杜卫,李靖宇,王翠,李霞,王玉玲,王田,刘辉
DU Wei,LI Jingyu,WANG Cui,LI Xia,WANG Yuling,WANG Tian,LIU Hui

• 1:解放军第967医院神经内科
• 2:大连市中心医院神经内科

摘要(Abstract)：

目的:探讨缺血性脑卒中脑微出血(CMBs)的危险因素及阿托伐他汀钙的治疗效果。方法:选取1 064例缺血性脑卒中患者,根据有无并发CMBs分为无CMBs组(n=656)及并发CMBs组(n=408),比较2组患者年龄、性别、饮酒、吸烟、糖尿病、高血压、冠心病及血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、纤维蛋白原(FIB)、尿酸(UA)及同型半胱氨酸(Hcy),采用多因素Logistic回归分析缺血性脑卒中并发CMBs的危险因素;根据阿托伐他汀钙治疗剂量将缺血性脑卒中并发CMBs患者分为≤20 mg组(n=204)及40 mg组(n=204),比较2个剂量组患者治疗前、治疗6个月时的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平及CMBs病灶数。结果:多因素Logistic回归分析结果显示,年龄、高血压、肥胖、血UA升高是缺血性脑卒中并发CMBs的独立危险因素(P<0.05);阿托伐他汀钙治疗6个月时,2组患者血清TC、LDL-C、CRP、TNF-α及IL-6水平较治疗前降低(P<0.05),40 mg组显著低于≤20 mg组,差异有统计学意义(P<0.01);治疗前及治疗6个月时,2组患者CMBs病灶数比较,差异无统计学意义(P>0.05)。结论:年龄、高血压、肥胖及UA升高是影响缺血性脑卒中患者并发CMBs的独立危险因素,高剂量阿托伐他汀钙治疗缺血性脑卒中并发CMBs能降低患者血清炎症因子及血脂水平。
Objective: To investigate the risk factors of cerebralmicrobles(CMBs) in patients with ischemic stroke and the intervention effect of atorvastatin calcium. Methods: 1 064 patients with ischemic stroke were selected and divided into no complication CMBs group(n=656) and complication CMBs group(n=408). Logistic regression analysis was used to analyze the risk factors of CMBs in patients with ischemic stroke: age, gender, history of drinking and smoking, diabetes, hypertension, coronary disease, TC, TG, HDL, LDL, FIB, US and Hcy. According to different doses of atorvastatin calcium, patients in complication CMBs group were divided into ≤20 mg group(n=204), 40 mg group(n=204). The serum total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), the number of cerebral microhemorrhage foci and the levels of inflammatory tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and C-reactive protein(CRP) of before treatment and 6 months after treatment were compared between the two groups. Results: Multivariate Logistic regression analysis showed that age, hypertension, obesity and increased blood uric acid(UA) were independent risk factors for CMBs in patients with ischemic stroke(P<0.05). Compared with before treatment, the levels of serum TC, LDL-C, CRP, TNF-α, IL-6 in both groups were decreased after 6 months of treatment(P<0.05); 40 mg group was significantly lower than the ≤20 mg group, differences were statistically significant(P<0.01). Number of CMBs foci before treatment and 6 months after treatment showed no statistical significance(P>0.05). Conclusion: Age, hypertension, obesity and elevated UA were independent risk factors for CMBs in patients with ischemic stroke. High dose of atorvastatin calcium in the treatment of ischemic stroke complicated with CMBs reduced the level of inflammatory factors and blood lipids.

关键词(KeyWords)： 缺血性脑卒中;脑微出血;危险因素;阿托伐他汀钙;血脂;出血灶;炎性因子
ischemic stroke;cerebral microbleeds;risk factors;atorvastatin calcium;blood fat;hemorrhagic foci;inflammatory factors

Abstract:

Keywords:

基金项目(Foundation): 大连市卫生和计划生育委员会医学研究课题(1612037)

作者(Author): 杜卫,李靖宇,王翠,李霞,王玉玲,王田,刘辉
DU Wei,LI Jingyu,WANG Cui,LI Xia,WANG Yuling,WANG Tian,LIU Hui

DOI: 10.19367/j.cnki.1000-2707.2019.12.023

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