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目的探讨阿托伐他汀钙联合氯吡格雷治疗短暂性脑缺血发作(TIA)颅内动脉粥样硬化的疗效及对血清胱抑素C(CysC)水平的影响。方法选取宝鸡市中医医院2014年8月至2016年8月收治的90例TIA患者作为研究对象,按照随机数字表法分为联合治疗组和对照组,每组45例,患者均口服氯吡格雷治疗,联合治疗组患者在以上治疗基础上口服阿托伐他汀钙治疗,于治疗前后测定两组患者血脂和血清CysC水平,并进行颈动脉狭窄及程度的超声检查。用SPSS 13.0统计软件进行t检验、方差分析和Spearman相关分析。结果两组患者治疗前TC、TG、LDL-C和HDL-C水平比较,差异均无统计学意义(P>0.05),与治疗前相比,两组患者治疗后TC、TG、LDL-C水平均明显降低,HDL-C水平明显升高,差异均有统计学意义(P<0.05),联合治疗组治疗后TC、TG、LDL-C水平均明显低于对照组治疗后,HDL-C水平明显高于对照组治疗后,差异均有统计学意义(P<0.05);两组患者治疗前颈动脉内膜中层厚度(IMT)与斑块面积差异均无统计学意义(P>0.05),与治疗前相比,两组患者治疗后IMT与斑块面积均明显降低,差异均有统计学意义(P<0.05),治疗后联合治疗组患者IMT和斑块面积均小于对照组,差异均有统计学意义(P<0.05)。联合治疗组和对照组治疗前CysC水平分别为(1.51±0.78)、(1.51±0.78)mg/L,差异无统计学意义(P>0.05),治疗后分别为(1.08±0.06)、(1.27±0.06)mg/L,两组患者治疗后CysC水平明显低于治疗前,差异均有统计学意义(P<0.05),联合治疗组治疗后CysC水平明显低于对照组治疗后,差异有统计学意义(P<0.05)。与治疗前相比,两组患者治疗后不同病变程度CysC水平均明显降低,差异均有统计学意义(P<0.05);两组多支病变患者CysC水平均明显高于双支病变和单支病变患者,差异均有统计学意义(P<0.05)。TIA动脉粥样硬化程度与CysC水平呈正相关(r=0.679,P<0.05)。结论阿托伐他汀钙联合氯吡格雷治疗TIA颅内动脉粥样硬化可以明显改善患者血脂水平,降低粥样硬化发生风险,并且可能通过降低CysC水平起作用。
Objective To investigate the effect of atorvastatin calcium combined with clopidogrel on intracranial atherosclerosis in patients with transient ischemic attack (TIA) and its effect on the level of serum cystatin C (CysC). Methods Ninety patients with TIA admitted from August 2014 to August 2016 in Baoji Chinese Medicine Hospital were enrolled in this study. According to the random number table, they were divided into combined treatment group and control group, with 45 patients in each group. Patients were given oral clopidogrel The patients in the treatment and combination groups received atorvastatin calcium orally on the basis of the above treatment, and the levels of serum lipids and serum CysC were measured before and after treatment. The carotid artery stenosis and degree of ultrasound examination were performed. SPSS 13.0 statistical software for t test, analysis of variance and Spearman correlation analysis. Results The levels of TC, TG, LDL-C and HDL-C before treatment in both groups were not significantly different (P> 0.05). Compared with those before treatment, TC, TG, LDL- (P <0.05). The levels of TC, TG and LDL-C in the combined treatment group were significantly lower than those in the control group after treatment, while the levels of HDL-C (P <0.05). There was no significant difference in carotid intima-media thickness (IMT) and plaque area between the two groups before treatment (P> 0.05) , Compared with that before treatment, the IMT and plaque area of both groups were significantly decreased after treatment, the differences were statistically significant (P <0.05), after treatment, the IMT and plaque area in the combined treatment group were less than the control group, the difference All were statistically significant (P <0.05). The levels of CysC in the combined treatment group and control group before treatment were (1.51 ± 0.78) and (1.51 ± 0.78) mg / L respectively, with no significant difference (P> 0.05), and the levels of CysC were (1.08 ± 0.06) and ± 0.06) mg / L, the level of CysC in the two groups was significantly lower than that before treatment (P <0.05), and the level of CysC in the combined treatment group was significantly lower than that in the control group after treatment Significance (P <0.05). Compared with those before treatment, the levels of CysC in the two groups were significantly decreased after treatment, the differences were statistically significant (P <0.05); CysC levels were significantly higher in the two groups than in the double-vessel disease and single Lesion patients, the differences were statistically significant (P <0.05). TIA atherosclerosis and CysC levels were positively correlated (r = 0.679, P <0.05). Conclusions Atorvastatin combined with clopidogrel for TIA can significantly improve the level of serum lipids, reduce the risk of atherosclerosis and may play a role in reducing CysC level.