摘要：

目的 分析阿托伐他汀对动脉粥样硬化性脑梗死患者的调脂效果及对颈动脉粥样硬化斑块的影响。方法 92 例动脉粥样硬化性脑梗死患者采用随机数字表法随机分为阿托伐他汀（20 mg/d）治疗组和非他汀类药物治疗组（对照组），评价两组患者治疗前后血脂水平和颈动脉斑块变化。结果 经阿托伐他汀治疗后，阿托伐他汀组患者血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平降低（均P < 0.05），高密度脂蛋白胆固醇水平升高（P < 0.05）；颈动脉斑块面积、斑块厚度和颈动脉内-中膜厚度明显改善（均P < 0.05）。结论 阿托伐他汀具有改善动脉粥样硬化性脑梗死患者血脂水平、软化甚至缩小颈动脉斑块作用，有利于脑梗死患者的二级预防且无明显不良反应。

关键词: 脑梗死, 动脉粥样硬化, 降血脂药

Abstract:

Objective  To analyze the effect of intensive lipid regulation treatment with atorvastatin on the blood lipid levels and carotid artery plaques in patients with atherosclerotic cerebral infarction.  Methods  Ninety-two patients with atherosclerotic cerebral infarction were randomly divided into two groups: observation group (treated by atorvastatin calcium with the dosage of 20 mg/d, N = 46) and control group (treated by diet without lipid-rich food, N=46). Besides, other drugs given to the patients in two groups were the same. The blood lipid levels and the changes of carotid artery plaques in two groups were analyzed and compared before treatment and 3 months after treatment.  Results  After treatment, the concentrations of total cholesterol [TC, (4.23 ± 0.92) mmol/L vs (5.24 ± 0.68) mmol/L], triglyceride [TG, (2.46 ± 0.28) mmol/L vs (3.33 ± 0.47) mmol/L], low-density lipoprotein cholesterol [LDL-C, (2.52 ± 0.38) mmol/L vs (4.78 ± 0.86) mmol/L] in the patients of observation group were all decreased and significantly lower than those in the control group (P = 0.000, for all), and the concentration of high-density lipoprotein cholesterol [HDL-C, (1.13 ± 0.41) mmol/L vs (0.85 ± 0.32) mmol/L] in the patients of observation group was increased and significantly than that in the control group (P = 0.003). The carotid artery plaque size [(20.25 ± 0.32) mm² vs (24.42 ± 10.33) mm²] and thickness [(0.59 ± 0.13) mm vs (1.93 ± 0.23) mm] of carotid artery plaques and intima?media thickness [IMT, (1.32 ± 0.67) mm vs (1.63 ± 0.56) mm] of common carotid artery (CCA) in the patients of observation group were all significantly lower than those in patients in the control group (P = 0.000, 0.000, 0.010, respectively). Comparing serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK) and creatinine (Cr) levels after treatment with before treatment, there was no significant difference between 2 groups (P > 0.05, for all).  Conclusions  Atorvastatin can effectively improve the abnormal blood lipids and soften or even lessen the carotid artery plaques in patients with atherosclerotic cerebral infarction, therefore it is helpful to the second prevention of cerebral infarction with no obvious adverse reactions.

Key words: Brain infarction, Atherosclerosis, Antilipemic agents