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目的探讨普罗布考联合阿托伐他汀治疗对脑梗死患者预后的影响。方法急性脑梗死患者120例,入院查颈动脉彩超提示存在动脉粥样硬化(AS)斑块,男性68例,女性52例,年龄39～84岁,平均年龄74±15岁。随机分为两组,第一组男性35例,女性25例,年龄39～83岁,平均年龄73±16岁,予阿托伐他汀(20mg.d-1);第二组男性33例,女性27例,年龄41～84岁,平均年龄76±18岁,予阿托伐他汀(20mg.d-1)、普罗布考(500mg.d-1)联合治疗。两组患者分别于治疗前、治疗后6个月(6M)、12个月(12M)、24个月(24M)进行NIHSS评分、改良Rankin量表(mRS)评定患者临床预后,mRS 0～2分为预后良好,3～6分为预后不良,并记录脑梗死复发情况,进行分组分析。结果 (1)两组各时间点NIHSS评分情况:第一组治疗后6M、12M、24M的NIHSS评分分别为5.83±3.25、4.96±2.61、5.02±3.11,较治疗前9.42±3.38有不同程度下降,其中12M时下降较明显(P<0.01);第二组治疗后6M、12M、24M的NIHSS评分分别为6.01±3.74、3.24±2.08、3.17±2.52,治疗后6M较治疗前NIHSS评分(9.89±3.67)有所下降(P<0.05),治疗后12M、24M较治疗前下降更明显(P<0.01),且治疗后12M、24M的NIHSS评分也低于治疗后6M(P<0.05);两组相比,治疗后24M第二组较第一组NIHSS评分下降更显著(P<0.05);(2)两组各时间点mRS情况:第二组治疗后24M预后良好率为90.7%,较该组治疗后6M的72.2%有所提高,且高于第一组治疗后同时间点的预后良好率(76.8%),P<0.05,其余各时间点两组mRS评价差异无统计学意义;(3)两组24M脑梗死复发率分别为28.6%、22.2%,两组比较,各时间点脑梗死复发率差异无统计学意义。结论稳定斑块是治疗脑梗死动脉粥样硬化的重要而长远的策略,普罗布考联合阿托伐他汀可从多方位、多靶点的抗AS作用,从而改善脑梗死后神经功能及生活质量,其在脑梗死二级预防中的作用有待于扩大样本,进一步完善随访,以获得更全面、更具有代表性的资料。
Objective To investigate the effect of probucol combined with atorvastatin on the prognosis of patients with cerebral infarction. Methods A total of 120 patients with acute cerebral infarction were enrolled in this study. Carotid ultrasonography revealed that there were atherosclerotic plaque in 68 males and 52 females, ranging in age from 39 to 84 years with a mean age of 74 ± 15 years. Randomly divided into two groups, the first group of 35 males and 25 females, aged 39 to 83 years, mean age 73 ± 16 years, to atorvastatin (20mg.d-1); the second group of 33 males, 27 females, aged 41 to 84 years old with an average age of 76 ± 18 years were treated with atorvastatin (20 mg.d-1) and probucol (500 mg.d-1). The NIHSS scores, the modified Rankin scale (mRS), the clinical prognosis of patients before treatment, 6 months (6M), 12 months (12M) and 24 months Divided into good prognosis, 3 to 6 points for the poor prognosis, and record the recurrence of cerebral infarction, the group analysis. Results (1) The NIHSS scores of the two groups at each time point: The NIHSS scores of the first group after treatment were 5.83 ± 3.25, 4.96 ± 2.61 and 5.02 ± 3.11 at 6M, 12M and 24M, respectively, which decreased to 9.42 ± 3.38 before treatment (P <0.01). The NIHSS scores of 6M, 12M and 24M in the second group were 6.01 ± 3.74,3.24 ± 2.08 and 3.17 ± 2.52, respectively. The NIHSS scores of the 6M, (P <0.05). After treatment, the levels of 12M and 24M decreased more significantly than those before treatment (P <0.01), and the NIHSS scores of 12M and 24M after treatment were also lower than those of 6M after treatment (P <0.05). Compared with the first group, the NIHSS score of the second group decreased more significantly (P <0.05); (2) The mRS of each group at each time point: The good prognosis of 24M after the second group was 90.7% Which was significantly higher than 72.2% of 6M after treatment in this group, which was higher than that of the first group (76.8%) at the same time point after treatment (P <0.05). There was no significant difference in mRS between the two groups at other time points ; (3) The recurrence rates of 24M cerebral infarction in two groups were 28.6% and 22.2% respectively. There was no significant difference in relapse rate of cerebral infarction between two groups at each time point. Conclusions Stable plaque is an important and long-term strategy for the treatment of atherosclerosis in cerebral infarction. Probucol combined with atorvastatin can improve the neurological function and quality of life after cerebral infarction , Its role in secondary prevention of cerebral infarction need to expand the sample to further improve the follow-up, in order to obtain more comprehensive and representative information.