强化降脂方案对急性脑梗死合并高血压伴血脂异常患者神经功能损伤程度、血脂及Vspin水平的影响
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摘要
目的探讨强化降脂方案对急性脑梗死合并高血压伴血脂异常患者神经功能损伤程度、血脂及Vaspin水平的影响。方法选取2015年8月至2018年2月收治的急性脑梗死合并高血压伴血脂异常患者114例,随机分为对照组和干预组,每组57例。分别在常规治疗基础上给予阿托伐他汀和阿托伐他汀+依折麦布方案治疗,比较2组治疗前后NIHSS评分、ADL-BI评分、mRS评分、血压指标、血脂指标、炎性因子指标及vaspin水平。结果干预组治疗后NIHSS评分、mRS评分及ADL-BI评分均显著优于对照组、治疗前(P<0.05);干预组治疗后血压和血脂指标水平均显著优于对照组、治疗前(P<0.05);联合组治疗后TNF-α和IL-6水平均显著低于对照组、治疗前(P<0.05);同时干预组治疗后Vaspin水平显著高于对照组、治疗前(P<0.05)。结论强化降脂方案用于急性脑梗死合并高血压伴血脂异常患者治疗可有效保护受损神经功能,提高生存质量,改善血压和血脂水平,降低机体炎性反应,且有助于上调vaspin水平。
Objective To investigate the effects of intensive lipid-lowering therapy on neurological impairment,blood lipid and Vaspin levels of patients with acute cerebral infarction complicated by hypertension and dyslipidemia.Methods A total of 114 patients with acute cerebral infarction complicated by hypertension and dyslipidemia who were admitted and treated in our hospital from August 2015 to February 2018 were randomly divided into control group(n=57) and intervention group(n=57).The patients in control group were treated by atorvastatin on the basis of systematic intervention,however,the patients in intervention group were treated by atorvastatin +ezetimibe on the basis of systematic intervention.The NIHSS score,ADL-BI score,mRS score,the levels of blood pressure,blood lipid indexes,inflammatory factors and Vaspin levels before and after treatment were obseved and compared between the two groups.Results After treatment the NIHSS scores,ADL-BI scores,mRS scores in intervention group were superiot to those in control group and those before treatment(P<0.05).The levels of blood pressure and blood lipid indexes in intervention group were superior to those in control group and those before treatment(P<0.05).Moreover the levels of IL-6 and TNF-α in intervention group were significant lower than those in control group(P<0.05). The levels of Vaspin in intervention group after treatment were significant higer than those in control group and those before treatment(P<0.05).Conclusion Intensive lipid-lowering therapy in treatment of patients with acute cerebral infarction complicated by hypertension and dyslipidemia can effectively protect the damage of nerve function,improve the life quality of patients,improve the levels of blood pressure and blood lipid,reduce the inflammatory reaction,moreover,which is helpful to up-regulate the levels of Vaspin.
Objective To investigate the effects of intensive lipid-lowering therapy on neurological impairment,blood lipid and Vaspin levels of patients with acute cerebral infarction complicated by hypertension and dyslipidemia.Methods A total of 114 patients with acute cerebral infarction complicated by hypertension and dyslipidemia who were admitted and treated in our hospital from August 2015 to February 2018 were randomly divided into control group(n=57) and intervention group(n=57).The patients in control group were treated by atorvastatin on the basis of systematic intervention,however,the patients in intervention group were treated by atorvastatin +ezetimibe on the basis of systematic intervention.The NIHSS score,ADL-BI score,mRS score,the levels of blood pressure,blood lipid indexes,inflammatory factors and Vaspin levels before and after treatment were obseved and compared between the two groups.Results After treatment the NIHSS scores,ADL-BI scores,mRS scores in intervention group were superiot to those in control group and those before treatment(P<0.05).The levels of blood pressure and blood lipid indexes in intervention group were superior to those in control group and those before treatment(P<0.05).Moreover the levels of IL-6 and TNF-α in intervention group were significant lower than those in control group(P<0.05). The levels of Vaspin in intervention group after treatment were significant higer than those in control group and those before treatment(P<0.05).Conclusion Intensive lipid-lowering therapy in treatment of patients with acute cerebral infarction complicated by hypertension and dyslipidemia can effectively protect the damage of nerve function,improve the life quality of patients,improve the levels of blood pressure and blood lipid,reduce the inflammatory reaction,moreover,which is helpful to up-regulate the levels of Vaspin.
引文
1 Ikeda K,Sawada M,Morioka H,et al.Clinical profile and changes of serum lipid levels in epileptic patients after cerebral infarction.J Stroke Cerebrovasc Dis,2017,26:644-649.
2 Li W,Jin C,Vaidya A,et al.Blood pressure trajectories and the risk of intracerebral hemorrhage and cerebral infarction:a prospective study.Hypertension,2017,70:508-513.
3 Ip CK,Jin DM,Gao JJ,et al.Effects of add-on lipid-modifying therapy on top of background statin treatment on major cardiovascular events:A meta-analysis of randomized controlled trials.Int J Cardiol,2015,191:138-148.
4 Farnier M,Jones P,Severance R,et al.Efficacy and safety of adding alirocumab to rosuvastatin versus adding ezetimibe or doubling the rosuvastatin dose in high cardiovascular-risk patients:the odyssey options II randomized trial.Atherosclerosis,2016,244:138-46.
5 中国高血压防治指南修订委员会主编.中国高血压防治指南.2010年修订版.北京.人民卫生出版社,2012.14-15.
6 中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志,2015,48:246-257.
7 樊新生主编.实用内科学.第1版.北京.科学出版社,2015.109-110.
8 Kazandjian C,Kretz B,Lemogne B,et al.Influence of the type of cerebral infarct and timing of intervention in the early outcomes after carotid endarterectomy for symptomatic stenosis.Journal of Vascular Surgery,2016,63:1256-1261.
9 Psarros C,Economou EK,Koutsilieris M,et al.Statins as Pleiotropic Modifiers of Vascular Oxidative Stress and Inflammation.J Critical Care Med,2015,1:43-54.
10 Mirjani-Azari B,Jeli-Ivanovi Z,Zeljkovi A,et al.The Pleiotropic Effects of Atorvastatin on Stable Angina Patients:Evidence by Analysis of High-Density Lipoprotein Size and Subclasses,and Plasma mRNA.J Med Biochem,2015,34:314-322.
11 Menon AS,Kotwal N,Singh Y,et al.Statins:Cholesterol guidelines and Indian perspective.Indian J Endocrinol Metab,2015,19:546-553.
12 Pattan V,Seth S,Jehangir W,et al.Effect of Atorvastatin and Pioglitazone on Plasma Levels of Adhesion Molecules in Non-Diabetic Patients With Hypertension or Stable Angina or Both.J Clin Med Res,2015,7:613-618.
13 Joo HK,Yu RL,Kang G,et al.The 18-kDa Translocator Protein Inhibits Vascular Cell Adhesion Molecule-1 Expression via Inhibition of Mitochondrial Reactive Oxygen Species.Mol Cells,2015,38:1064-1070.
14 Pytel E,Jackowska P,Chwatko G,et al.Intensive statin therapy,used alone or in combination with ezetimibe,improves homocysteine level and lipid peroxidation to a similar degree in patients with coronary artery diseases.Pharmacol Rep,2016,68:344-348.
15 Lin M,Dai H,Zhao S.Long-term atorvastatin-ezetimibe-probucol triple therapy for homozygous familial hypercholesterolaemia from early childhood.Cardiol Young,2016,26:197-201.
16 Kei A,Filippatos TD,Elisaf MS.The safety of ezetimibe and simvastatin combination for the treatment of hypercholesterolemia.Expert Opin Drug Saf,2016,15:559-569.
2 Li W,Jin C,Vaidya A,et al.Blood pressure trajectories and the risk of intracerebral hemorrhage and cerebral infarction:a prospective study.Hypertension,2017,70:508-513.
3 Ip CK,Jin DM,Gao JJ,et al.Effects of add-on lipid-modifying therapy on top of background statin treatment on major cardiovascular events:A meta-analysis of randomized controlled trials.Int J Cardiol,2015,191:138-148.
4 Farnier M,Jones P,Severance R,et al.Efficacy and safety of adding alirocumab to rosuvastatin versus adding ezetimibe or doubling the rosuvastatin dose in high cardiovascular-risk patients:the odyssey options II randomized trial.Atherosclerosis,2016,244:138-46.
5 中国高血压防治指南修订委员会主编.中国高血压防治指南.2010年修订版.北京.人民卫生出版社,2012.14-15.
6 中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014.中华神经科杂志,2015,48:246-257.
7 樊新生主编.实用内科学.第1版.北京.科学出版社,2015.109-110.
8 Kazandjian C,Kretz B,Lemogne B,et al.Influence of the type of cerebral infarct and timing of intervention in the early outcomes after carotid endarterectomy for symptomatic stenosis.Journal of Vascular Surgery,2016,63:1256-1261.
9 Psarros C,Economou EK,Koutsilieris M,et al.Statins as Pleiotropic Modifiers of Vascular Oxidative Stress and Inflammation.J Critical Care Med,2015,1:43-54.
10 Mirjani-Azari B,Jeli-Ivanovi Z,Zeljkovi A,et al.The Pleiotropic Effects of Atorvastatin on Stable Angina Patients:Evidence by Analysis of High-Density Lipoprotein Size and Subclasses,and Plasma mRNA.J Med Biochem,2015,34:314-322.
11 Menon AS,Kotwal N,Singh Y,et al.Statins:Cholesterol guidelines and Indian perspective.Indian J Endocrinol Metab,2015,19:546-553.
12 Pattan V,Seth S,Jehangir W,et al.Effect of Atorvastatin and Pioglitazone on Plasma Levels of Adhesion Molecules in Non-Diabetic Patients With Hypertension or Stable Angina or Both.J Clin Med Res,2015,7:613-618.
13 Joo HK,Yu RL,Kang G,et al.The 18-kDa Translocator Protein Inhibits Vascular Cell Adhesion Molecule-1 Expression via Inhibition of Mitochondrial Reactive Oxygen Species.Mol Cells,2015,38:1064-1070.
14 Pytel E,Jackowska P,Chwatko G,et al.Intensive statin therapy,used alone or in combination with ezetimibe,improves homocysteine level and lipid peroxidation to a similar degree in patients with coronary artery diseases.Pharmacol Rep,2016,68:344-348.
15 Lin M,Dai H,Zhao S.Long-term atorvastatin-ezetimibe-probucol triple therapy for homozygous familial hypercholesterolaemia from early childhood.Cardiol Young,2016,26:197-201.
16 Kei A,Filippatos TD,Elisaf MS.The safety of ezetimibe and simvastatin combination for the treatment of hypercholesterolemia.Expert Opin Drug Saf,2016,15:559-569.