缬沙坦对颈动脉不稳定斑块患者血清炎症介质及缺血性脑卒中复发的影响

目的探讨缬沙坦对颈动脉不稳定斑块患者血清C-反应蛋白(CRP)、可溶性血管内皮细胞黏附分子-1(sVCAM-1)、白细胞介素-6(IL-6)的影响及对缺血性脑卒中复发干预的临床研究。方法不稳定斑块65例,缬沙坦治疗组33例,缬沙坦胶囊,80 mg,每日1次,口服,其他治疗措施与对照组基本相同。对照组32例,利尿降压药,口服。治疗前、1个月、2个月、38个月抽空腹静脉血共计5 ml,检测CRP、sVCAM-1、IL-6、血糖,同时监测血压。38个月时统计两组脑梗死复发和死亡情况,以CT或磁共振成像(MRI)出现新的梗塞灶为准。结果在1、2、38个月后治疗组血清CRP、sVCAM-1I、L-6浓度逐渐降低,组内相比差异有统计学意义(P<0.05),对照组除转变为硬斑者外其余变化不大。治疗组和对照组组间相比变化较大,差异有统计学意义(P<0.05)。终点38个月时,治疗组、对照组经CT或MRI证实脑梗死复发为7例(21.2%)和15例(46.9%)例,死亡为2例(6.1%)和5例(15.6%)例,治疗组复发率和病死率明显低于对照组(P<0.05)。结论缬沙坦稳定颈动脉斑块与血清中CRP、sVCAM-1I、L-6炎症介质的降低密切相关,降低不稳定斑块的破裂,从而减少了缺血性脑卒中的复发和死亡。

Valsartan on influence of serum inflammation mediator of carotid unstable plaque patients and ischemic stroke recurrence

Objective To study the influence of valsartan on serum C-reactive protein(CRP),soluble vascular cell adhesion molecule-1(sVCAM-1),interleukin-6(IL-6) of carotid unstable plaque patients and its interferring effect on ischemic stroke recurrence.Methods Sixty-five patients of unstable plaque,the treatment group 33 cases,valsartan,80 mg,once daily,orally,the control group 32 cases,the diuretic drug of the abasing blood pressure,orally.CRP,sVCAM-1,IL-6 and blood glucose were detected by the separated serum according to about 5 ml the venous blood sample without breakfast before treatment,1th,2th and 38th month and was monitored the blood pressure synchrometively.The recurrence and death rate of cerebral infarction of treatment group and control group were recorded at terminal(38th month) according to the level of the appearing new infarction site of CT or MRI.Results The serum CRP and sVCAM-1 and IL-6 of treatment group after 1th and 2th and 38th months were gradually decreased,the difference in the internal group had statistic significance(P<0.05).The control group did not change significantly except the transformed stiff plaque.The comparison between treatment group and control group showed apparent change(P<0.05).At the time of 38th month,the new cerebral infarction of the treatment group and the control group was confirmed by CT or MRI,the recurrence was 7(21.2%) vs 15 casess(46.9%)(P<0.05),the death 2(6.1%) vs 5 cases(15.6%)(P<0.05).These rates of the treatment group were evidently lower than those of control group.Conclusion The stabilizing carotid plaque of valsartan has an intimate relation with the decreasing of the inflammation mediators of serum CRP and sVCAM-1 and IL-6,the decreasing rupture of unstable plaque may decrease the recurrence and death of ischemic stroke.