大剂量阿托伐他汀对急性脑梗死患者血清细胞因子及动脉粥样硬化斑块的影响

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超敏C反应蛋白(hs-CRP)、白细胞介素-17(IL-17)及基质金属蛋白酶-8(MMP-8)的影响,观察其对动脉粥样硬化斑块的消退作用。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)。抽血检查后再随机分为小剂量组68例(阿托伐他汀10mg/d,口服)和大剂量组68例(阿托伐他汀40mg/d,口服)。比较治疗前后血脂、血清hs-CRP、IL-17和MMP-8水平;观察治疗前后颈动脉内-中膜厚度(IMT值)、斑块厚度及颈动脉粥样硬化斑块回声变化。结果治疗前,两组中血脂及血清hs-CRP、IL-17和MMP-8水平差异无统计学意义(均P>0.05)。治疗后2周及4周,大剂量组中血清LDL-C、TG、TC水平均低于小剂量组(P<0.01),治疗后4周,大剂量组血清hs-CRP、IL-17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,差异具有统计学意义(P<0.01);治疗后6月,两组IMT值和斑块厚度较治疗前降低,且大剂量组两项指标低于小剂量组,差异具有统计学意义(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。

Effect of high-dose atorvastatin on serum interleukin-17,marix metalloproteinases-8 and atheromatous plaque resolution of carotid artery in patients with acute cerebral infarction

Objective To investigate the effect of high-dose atorvastatin on the inflammatory factors such as high sensitivity C-reactive protein(hs-CRP),interleukin-17(IL-17) and marix metalloproteinases-8(MMP-8) in the patients with acute stroke,and to observe its degrading role on atherosclerosis plaque.Methods 136 patients with acute cerebral infarction were divided into the carotid vulnerable plaque group and the carotid stable plaque group according to the results of carotid B-mode ultrasonography.After collecting blood for detection,they were randomly redivided into the low-dose group(n=68) and the high-dose group(n=68).The low-dose group received oal atorvastatin 10 mg daily,whereas the high-dose group received atorvastatin 40 mg daily.Blood lipoproteins were measured in all patients before treatment,in 2,4 weeks after treatment.Levels of serum hs-CRP,IL-17 and MMP-8 were measured in all patients before treatment and in 4 weeks after treatment.The intima-media thickness,plaque thickness and echogenicity of carotid plaques were evaluated by Doppler ultrasonography during a 6-month follow-up period.Results Before treatment,there were no significantly differences in blood lipoprotein,hs-CRP,IL-17 and MMP-8 between the low-dose group and the high-dose group(P>0.05).No matter what treatment accepted,levels of hs-CRP,IL-17 and MMP-8 were obviously higher in the patients with unstable plaques than those with stable plaques.After 2-week and 4-week treatment,the levels of LDL-C,TG and TC were obviously lower in the patients treated with high-dose atorvastatin than those treated with low-dose atorvastatin(P<0.01).Compared with before treatment,the levels of hs-CRP,IL-17 and MMP-8 were significantly decreased in the patients treated with high-dose atorvastatin for 4 weeks,as well as in the patients treated with low-dose atorvastatin(P<0.01).In comparison of drop scope,the decrease in the level of of hs-CRP,IL-17 and MMP-8 in the high-dose group was obviously higher than that in the low-dose group(P<0.01).Whether the high-dose or the low-dose group,significant increases in echogenicity of carotid plaques and decreases in plaque thickness and intima-media thickness were noted after statin therapy.However,the value of IMT and plaque thickness in the high-dose group were significantly lower than those in the low-dose group(P<0.01).Compared with before treatment,the number of echogenic cases of hypoechoic plaques in the high-dose group was increased significantly(P<0.01).Conclusion High-dose atorvastatin could rapidly reduce serum inflammatory factors in the patients with acute cerebral infarction,might have the stronger anti-inflammation function,might reverse and stabilize the atherosclerosis plaque.