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阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响

作者 / Author:李学仲 杨清成

摘要 / Abstract:

目的 研究及观察阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响。方法 将2015-06—2016-06 安阳市人民医院收治的66例急性脑梗死患者选为研究对象,66例患者随机分为对照组和观察组各33例,对照组进行常规脑梗死治疗,观察组则在对照组常规治疗的基础上加用阿托伐他汀钙,然后将对照组和观察组治疗前后不同时间的神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标进行比较。结果 治疗前2组患者的神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标比较

关键词 / KeyWords:

阿托伐他汀钙,急性脑梗死,血浆,高迁移率族蛋白b1,神经功能指标,血管损伤指标

阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响

李学仲  杨清成
安阳市人民医院神经内科,河南 安阳 455000
作者简介:李学仲,Email:lxz609@sina.com  
通信作者:杨清成,Email:ay03728378 @163.com
摘要  目的  研究及观察阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响。方法  将2015-06—2016-06 安阳市人民医院收治的66例急性脑梗死患者选为研究对象,66例患者随机分为对照组和观察组各33例,对照组进行常规脑梗死治疗,观察组则在对照组常规治疗的基础上加用阿托伐他汀钙,然后将对照组和观察组治疗前后不同时间的神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标进行比较。结果  治疗前2组患者的神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标比较,P>0.05;治疗后不同时间观察组的评分及血浆指标检测结果均显著好于对照组,P<0.05。结论  阿托伐他汀钙可有效改善急性脑梗死患者的神经功能及血管损伤指标。
关键词】  阿托伐他汀钙;急性脑梗死;血浆;高迁移率族蛋白b1;神经功能指标;血管损伤指标
中图分类号】  R743.33    【文献标识码】  A    【文章编号】  1673-5110(2018)20-2265-05  DOI:10.12083/SYSJ.2018.20.488
Study on the influence of atorvastatin calcium for the neurologic function and vascular injury indexes of patients with acute cerebral infarction
LI XuezhongYANG Qingcheng
Department of NeurologyAnyang People's HospitalAnyang 455000,China
Abstract 】  Objective  To study and observe the influence of atorvastatin calcium for the nerve function and vascular injury indexes of patients with acute cerebral infarction.Methods  66 patients with acute cerebral infarction in our hospital from June 2015 to June 2016 were selected as the study object and were randomly divided into control group and observation group with 33 cases in each group,then the control group were treated with routine treatment of acute cerebral infarction,the observation group were treated with atorvastatin calcium on the routine treatment of control group,then the neuralogic function defect score,plasma high mobility group box-1protein,nerve function related indexes and vascular injury related indexes of control group and observation group at different time before and after the treatment were compared.Results  The neurologic function defect score,plasma high mobility group box-1protein,neurologic function related indexes and vascular injury related indexes of two groups before the treatment were compared,all P>0.05,while the neural function defect score and plasma detection indexes of observation group were all significantly better than those of control group (P<0.05).Conclusions  Atorvastatin calcium can effectively improve the nerve function and vascular injury indexes of patients with acute cerebral infarction.
Key words】  Atorvastatin calcium;Acute cerebral infarction;plasma;High mobility group box-1protein;Neurologic function indexes;Vascular injury indexes
        急性脑梗死患者的神经功能受损情况十分突出,因此在患者的治疗过程中,神经功能状态的改善是极为重要的一个方面,此类患者的血管功能也处于相对较差的状态,因此对其改善的需求同样较高,而高迁移率族蛋白b1作为血管损伤、血管炎等情况的重要反应指标[1-3],对其进行表达水平的控制同样重要。本文中我们就阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响进行研究与观察,以了解阿托伐他汀钙在此类患者中的应用价值。
1  资料与方法
1.1  临床资料  将2015-06—2017-06安阳市人民医院收治的66例急性脑梗死患者选为研究对象,66例患者随机分为对照组和观察组各33例。对照组中男20例,女13例,年龄38~78(64.4±7.0)岁,发病至治疗时间为0.3~12.9 (4.1±0.5)h;病灶部位:基底节区者24例,其他部位者9例。观察组中男19例,女14例,年龄37~78(64.6±6.8)岁,发病至治疗时间为0.3~13.1(4.2±0.4)h;病灶部位:基底节区者23例,其他部位者10例。2组基本资料数据比较差异无统计学意义(P>0.05),具有可比性。
1.2  方法
1.2.1  治疗方法:对照组给予常规脑梗死治疗,主要行溶栓治疗、降低颅内压、营养神经及抗凝治疗,另给予保持呼吸道通畅。观察组则在对照组常规治疗的基础上加用阿托伐他汀钙,每次10 mg口服,1次/d。2组均连续治疗14 d。然后将2组治疗前后不同时间的神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标进行比较。
1.2.2  检测方法:分别于治疗前和治疗后3 d、7 d及14 d采集2组空腹静脉血标本送检,将其血浆部分进行检测,检测指标为血浆高迁移率族蛋白b1、神经功能指标及血管损伤指标,神经功能指标为NSE、NGF及S100B,血管损伤指标为ET-1、vWF及NO,检测均以酶联免疫试剂盒进行检测。然后分别统计及比较2组的检测结果。
1.3  评价标准  神经功能缺损程度以神经功能缺损评分为准进行评估,本标准包括8个评估方面,总分值范围为0~45分,其中0~15分、16~30分及31~45分分别表示轻型、中型及重型损伤[4]
1.4  统计学方法  采用SPSS 17.0统计学软件对数据进行分析,计量资料以均数±标准差(x±s)表示,采用t检验,计数资料以百分率(%)表示,采用χ2检验,P<0.05为差异有统计学意义。
2  结果
2.1  2组治疗前后不同时间的神经功能缺损评分比较  治疗前2组患者的神经功能缺损评分重型者比例比较,P>0.05,而治疗后3 d、7 d及14 d观察组重型者比例均低于对照组,P<0.05。见表1。
2.2  2组治疗前后不同时间的血浆高迁移率族蛋白b1及神经功能指标比较  治疗前2组患者的血浆高迁移率族蛋白b1及神经功能指标比较,P均>0.05,而治疗后3 d、7 d及14 d观察组的血浆高迁移率族蛋白b1及神经功能指标均低于对照组,P均<0.05。见表2。
2.3  2组治疗前后不同时间的血浆血管损伤指标比较  治疗前2组患者的血浆血管损伤指标比较,P均>0.05,而治疗后3 d、7 d及14 d观察组的血浆血管损伤指标均好于对照组,P均<0.05。见表3。
表1  2组治疗前后不同时间的神经功能缺损评分比较  [n(%)]
Table 1  Comparison of neurological deficit scores between 2 groups before and after treatment  [n(%)]
组别 n   轻型 中型 重型
对照组 33 治疗前 6(18.18) 15(45.45) 12(36.36)
    治疗后3 d 8(24.24) 14(42.42) 11(33.33)
    治疗后7 d 12(36.36) 12(36.36) 9(27.27)
    治疗后14 d 19(57.58) 8(24.24) 6(18.18)
观察组 33 疗前 5(15.15) 16(48.48) 12(36.36)
    治疗后3 d 14(42.42) 13(39.39) 6(18.18)*
    治疗后7 d 20(60.61) 10(30.30) 3(9.09)*
    治疗后14 d 27(81.82) 5(15.15) 1(3.03)*
              注:与对照组比较,*P<0.05
表2  2组治疗前后不同时间的血浆高迁移率族蛋白b1及神经功能指标比较  (x±s)
Table 2  Comparison of plasma high mobility group protein B1 and neurological function in 2 groups before and after treatment  (x±s)
组别 n   高迁移率族蛋白b1(μg/mL) NSE(μg/L) NGF(pg/mL) S100B(μg/L)
对照组 33 治疗前 8.75±0.64 15.65±1.71 285.61±23.32 0.93±0.12
    治疗后3 d 5.81±0.51 13.73±1.24 245.65±21.73 0.73±0.08
    治疗后7 d 3.45±0.38 10.26±0.92 195.45±19.63 0.61±0.07
    治疗后14 d 2.75±0.26 8.65±0.82 151.61±16.02 0.45±0.04
观察组 33 治疗前 8.77±0.61 15.68±1.68 286.10±23.30 0.95±0.11
    治疗后3 d 3.63±0.40* 10.15±0.89* 191.84±18.72* 0.49±0.05*
    治疗后7 d 1.75±0.23* 7.39±0.73* 150.45±15.63* 0.30±0.03*
    治疗后14 d 1.12±0.15* 6.41±0.56* 121.61±12.64* 0.22±0.02*
  注:与对照组比较,*P<0.05
表3  2组治疗前后不同时间的血浆血管损伤指标比较  (x±s)
Table 3  Comparison of plasma vascular injury indexes in 2 groups before and after treatment  (x±s)
组别 n   ET-1(ng/L) vWF(%) NO(μmol/L)
对照组 33 治疗前 81.61±7.62 121.51±10.78 61.54±6.53
    治疗后3 d 75.95±7.20 116.84±9.41 68.58±6.73
    治疗后7 d 70.12±6.17 110.73±8.75 72.53±7.24
    治疗后14 d 62.32±5.88 106.97±8.60 80.01±7.66
观察组 33 治疗前 81.65±7.58 121.53±10.69 61.60±6.48
    治疗后3 d 68.78±6.13* 105.65±8.41* 75.65±7.40*
    治疗后7 d 60.14±5.76* 101.41±8.15* 83.24±7.95*
    治疗后14 d 54.78±5.23* 95.35±7.81* 89.52±8.43*
              注:与对照组比较,*P<0.05
3  讨论
        急性脑梗死的危害极大,本病的致残率致死率均较高,且发病急骤,受众多因素的影响,本病的发病率呈现持续升高的状态,因此对进行脑梗死的诊治需求较高,相关研究也极为多见[5-9]。其作为心脑血管疾病,患者的血管受损情况表现突出,因此与血管受损的指标也表达出明显异常的状态,其中高迁移率族蛋白b1即是与血管损伤[10-16],尤其是血管炎性损伤密切相关的重要指标,因此对其在此类患者中的表达控制极为必要。ET-1、vWF及NO等作为常见的血管内皮功能状态相关指标,其表达水平的调控需求也较高[17-22],同时其调控的幅度是评估疗效的重要参考指标。脑梗死作为神经损伤类疾病,患者的神经功能状态,包括神经功能受损评分及相关血浆指标的表达水平等均处于较差的状态,对其进行调控的需求也较高,同时也是评估治疗效果的重要方面。阿托伐他汀钙作为临床中常见的血脂调控药物[23-28],其对于急性脑梗死患者的应用效果较受肯定,但关于本药对患者上述神经损伤及血管损伤指标的影响研究却极为不足,因此此方面的研究极为必要。
        本研究显示,加用阿托伐他汀钙治疗的患者其神经功能缺损评分、血浆高迁移率族蛋白b1、神经功能相关指标及血管损伤指标均显著地好于未应用阿托伐他汀钙治疗的患者,说明阿托伐他汀钙在此类患者中的应用效果较好。分析原因认为,与阿托伐他汀钙对于血脂的调控有效改善了由此导致的血管不良情况有关[29-38]
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(收稿2016-11-05  修回2018-03-28)
本文责编:关慧
本文引用信息:李学仲,杨清成.阿托伐他汀钙对急性脑梗死患者神经功能及血管损伤指标的影响[J].中国实用神经疾病杂志,2018,21(20):2265-2269.DOI:10.12083/SYSJ.2018.20.488
Reference information:LI Xuezhong,YANG Qingcheng.Study on the influence of atorvastatin calcium for the neurologic function and vascular injury indexes of patients with acute cerebral infarction[J].Chinese Journal of Practical Nervous Diseases,2018,21(20):2265-2269.DOI:10.12083/SYSJ.2018.20.488
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