三种他汀类药物对大动脉粥样硬化型觉醒型卒中患者血脂及前蛋白转化酶枯草溶菌素9水平的影响
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摘要
目的探讨三种他汀类药物对大动脉粥样硬化型觉醒型卒中患者血脂及前蛋白转化酶枯草溶菌素9(PCSK9)水平的影响。方法我院使用他汀类药物进行降脂治疗的住院大动脉粥样硬化型觉醒型卒中患者90例,按随机数字表法分为瑞舒伐他汀组、阿托伐他汀组、辛伐他汀组各30例,比较各组入院时第二天和治疗后一个月的血糖、血脂、肝功能、血清肌酸激酶、C-反应蛋白(CRP)、美国国立卫生研究院神经功能缺损评分(NIHSS)、PCSK9水平。结果三组使用他汀类药物后,总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、CRP水平和NIHSS评分明显降低,高密度脂蛋白(HDL-C)明显升高(P<0.05)。三组治疗1个月后的PCSK9水平均高于治疗前,瑞舒伐他汀组低于阿托伐他汀组和辛伐他汀组(P<0.05)。随着治疗时间的延长(4~16周),患者TC、TG、LDL-C水平无进一步降低。PCSK9水平无进一步升高。结论瑞舒伐他汀、阿托伐他汀、辛伐他汀三种药物均可有效降低患者的血脂水平,其中瑞舒伐他汀降脂效果最为明显;同时三种药物也会明显提高PCSK9水平,对降脂效果起一定的反作用,建议使用他汀类药物联合PCSK9的方案。
Objective To investigate the three types of statins on blood lipids and proprotein convertase subtilisin/kexin type9( PCSK9) levels in patients with atherosclerotic awakening stroke.Methods Ninety inpatients with atherosclerotic awakening stroke who received statins lipid-lowering therapy in our hospital were randomly divided into groups of rosuvastatin,atorvastatin and simvastatin,30 in each group. The blood sugar,blood lipid,liver function,serum creatine kinase,c-reactive protein and National Institutes of Health Stroke Scale( NIHSS) and PCSK9 were compared on the next day of admission and after one month of treatment among the three groups.Results After the use of statins,total cholesterol( TC),triglyceride( TG),low density lipoprotein( LDL-C),CRP and NIHSS score were significantly decreased while high density lipoprotein( HDL-C) was obviously increased( P < 0. 05). The levels of PCSK9 after one month of treatment were significantly higher than that before treatment,but it was lower in the rosuvastatin group than that in the atorvastatin group and the simvastatin group( P < 0. 05).However,with further treatment( 4-16 weeks),there were no obvious changes in the levels of TC,TG,LDL-C and PCSK9.Conclusion The three types of statins all can effectively reduce the patients' blood lipid levels,of which simvastatin has more effect than another two drugs.Combination of the three drugs at the same time can significantly improve the level of PCSK9 that has a certain adverse effect.Therefore,it is recommended using a regime of statins combined with PCSK9.
Objective To investigate the three types of statins on blood lipids and proprotein convertase subtilisin/kexin type9( PCSK9) levels in patients with atherosclerotic awakening stroke.Methods Ninety inpatients with atherosclerotic awakening stroke who received statins lipid-lowering therapy in our hospital were randomly divided into groups of rosuvastatin,atorvastatin and simvastatin,30 in each group. The blood sugar,blood lipid,liver function,serum creatine kinase,c-reactive protein and National Institutes of Health Stroke Scale( NIHSS) and PCSK9 were compared on the next day of admission and after one month of treatment among the three groups.Results After the use of statins,total cholesterol( TC),triglyceride( TG),low density lipoprotein( LDL-C),CRP and NIHSS score were significantly decreased while high density lipoprotein( HDL-C) was obviously increased( P < 0. 05). The levels of PCSK9 after one month of treatment were significantly higher than that before treatment,but it was lower in the rosuvastatin group than that in the atorvastatin group and the simvastatin group( P < 0. 05).However,with further treatment( 4-16 weeks),there were no obvious changes in the levels of TC,TG,LDL-C and PCSK9.Conclusion The three types of statins all can effectively reduce the patients' blood lipid levels,of which simvastatin has more effect than another two drugs.Combination of the three drugs at the same time can significantly improve the level of PCSK9 that has a certain adverse effect.Therefore,it is recommended using a regime of statins combined with PCSK9.
引文
[1]刘旭,朱瑞霞,李瞿,等.OLR1基因多态性与动脉粥样硬化性脑梗死的相关性研究[J].解剖学研究,2016,38(2):95-99.
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[12]王玉东,马广蕊,杨冬梅,等.糖、脂类、C反应蛋白与冠心病患者Gensini积分的相关性研究[J].标记免疫分析与临床,2016,23(12):1403-1405.
[13]齐珊珊,付赵虎,唐灵涛.普罗布考联合阿托伐他汀治疗大动脉粥样硬化性脑梗死的临床研究[J].现代药物与临床,2016,31(11):1707-1711.
[14]郑修广,张作文,陈光伟,等.腔隙性脑梗死与颅外大动脉粥样硬化的关系[C].2015临床急重症经验交流第二次高峰论坛,2015:1-2.
[15]张然.觉醒型卒中临床特征、危险因素、CISS分型及预后研究[D].河北医科大学,2015.
[2]赵艳,韩宁,卢应.老年脑梗死患者颅内外大动脉粥样硬化性狭窄与不同血糖水平代谢综合征相关性分析[J].临床军医杂志,2017,45(12):1302-1304.
[3]董亚琳,董卫华.他汀类药物的研究进展[J].中国新药杂志,2003,12(3):175-178.
[4]徐庆松,王红艳,李连波,等.双抗与抗凝治疗大动脉粥样硬化型脑梗死110例对比分析[J].检验医学与临床,2017,14(4):560-562.
[5]杜真真,张灿飞,汤媛媛,等.大动脉粥样硬化性脑梗死不同发病机制的危险因素分析[J].中华老年心脑血管病杂志,2016,18(4):394-397.
[6]张广波,于凯,冀瑞俊,等.大动脉粥样硬化狭窄性脑梗死的危险因素分析[J].临床荟萃,2016,31(1):77-80.
[7]高菲,马博雅,王钊,等.非大动脉粥样硬化型脑梗死130例临床分析[J].中风与神经疾病杂志,2017,34(3):230-233.
[8]鞠德仁,郑咏梅,李青,等.联合用药在急性大动脉粥样硬化性脑梗死中的疗效分析[J].当代医学,2016,22(33):67-68.
[9]万鹏,付强,张倩,等.他汀类药物对急性ST段抬高型心肌梗死患者PCSK9含量的影响[J].江苏大学学报(医学版),2017,27(1):64-68.
[10]吕晨铃,陈雅文,朱敏,等.ADAMTS-1基因多态性与急性大动脉粥样硬化性脑梗死的相关性[J].中华医学遗传学杂志,2015,32(6):844-848.
[11]钟晓,王岭,徐翔,等.大动脉粥样硬化型脑梗死患者TLR4基因多态性观察[J].山东医药,2017,57(15):74-77.
[12]王玉东,马广蕊,杨冬梅,等.糖、脂类、C反应蛋白与冠心病患者Gensini积分的相关性研究[J].标记免疫分析与临床,2016,23(12):1403-1405.
[13]齐珊珊,付赵虎,唐灵涛.普罗布考联合阿托伐他汀治疗大动脉粥样硬化性脑梗死的临床研究[J].现代药物与临床,2016,31(11):1707-1711.
[14]郑修广,张作文,陈光伟,等.腔隙性脑梗死与颅外大动脉粥样硬化的关系[C].2015临床急重症经验交流第二次高峰论坛,2015:1-2.
[15]张然.觉醒型卒中临床特征、危险因素、CISS分型及预后研究[D].河北医科大学,2015.