海南医科大学学报

目的:探讨正丁基苯酞对缺血性脑血管病患者血清超敏C-反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)及肿瘤坏死因子-α(TNF-α)的影响,以评估其对颈动脉硬化斑块的治疗效果。方法 :根据颈动脉超声检查结果,将缺血性脑卒中患者分为颈动脉稳定斑块组(对照组)、颈动脉易损斑块组,按随机数字法将易损斑块组分为干预1组及干预2组,2组均给予拜阿司匹林及阿托伐他汀口服治疗,干预1组在上述治疗基础上加服丁苯酞软胶囊治疗;分别检测各组治疗前及治疗6个月血清hs-CRP、MMP-9、TNF-α浓度,采用彩色多普勒超声诊断测量并评介颈动脉内-中膜厚度值(IMT)、斑块Crous积分、斑块回声变化。结果:易损斑块2亚组治疗前血清hs-CRP、MMP-9及TNF-α水平均高于对照组(P<0.05),但干预1组及干预2组间血清hs-CRP、MMP-9、TNF-α水平比较无显著差异(P>0.05);治疗后6个月易损斑块2亚组中血清hs-CRP、MMP-9及TNF-α水平均下降(P<0.05),干预1组治疗后血清hs-CRP、MMP-9及TNF-α水平均低于干预2组(P<0.05);易损斑块2亚组治疗后6个月后IMT值均下降(P<0.05),干预1组治疗后IMT值下降幅度大于干预2组(P<0.05);2亚组治疗后斑块Crous积分均有所下降(P<0.05),但治疗后组间比较无统计学差异(P>0.05);治疗后2组不稳定斑块数量明显下降(P<0.05),干预1组治疗后不稳定斑块数量明显低于干预2组(P<0.05)。结论:丁苯酞软胶囊具有抗炎、逆转颈动脉内膜增生及稳定斑块作用,可使易损斑块稳定而非动脉粥样硬化斑块消退。

Objective:To explore the effect of butylphthalide soft capsule on the serum hs-CRP,MMP-9,and TNF-αin patients with ischemic cerebrovascular disease in order to evaluate the the therapeutic effect in the treatment of carotid atherosclerosis.Methods:According to the carotid ultrasound results,the patients were divided into the stable plaque group(control group)and the vulnerable plaque group.The patients in the vulnerable plaque group were randomized into the intervention 1group and intervention 2group.The patients in the two subgroups were given bayaspirin and atorvastatin.On this basis,the patients in the intervention 1group were given butylphthalide soft capsules.The serum hs-CRP,MMP-9,and TNF-αbefore treatment and 6months after treatment in each group were detected.The color Doppler ultrasound was used to measure and evaluate IMT,Crouse score,and plaque echo change.Results:The serum hs-CRP,MMP-9,and TNF-αlevels before treatment between the two subgroups were significantly higher than those in the control group(P<0.05),but the comparison between intervention 1group and intervention 2group was not statistically significant(P>0.05).The serum hs-CRP,MMP-9,and TNF-αlevels 6months after treatment in the two subgroups were significantly reduced when compared with before treatment(P<0.05).The serum hs-CRP,MMP-9,and TNF-αlevels after treatment in the intervention 1group were significantly lower than those in the intervention 2group(P<0.05).IMT 6 months after treatment in the two subgroups was significantly reduced when compared with before treatment(P<0.05).The reduced degree of IMT after treatment in the intervention 1group was significantly greater than that in the intervention 2group(P<0.05).Crouse score after treatment in the two subgroups was significantly reduced when compared with before treatment(P<0.05),but the comparison between the two groups was not statistically significant(P>0.05).The unstable plaque number after treatment in the two subgroups was significantly reduced when compared with before treatment(P <0.05).The unstable plaque number after treatment in the intervention 1group was significantly lower than that in the intervention 2group(P<0.05).Conclusions:Butylphthalide soft capsule can resist the inflammation,reverse the prolieration of carotid intima,stabilize the vulnerable plaque,and remove the non-atherosclerotic plaque.