2017 年第 10 期 第 12 卷

不同剂量瑞舒伐他汀联合注射用阿替普酶治疗急性脑梗死的临床效果

Clinical effects of different doses of rosuvastatin combined with recombinant human tissue plasminogen activator for injection on acute cerebral infarction

作者：郭东金勇蒋智林万婷李聪

英文作者：Guo Dong Jin Yong Jiang Zhilin Wan Ting Li Cong

单位：110001沈阳，解放军第二〇二医院神经内科（郭东、蒋智林、万婷、李聪），药剂科（金勇）

英文单位：Department of Neurology Chinese People′s Liberation Army No.202 Hospital Shenyang 110001 China（Guo D Jiang ZL Wan T Li C）; Department of Pharmacy Chinese People′s Liberation Army No.202 Hospital Shenyang 110001 China（Jin Y）

关键词：急性脑梗死；注射用阿替普酶；瑞舒伐他汀

英文关键词：Acutecerebralinfarction；Recombinanthumantissueplasminogenactivatorforinjection；Rosuvastatin

• 摘要：

• 目的 探讨不同剂量瑞舒伐他汀联合注射用阿替普酶（rt-PA）治疗急性脑梗死的临床效果。方法 选取2014年7月至2016年3月解放军第二〇二医院神经内科收治的急性脑梗死患者84例，完全随机分为观察组与对照组，各42例。控制2组患者血压、血糖，观察组患者静脉滴注rt-PA 0.9 mg/kg，最大剂量不超过90 mg，并口服瑞舒伐他汀钙片20 mg/d；对照组患者给予同等剂量的rt-PA，并口服瑞舒伐他汀钙片10 mg/d，2组患者均治疗1个月。比较2组患者治疗前后血脂水平、美国国立卫生研究院卒中量表（NIHSS）和日常生活能力指数（BI）评分，评价2组患者的临床疗效。结果 治疗前,2组患者总胆固醇、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平比较，差异均无统计学意义（均P＞0.05）。治疗后，观察组与对照组总胆固醇与LDL-C水平均明显改善［观察组：（3.6±1.4）mmol/L比（5.7±1.3）mmol/L、（3.0±0.5）mmol/L比（3.5±1.0）mmol/L；对照组：（5.3±1.3）mmol/L比（5.7±1.3）mmol/L、（3.4±0.7）mmol/L比（3.5±1.0）mmol/L］，且观察组改善明显优于对照组，差异均有统计学意义（均P＜0.05）；2组HDL-C水平与治疗前比较，观察组与对照组比较，差异均无统计学意义（均P＞0.05）。治疗前，对照组与观察组患者的NIHSS与BI评分比较，差异均无统计学意义（均P＞0.05）；治疗后，2组患者的NIHSS评分均低于治疗前，BI评分均高于治疗前，且观察组NIHSS评分低于对照组［（2.2±1.2）分比（4.3±1.4）分］，BI评分高于对照组［（66±23）分比（56±20）分］，差异均有统计学意义（均P＜0.05）。观察组总有效率明显高于对照组［92.9%（39/42）比76.2%（32/42）］，差异有统计学意义（χ2=4.459，P=0.035）。结论 大剂量瑞舒伐他汀联合rt-PA治疗急性脑梗死能明显改善患者血脂水平、神经功能缺损症状和日常生活能力，具有更好的临床效果。

• Objective To explore clinical effects of different doses of rosuvastatin combined with recombinant human tissue plasminogen activator for injection（rt-PA） on acute cerebral infarction. Methods Eighty-four patients with acute cerebral infarction admitted from July 2014 to March 2016 in Chinese People′s Liberation Army No.202 Hospital were randomly divided into observation group and control group, with 42 cases in each group. All patients received antihypertensive and hypolipidemic therapies; the observation group was treated with rt-PA 0.9 mg/kg（the maximum dose≤90 mg） plus rosuvastatin calcium tablets 20 mg/d for 1 month; the control group was treated with same dose of rt-PA plus rosuvastatin calcium tablets 10 mg/d for 1 month. Blood lipid level, scores of the National Institutes of Health Stroke Scale（NIHSS） and Barthel Index（BI） were recorded before and after treatment. The therapeutic effect was analyzed. Results There were no significant differences of total cholesterol（TC）, low-density lipoprotein cholesterol（LDL-C） and high-density lipoprotein cholesterol（HDL-C） between groups before treatment（P＞0.05）. After treatment, levels of TC and LDL-C significantly decreased compared to those before treatment in both groups［（3.6±1.4）mmol/L vs （5.7±1.3）mmol/L, （3.0±0.5）mmol/L vs （3.5±1.0）mmol/L； （5.3±1.3）mmol/L vs （5.7±1.3）mmol/L, （3.4±0.7）mmol/L vs （3.5±1.0）mmol/L］; there were also significant differences between groups（P＜0.05）. The level of HDL-C after treatment showed no significant difference between groups（P＞0.05）. Scores of NIHSS and BI had no significant differences between groups before treatment（P＞0.05）. After treatment, NIHSS score in observation group was significantly lower and BI score was significantly higher than those in control group［（2.2±1.2）scores vs （4.3±1.4）scores, （66±23）scores vs （56±20）scores］（P＜0.05）. The total effective rate in observation group was significantly higher than that in control group［92.9%（39/42） vs 76.2%（32/42）］（χ2＝4.459, P＝0.035）. Conclusion High dose of rosuvastatin combined with rt-PA can effectively control blood lipid level, promote recovery of neurological deficits and improve ability of daily living in patients with acute cerebral infarction.