烟酸缓释片干预脂蛋白a治疗对急性前循环脑梗死预后的影响

    Effect of nicotinic acid sustained-release tablets on the prognosis of acute anterior circulation cerebral infarction via interfering lipoprotein α

    • 摘要:
      目的: 观察烟酸缓释片对急性前循环脑梗死病人脂蛋白alipoprotein(a), Lp(a)的治疗效果及其对颈总动脉内膜厚度、斑块面积的影响,探讨烟酸缓释片治疗与急性脑梗死预后的关系。
      方法: 纳入142例急性前循环脑梗死病人,随机分为对照组(阿托伐他汀治疗组)和观察组(阿托伐他汀 + 烟酸缓释片治疗组),以美国国立卫生研究院卒中量表(NIHSS)评分评估2组入院时病情严重程度,于入院后次日抽取晨间空腹血检测Lp(a)水平;彩色多普勒超声测量2组颈总动脉内膜中层厚度(IMT)及斑块面积;出院后90 d复测Lp(a)、颈总动脉IMT及斑块面积,改良Rankin量表(mRS)评价2组出院后90 d独立生活能力。
      结果: Lp(a)水平与入院时NIHSS评分、颈总动脉IMT及斑块面积呈正相关关系(r = 0.525,P < 0.01;r = 0.231,P < 0.01;r = 0.252,P < 0.05);出院后90 d观察组Lp(a)水平较对照组下降(P < 0.05),颈总动脉IMT及斑块面积较对照组减小(P < 0.05 ~ P < 0.01)。2组mRS分级比较差异无统计学意义(P > 0.05)。
      结论: 急性前循环脑梗死病人Lp(a)水平与脑梗死病情呈正相关关系,烟酸缓释剂可有效降低Lp(a)水平,减小IMT及颈动脉斑块面积,改善脑梗死预后。

       

      Abstract:
      Objective To investigate the therapeutic effects of nicotinic acid sustained-release tablets on lipoprotein(a)Lp(a) in patients with acute anterior circulation cerebral infarction, its influence on carotid artery intima thickness and plaque area, and analyze the relationship between the treatment of nicotinic acid sustained-release tablets and prognosis of acute cerebral infarction.
      Methods A total of 142 patients with acute anterior circulation cerebral infarction were randomly divided into the control group(atorvastatin treatment group) and observation group(atorvastatin + niacin sustained-release tablets treatment group). The severity of illness in two groups on admission were evaluated using the NIHSS, and the serum levels of Lp(a) were detected at 2d after admission. The intima media thickness (IMT) and carotid plaque area of common carotid artery in two groups were measured by color Doppler flow imaging. The Lp(a), common carotid artery IMT and plaque area were remeasured, and the mRS was used to evaluate the independent living ability of two groups after 90d of discharge.
      Results The Lp(a) level was positively correlated with NIHSS score, common carotid artery IMT and plaque area at admission (r = 0.525, P < 0.01; r = 0.231, P < 0.01; r = 0.252, P < 0.05). After 90 days of discharge, the level of Lp(a) in the observation group decreased compared with that of control group (P < 0.05), the carotid artery IMT and plaque area reduced compared with that of control group (P < 0.05 to P < 0.01), and there was no statistical significant in the mRS grading between two groups (P > 0.05).
      Conclusions The level of Lp(a) is positively correlated with the severity of acute anterior circulation cerebral infarction. Nicotinic acid sustained-release tablets can effectively decrease the level of Lp(a), reduce the IMT and carotid plaque area, and improve the prognosis of cerebral infarction.

       

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