急性脑梗死患者血清HMGB1、OPG和MIF水平的变化及PAS三联疗法的干预作用

目的 探讨急性脑梗死患者血清高迁移率族蛋白BI( HMGB1)、骨保护素(OPG)及巨噬细胞移动抑制因子(MIF)水平的变化以及普罗布考、阿司匹林、他汀类药物(PAS)三联疗法对其干预作用.方法 选择150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(50例)和颈动脉易损斑块组(100例).将稳定斑块组作为对照组,易损斑块组抽血检查后按随机数字法分为AS组50例(阿司匹林100 mg/d,阿托伐他汀20 mg/d,口服)和PAS组50例(阿司匹林100 mg/d,阿托伐他汀20 mg/d,普罗布考0.25/次,2次／d,口服).比较治疗前和治疗后4周血清HMGB1、OPG和MIF水平.结果 治疗前,易损斑块组中两亚组血清HMGB1、OPG和MIF含量均明显高于稳定斑块组,差异有显著统计学意义(均P＜0.01)；两亚组中血清HMGB1、OPG和MIF含量差异无统计学意义(均P＞0.05).治疗后4周,PAS组中血清HMGB1,OPG和MIF含量均明显低于AS组,且各指标下降幅度均高于AS组,差异有显著统计学意义(均P＜0.01).结论 血清HMGB1、OPG和MIF均参与脑梗死患者动脉粥样硬化的进程,可作为评估颈动脉粥样硬化斑块不稳定性的预测因子,PAS三联疗法可有效降低其血清浓度,具有更强的抗炎作用,可提高易损斑块的稳定性.

Changes of serum levels of HMGB1, OPG and MIF in patients with acute cerebral infarction and intervention of PAS therapy

Objective To observe the changes of levels of high-mobility group box 1 protein （HMGB1） ,osteoprotegerin（OPG） and macrophage migration inhibitory factor（MIF） in patients with acute cerebral infarction（ACI） and the influence of combination therapy of probucol, aspirin and statins drugs （PAS）. Methods According to the results of carotid artery ultrasound, 150 cases of patients with ACI were divided into carotid stable plaque group （ n = 50） and carotid vulnerable plaque group （ n = 100）. Stable plaque group was considered as control group. 100 cases with carotid vulnerable plaque were randomly divided into aspirin and statins drugs （AS） group （ n = 50, aspirin 100 mg/d, atorvastatin 20 mg/d, oral） and PAS group （ n = 50, aspirin 100 mg/d, atorvastatin 20 mg/d, probucol O. 25/time, 2 times/day, oral）. Serum levels of HMGB1, OPG and MIF were detected in all patients before treatment and four weeks after drug therapy. Results Before treatment, serum HMGB1, OPG and MIF levels in two subgroups of vulnerable plaque group（ AS group and PAS group）were higher than stable plaque group （control group） （all P 〈 0.01 ） ,there were no significantly differences of HMGB1, OPG and MIF between AS group and PAS group （all P 〉 0.05）. Four weeks later, levels of HMGB1, OPG and MIF in patients who treated with probucol,aspirin and statins drugs （PAS） were lower significantly than that in patients who treated with aspirin and statins drugs（AS）, and the decrease of levels of HMGB1, OPG and MIF were obviously higher in PAS group than that in AS group （ all P 〈 0.01 ）. Conclusions HMGB1, OPG and MIF may be involved in the pathological process in patients with acute cerebral infarction, may be used as the prediction factor of instable atherosclerosis plaque. PAS triple therapy might effectively reduce serum levels of HMGB1, OPG and MIF, might have the stronger anti-inflammation function, could stabilize the atherosclerosis vulnerable plaque.