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目的探讨大剂量阿托伐他汀调脂治疗对急性脑梗死患者血清高敏C反应蛋白(hs-CRP)、可溶性CD40配体(sCD40L)及基质金属蛋白酶8(MMP-8)的影响,观察其对动脉粥样斑块的干预作用。方法136例急性脑梗死患者根据颈动脉超声检查结果分为颈动脉稳定斑块组(n=68)和颈动脉易损斑块组(n=68)。抽血检查后随机分为小剂量组68例(阿托伐他汀10 mg.d-1,口服)和大剂量组68例(阿托伐他汀40 mg.d-1,口服),疗程6 mo。比较治疗前和治疗后2 wk、4 wk血脂水平的变化,比较治疗前和治疗后4 wk血清hs-CRP、sCD40L和MMP-8水平;观察治疗前及治疗后6 mo颈动脉内-中膜厚度(IMT)、斑块厚度及颈动脉粥样硬化斑块回声变化。结果治疗前,大、小剂量组血脂、血清hs-CRP、sCD40L和MMP-8水平差异无显著性(均P>0.05)。治疗后2 wk及4 wk,大剂量组血清LDL-C、TG、TC水平均低于小剂量组(均P<0.01),治疗后4 wk,大剂量组血清hs-CRP、sCD40L和MMP-8均低于小剂量组,且大剂量组下降幅度均大于小剂量组,有非常显著差异(均P<0.01);治疗6 mo后,大、小剂量组IMT值和斑块厚度较治疗前降低,且大剂量组2项指标低于小剂量组,有非常显著差异(均P<0.01);大剂量组低回声斑块回声增强例数较治疗前明显增加(P<0.01)。结论大剂量阿托伐他汀调脂治疗能迅速降低脑梗死患者的血清炎症因子水平,具有更强的抗炎作用,可逆转稳定斑块。
Objective To investigate the effects of high-dose atorvastatin on serum high-sensitivity C-reactive protein (hs-CRP), soluble CD40 ligand (sCD40L) and matrix metalloproteinase 8 (MMP-8) in patients with acute cerebral infarction Atherosclerotic plaque intervention. Methods 136 patients with acute cerebral infarction were divided into carotid stable plaque group (n = 68) and carotid vulnerable plaque group (n = 68) according to the results of carotid ultrasound examination. Sixty-eight patients (atorvastatin 10 mg.d-1, orally) and 68 patients (atorvastatin 40 mg.d-1, orally) were randomly divided into low-dose group and low-dose group for 6 months . The levels of serum hs-CRP, sCD40L and MMP-8 in pre-treatment and post-treatment groups were compared before and after treatment and at 2 wk and 4 wk respectively. The carotid intima-media Thickness (IMT), plaque thickness and carotid atherosclerotic plaque echo changes. Results Before treatment, there were no significant differences in serum lipids, serum hs-CRP, sCD40L and MMP-8 levels between the large and small dose groups (all P> 0.05). Serum levels of LDL-C, TG and TC in the high-dose group were significantly lower than those in the low-dose group (P <0.01) at 2 weeks and 4 weeks after treatment. After 4 weeks of treatment, the levels of serum hs-CRP, sCD40L and MMP- 8 were lower than the low dose group, and large dose group decreased more than the low dose group, there was a significant difference (all P <0.01); 6 months after treatment, large and small doses of IMT value and plaque thickness than before treatment (P <0.01). The number of enhancement of hypoechoic plaque in high dose group was significantly higher than that before treatment (P <0.01). Conclusions High-dose atorvastatin can decrease the level of serum inflammatory cytokines in patients with cerebral infarction rapidly, and has more anti-inflammatory effect and reversible stabilization of plaque.