不同剂量普伐他汀治疗急性脑梗死的疗效和安全性研究

目的：探讨不同剂量普伐他汀在脑梗死急性期治疗的可行性、降脂疗效及安全性。方法：脑梗死急性期病人146例，随机分为3组，A组（50例）为对照组，B组（49例）每晚服普伐他汀10mg，C组（47例）每晚服普伐他汀20mg，观察30d。比较治疗前后血脂、神经功能缺损评分、生化指标等变化，并记录服药后不良反应。结果：各组总胆固醇（TC）、低密度脂蛋白（LDL-C）、超敏C-反应蛋白（hs-CRP）在治疗后都有所下降，C组下降最显著，B组次之，A组下降程度较小。A组TG治疗前后无明显变化，B组和C组TG治疗后有所下降，两组间无明显差别。脂蛋白（Lpa）在A组治疗后有下降，B组无明显变化，C组较前轻度升高。各组治疗前后神经功能缺损评分均有降低，但各组之间比较无明显差异（P〉0.05）。观察期间所有病人均能耐受普伐他汀，治疗前后肝、肾功能、肌酸激酶（CK）等无明显变化。结论：在脑梗死急性期应用普伐他汀（每日10～20mg）是安全可行的，且每日20mgTC、TG降低更显著，脑梗死急性期的病人应用普伐他汀后取得较好的降脂疗效，神经功能缺损评分的改善有待较长期观察。

Efficacy and Safety of Different Doses of Pravastatin in the Treatment of Patients with Acute Cere-bral Infarction

Objective： To investigate the efficacy and safety of different doses of pravastatin used in the treatment of patients with acute cerebral infarction. Methods： 146 Patients with acute cerebral infarction were randomly divided into three groups,： group A （50 cases） for the control group, group B （49 cases） received 10 mg pravastatin at night, group C （47 cases） received 20 mg pravas- tatin at night, which were all observed for 30 days. The blood lipid, neurological deficit scores and other biochemical changes were compared before and after the treatment, and the adverse reactions were recorded after medication. Results： The total cholesterol （TC）, low density lipoprotein （LDL-C）, high-sensitivity C-reactive protein （hs-CRP） had declined after treatment in each group, group C fell the most significantly, followed by group B, and then group A. TG in group A had no significant change before and after treatment, TG in group B and group C decreased after treatment with no significant difference between the two groups. Lipoprotein （Lpa） in group A decreased after treatment, B had no significant change, C was slightly higher than that before the treatment. Neurological deficit scores in each group were lower after treatment than before, hut there were no significant differences between each group （P 〉 0.05）. All patients had the tolerance of pravastatin during the observation. The liver, renal function, creatine kinase （CK） had no significant change before and after treatment. Conclusion： The application of pravastatin in patients with acute cerebral infarction （10 20 mg ever）, day） is safe and feasible. TC, TG decreased significantly （20 mg every day）. Pravastatin has a good efficacy in lipidlowering in the treatment of patients with acute cerebral infarction, and the improvement of neurological deficit scores needs a longterm observation.