatment. Compared with the 10mg group, the EPCs level in the 20mg group was significantly higher than that in the 10mg group on the 14th day after treatment (P 0.05), and the number of EPCs in both groups was linearly correlated with the change of time. Compared with 10mg group, the plasma hsCRP level of 20 mg group decreased more significantly than that of 10mg group on the 14th day after treatment. After treatment, the NIHSS score improved gradually, and the NIHSS score of the 20mg group was more significantly improved than that of the 10mg group at 30 days after treatment, and the difference was statistically significant within 72 hours after treatment. There was a negative correlation between the number of EPCs in peripheral blood and the score of NIHSS, the level of hsCRP in plasma was positively correlated with the score of NIHSS, and the quantity of EPCs in peripheral blood was negatively correlated with the level of hsCRP in plasma. Conclusion: compared with 10mg, rosuvastatin (20 mg) can effectively improve the blood lipid level, increase the number of EPCs, decrease the hsCRP level and improve the neurological function defect in patients with ACI. But large cohort studies are needed to determine whether ACI patients can take high-dose statins for long-term treatment.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.33

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