瑞舒伐他汀鈣聯(lián)合普羅布考對(duì)缺血性腦血管病患者脂蛋白磷脂酶A2、超敏C反應(yīng)蛋白和斑塊易損性的影響
發(fā)布時(shí)間：2018-08-05 17:24
【摘要】：目的腦血管病發(fā)生、發(fā)展的過(guò)程中,脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)及動(dòng)脈粥樣硬化不穩(wěn)定斑塊起著尤為重要的作用。臨床上,將瑞舒伐他汀及普羅布考聯(lián)合應(yīng)用,可能產(chǎn)生協(xié)同的抗氧化、抗炎、抗動(dòng)脈粥樣硬化、改善血管內(nèi)皮功能、穩(wěn)定和逆轉(zhuǎn)斑塊的作用,從而減少腦梗死的發(fā)生和復(fù)發(fā)。本課題通過(guò)給予存在頸動(dòng)脈粥樣硬化斑塊的患者聯(lián)合應(yīng)用瑞舒伐他汀及普羅布考治療,研究其治療前后外周血中的脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)水平的變化及頸動(dòng)脈超聲形態(tài)學(xué)、頸動(dòng)脈內(nèi)-中膜厚度、斑塊數(shù)量和斑塊超聲回聲特征的變化,探討聯(lián)合應(yīng)用瑞舒伐他汀及普羅布考干預(yù)治療對(duì)脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)及頸動(dòng)脈粥樣硬化斑塊易損性的影響。方法隨機(jī)選取在2013年4月至2014年1月于本院神經(jīng)內(nèi)科住院的首次發(fā)生缺血性腦卒中并且經(jīng)頸部血管彩超證實(shí)存在ACS的患者100例,其中男性62例,女性38例,年齡在50-80歲,所選上述病例均符合WHO建議的ACS的診斷標(biāo)準(zhǔn)。所選病例無(wú)腦血管病病史,并且排除中途因其他原因死亡,感染性疾病、癌癥、心衰、糖尿病、肝腎功能衰竭病例。對(duì)于所選病例隨機(jī)單盲分為2組,分別為:對(duì)照組和治療組,兩組病例各50例,對(duì)照組:男性27例,女性23例,年齡52-78歲,平均年齡61.3±3.2歲;治療組:男性35例,女性15例,年齡在50-80歲,平均年齡63.2±2.3歲。兩組(治療組、對(duì)照組)之間在年齡、性別、體重指數(shù)、吸煙例數(shù)、高血壓例數(shù)、左室射血分?jǐn)?shù)、血壓、心率、血脂水平的差異上均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組入院次日均空腹抽取6ml靜脈血,測(cè)定外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)水平,并均行頸部血管彩超檢查了解頸動(dòng)脈形態(tài)、頸動(dòng)脈內(nèi)-中膜厚度、斑塊數(shù)量和斑塊回聲特征。對(duì)照組給予飲食治療,改善生活方式,且48h內(nèi)應(yīng)用瑞舒伐他汀(IPR Pharmaceuticals,INC.生產(chǎn),商品名可定,規(guī)格10mg/片)10mg睡前一次。治療組除上述措施外,另外加服普羅布考(承德頸復(fù)康藥業(yè)集團(tuán)生產(chǎn),商品名暢泰,規(guī)格0.25g/片)0.5g早晚餐時(shí)各一次。經(jīng)臨床治療6個(gè)月后復(fù)查,觀察兩組治療前后及兩組治療后外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)的水平變化,及頸動(dòng)脈形態(tài)、頸動(dòng)脈內(nèi)-中膜厚度、斑塊數(shù)量和斑塊回聲特征的變化。脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)以散射比濁法測(cè)定,由南京諾爾曼生物技術(shù)有限公司提供試劑盒,由我院生化室的全自動(dòng)生化分析儀來(lái)進(jìn)行數(shù)據(jù)的測(cè)定。超敏C-反應(yīng)蛋白(hs-CRP)以免疫投射比濁法測(cè)定,由天津九鼎生物工程有限公司提供試劑盒,由我院生化室的全自動(dòng)生化分析儀來(lái)進(jìn)行數(shù)據(jù)的測(cè)定。頸部血管彩超應(yīng)用HDI-3500彩色多普勒超聲儀全程檢測(cè)頸總動(dòng)脈及頸內(nèi)動(dòng)脈的顱外段,觀察頸動(dòng)脈有無(wú)狹窄及狹窄程度、內(nèi)膜厚度及斑塊情況。常用的檢測(cè)指標(biāo)包括:頸動(dòng)脈IMT測(cè)定、頸動(dòng)脈粥樣硬化斑塊積分、斑塊面積、斑塊情況(包括斑塊大小、斑塊形態(tài)、斑塊回聲特征。結(jié)果對(duì)照組及治療組治療前外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)的水平及頸動(dòng)脈內(nèi)-中膜厚度(CIMT)、斑塊面積、斑塊數(shù)量、易損斑塊數(shù)目比較差異無(wú)顯著性(P0.5)。對(duì)照組及治療組治療前后比較外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)的水平及頸動(dòng)脈內(nèi)-中膜厚度(CIMT)、斑塊面積、斑塊數(shù)量、易損斑塊數(shù)目均有下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。說(shuō)明單用瑞舒伐他汀與聯(lián)合應(yīng)用瑞舒伐他汀及普羅布考均能降低外周血Lp-PLA2、hs-CRP水平,并能減少CIMT、斑塊面積、斑塊數(shù)量、低回聲斑塊數(shù)量。而試驗(yàn)又表明:兩組經(jīng)治療后,治療組比對(duì)照組對(duì)外周血超敏C-反應(yīng)蛋白水平、CIMT、斑塊面積、斑塊數(shù)量、低回聲斑塊數(shù)量的降低幅度更大,差異有統(tǒng)計(jì)學(xué)意義(P0.05),并且治療后治療組比對(duì)照組對(duì)外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)水平的降低幅度更為顯著,差異有顯著性(P0.01)。說(shuō)明聯(lián)合應(yīng)用瑞舒伐他汀及普羅布考在降低外周血脂蛋白相關(guān)性磷脂酶A2(Lp-PLA2)、超敏C-反應(yīng)蛋白(hs-CRP)水平、減少頸動(dòng)脈內(nèi)-中膜厚度(CIMT)、斑塊面積、斑塊數(shù)量、易損斑塊數(shù)目方面優(yōu)于單用瑞舒伐他汀。結(jié)論瑞舒伐他汀聯(lián)合普羅布考,不但可以調(diào)脂、抗氧化,還具有抗炎作用,可有效減低血Lp-PLA2、hs-CRP、延緩動(dòng)脈粥樣硬化及斑塊形成。
[Abstract]:Objective in the course of the development of cerebrovascular disease, lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and atherosclerotic unstable plaques play an important role. The combination of rosuvastatin and probucol may produce synergistic antioxidation, anti-inflammatory, anti atherosclerosis, and improvement. Vascular endothelial function, stabilizing and reversing the role of plaque, thus reducing the occurrence and recurrence of cerebral infarction. In this study, the lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (H) in the peripheral blood of the patients with carotid atherosclerotic plaques were treated with the combined use of rosuvastatin and probucol. S-CRP) changes in level and carotid artery ultrasound morphology, carotid artery and middle membrane thickness, plaque quantity and changes in ultrasonic echo characteristics of plaque, and explore the effects of combined use of rosuvastatin and probucol on lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and vulnerability of carotid atherosclerotic plaques Methods a random selection of 100 patients with ACS in the neurology department of our hospital from April 2013 to January 2014 was selected and confirmed by cervical vascular color Doppler ultrasound. There were 62 males, 38 females, 38 women and 50-80 years old. The selected cases were all in accordance with the diagnostic criteria of ACS recommended by WHO. The history of disease, and the exclusion of other causes of death, infectious diseases, cancer, heart failure, diabetes, liver and kidney failure cases. The selected cases were randomly divided into 2 groups, the control group and the treatment group, 50 cases in the two groups and the control group, 27 males, 23 women, 52-78 years old, and the average age of 61.3 + 3.2 years; the treatment group: Male 35 cases, 15 women, age 50-80, the average age of 63.2 + 2.3 years. The two groups (treatment group, control group) between age, sex, body mass index, smoking cases, the number of hypertension, the left ventricular ejection fraction, blood pressure, heart rate, blood lipid level were not statistically significant (P0.05). The two group the next day the abdominal extraction of 6ml venous blood, determine the peripheral blood Blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, and cervical artery color Doppler ultrasound examination to understand the morphology of the carotid artery, the thickness of the carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The control group was given diet therapy to improve the lifestyle, and 48h was used in IPR Pharmaceuticals, INC. birth. Production, commodity name can be fixed, specification 10mg/ tablet) 10mg before bedtime. In addition to the above measures, the treatment group plus probucol (Chengde jufukang Pharmaceutical Group production, commodity name Chang Tai, 0.25g/ tablets) 0.5g breakfast each time. After 6 months of clinical treatment reexamination, observe the relationship between the two groups after treatment and two groups of peripheral blood lipid protein correlation The changes in the level of phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP), the morphology of the carotid artery, the thickness of the internal carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The lipoprotein related phospholipase A2 (Lp-PLA2) was determined by the scattering Turbidimetry. The kits were provided by the Nanjing Norman Biotechnology Co., Ltd. and the whole biochemical laboratory in our hospital. The automatic biochemical analyzer is used to determine the data. The hypersensitive C- reaction protein (hs-CRP) is determined by turbidimetry with immuno projection. The data is measured by the automatic biochemical analyzer of the biochemical laboratory in our hospital by Tianjin Jiuding Bioengineering Co., Ltd. and the whole course detection of the HDI-3500 color Doppler ultrasound apparatus for cervical vascular color super application. The extracranial segment of the common carotid artery and the internal carotid artery, the degree of stenosis and stenosis of the carotid artery, the thickness of the intima and the plaque condition. The common indicators included carotid IMT, plaque score, plaque area, and plaque condition (including plaque size, plaque shape, and plaque echo characteristics. Results control and treatment group treatment) The level of phospholipase A2 (Lp-PLA2), the level of hypersensitive C- reactive protein (hs-CRP) and the thickness of the internal carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques were not significantly different (P0.5). In the control group and the treatment group, the peripheral blood lipid protein related phospholipase A2 (Lp-PLA2) and hypersensitivity C- were compared in the control group and the treatment group. The level of hs-CRP and the thickness of the carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques decreased, and the difference was statistically significant (P0.05). It indicated that the single use of rosuvastatin and combined use of rosuvastatin and probucol could reduce the level of Lp-PLA2 and hs-CRP in peripheral blood and reduce the size of CIMT, plaque area, and plaque. The number of blocks and hypoechoic plaques in the two groups showed that after treatment, the level of CIMT, patch area, plaque quantity and low echo plaques in the two groups were significantly lower than those in the control group, and the difference was statistically significant (P0.05), and the treatment group was related to the peripheral blood lipid protein in the treatment group. The level of sex phospholipase A2 (Lp-PLA2) decreased significantly (P0.01), indicating that the combined use of rosuvastatin and probucol in reducing peripheral blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, reducing the thickness of the carotid artery and middle membrane (CIMT), plaque area, plaque quantity, vulnerable plaque The number is better than rosuvastatin alone. Conclusion rosuvastatin combined with probucol not only can regulate lipid, antioxidant, but also have anti-inflammatory effects, which can effectively reduce blood Lp-PLA2, hs-CRP, delay atherosclerosis and plaque formation.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743
本文編號(hào)：2166473
[Abstract]:Objective in the course of the development of cerebrovascular disease, lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and atherosclerotic unstable plaques play an important role. The combination of rosuvastatin and probucol may produce synergistic antioxidation, anti-inflammatory, anti atherosclerosis, and improvement. Vascular endothelial function, stabilizing and reversing the role of plaque, thus reducing the occurrence and recurrence of cerebral infarction. In this study, the lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (H) in the peripheral blood of the patients with carotid atherosclerotic plaques were treated with the combined use of rosuvastatin and probucol. S-CRP) changes in level and carotid artery ultrasound morphology, carotid artery and middle membrane thickness, plaque quantity and changes in ultrasonic echo characteristics of plaque, and explore the effects of combined use of rosuvastatin and probucol on lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and vulnerability of carotid atherosclerotic plaques Methods a random selection of 100 patients with ACS in the neurology department of our hospital from April 2013 to January 2014 was selected and confirmed by cervical vascular color Doppler ultrasound. There were 62 males, 38 females, 38 women and 50-80 years old. The selected cases were all in accordance with the diagnostic criteria of ACS recommended by WHO. The history of disease, and the exclusion of other causes of death, infectious diseases, cancer, heart failure, diabetes, liver and kidney failure cases. The selected cases were randomly divided into 2 groups, the control group and the treatment group, 50 cases in the two groups and the control group, 27 males, 23 women, 52-78 years old, and the average age of 61.3 + 3.2 years; the treatment group: Male 35 cases, 15 women, age 50-80, the average age of 63.2 + 2.3 years. The two groups (treatment group, control group) between age, sex, body mass index, smoking cases, the number of hypertension, the left ventricular ejection fraction, blood pressure, heart rate, blood lipid level were not statistically significant (P0.05). The two group the next day the abdominal extraction of 6ml venous blood, determine the peripheral blood Blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, and cervical artery color Doppler ultrasound examination to understand the morphology of the carotid artery, the thickness of the carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The control group was given diet therapy to improve the lifestyle, and 48h was used in IPR Pharmaceuticals, INC. birth. Production, commodity name can be fixed, specification 10mg/ tablet) 10mg before bedtime. In addition to the above measures, the treatment group plus probucol (Chengde jufukang Pharmaceutical Group production, commodity name Chang Tai, 0.25g/ tablets) 0.5g breakfast each time. After 6 months of clinical treatment reexamination, observe the relationship between the two groups after treatment and two groups of peripheral blood lipid protein correlation The changes in the level of phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP), the morphology of the carotid artery, the thickness of the internal carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The lipoprotein related phospholipase A2 (Lp-PLA2) was determined by the scattering Turbidimetry. The kits were provided by the Nanjing Norman Biotechnology Co., Ltd. and the whole biochemical laboratory in our hospital. The automatic biochemical analyzer is used to determine the data. The hypersensitive C- reaction protein (hs-CRP) is determined by turbidimetry with immuno projection. The data is measured by the automatic biochemical analyzer of the biochemical laboratory in our hospital by Tianjin Jiuding Bioengineering Co., Ltd. and the whole course detection of the HDI-3500 color Doppler ultrasound apparatus for cervical vascular color super application. The extracranial segment of the common carotid artery and the internal carotid artery, the degree of stenosis and stenosis of the carotid artery, the thickness of the intima and the plaque condition. The common indicators included carotid IMT, plaque score, plaque area, and plaque condition (including plaque size, plaque shape, and plaque echo characteristics. Results control and treatment group treatment) The level of phospholipase A2 (Lp-PLA2), the level of hypersensitive C- reactive protein (hs-CRP) and the thickness of the internal carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques were not significantly different (P0.5). In the control group and the treatment group, the peripheral blood lipid protein related phospholipase A2 (Lp-PLA2) and hypersensitivity C- were compared in the control group and the treatment group. The level of hs-CRP and the thickness of the carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques decreased, and the difference was statistically significant (P0.05). It indicated that the single use of rosuvastatin and combined use of rosuvastatin and probucol could reduce the level of Lp-PLA2 and hs-CRP in peripheral blood and reduce the size of CIMT, plaque area, and plaque. The number of blocks and hypoechoic plaques in the two groups showed that after treatment, the level of CIMT, patch area, plaque quantity and low echo plaques in the two groups were significantly lower than those in the control group, and the difference was statistically significant (P0.05), and the treatment group was related to the peripheral blood lipid protein in the treatment group. The level of sex phospholipase A2 (Lp-PLA2) decreased significantly (P0.01), indicating that the combined use of rosuvastatin and probucol in reducing peripheral blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, reducing the thickness of the carotid artery and middle membrane (CIMT), plaque area, plaque quantity, vulnerable plaque The number is better than rosuvastatin alone. Conclusion rosuvastatin combined with probucol not only can regulate lipid, antioxidant, but also have anti-inflammatory effects, which can effectively reduce blood Lp-PLA2, hs-CRP, delay atherosclerosis and plaque formation.
【學(xué)位授予單位】：泰山醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 譚澤梁;藍(lán)崧;楊職;;阿托伐他汀鈣對(duì)急性腦梗死患者血清C-反應(yīng)蛋白水平和腦梗死復(fù)發(fā)的影響[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2010年04期
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