| Object: Cerebral infarction is such kind of disease which can pose serious threat to human health, which is also one of the common disease among cerebrovascular diseases especially in the elderly. Along with the improvement of people’s living standard, the incidence and recurrence rate of cerebral infarction are increasing yearly. At the same time, the mortality rate and disability rate are keeping in the high position all the year round. With China’s aging process, data have showed that, the crowd of 300000000 people will be affected by acute cerebral accident among the aging people of 60-year-old to the year 2030, among which more than 90% for ischemic stroke, of which will bring great pressure to the family and society. Rosuvastatin is a new type of statins which mainly takes effect in the liver, which also can promote absorption and decomposition of the low density lipoprotein and decrease the concentration of cholesterol, meanwhile, which has the effect of anti-inflammatory, antioxidant, improving endothelial function, regulating immunity. Besides the effect of lowering cholesterol level, plasma cholesterol, probucol also possesses the ability of antioxidant, anti-inflammatory, and protecting endothelial as well as stabilizing the atherosclerotic plaques, which is the only American antioxidant drugs certified by FDA. Currently, there is few research upon curative effects of rosuvastatin combined with probucol for curing cerebral infarction, especially for those aged people over 80-year-old. We are aimed at further knowing the curative effects of rosuvastatin combined with probucol upon treatment of senile cerebral infarction and its related factors.Methods: Select 120 cases over the age of 80 from internal neural department of medicine of cadre ward in Bethune International Peace Hospital from March 2010 to December 2014. The enrolled cases are according with the "Chinese cerebrovascular disease prevention guidance" diagnostic criteria: ⑴Diagnosed by brain CT or MRI examination with cerebral infarction. ⑵Thickness of CA-IMT≥1.2mm detected by The carotid artery color Doppler examination. Exclusion criteria:①the carotid ultrasound showed intraluminal plaque have caused serious obstruction of blood flow;②Patients with acute coronary syndrome, severe heart failure, arrhythmia;③ Complicated with severe pulmonary infection, respiratory failure; ④Combined with severe liver and kidney dysfunction; ⑤ Associated malignant tumors; ⑥ Associated severe blood system diseases. Patients are randomly divided into two groups, one group was control group, 60 cases; another group of probucol group, 60 cases. There is no statistically significance difference in the two groups of patients with gender, age, risk factors(P>0.05). Operation method: two groups of patients are given health education, dietary guidance, moderate exercise, smooth control of basic diseases. In the premise of ensuring curative quality: the control group was given routine treatment: including anti platelet aggregation, lowering blood pressure, hypoglycemic, expansion of coronary artery and other treatments, and the application of rosuvastatin therapy. Probucol group were treated by probucol treatment upon conventional therapy.Index of observation: 6 months before and after treatment of carotid artery intima-media thickness(IMT) and carotid artery intima plaque area; blood lipid levels(including cholesterol, glycerin three fat, low density lipoprotein, high density lipoprotein); serum oxidized low density lipoprotein autoantibody(ox LDL-Ab); high sensitivity C C-reactive protein(hs-CRP); serum mechanism of metalloproteinase 9(MMP-9); interleukin 6(IL-6); tumor necrosis factor alpha(TNF- alpha); nerve function deficit score.Results: 1 Comparison of carotid intima-media thickness(IMT) comparison and carotid intimal plaque area, blood lipid level, ox LDL-Ab, hs-CRP, MMP-9, IL-6, TNF- alpha, nerve function deficit score 6 months before and after treatment of the control group: IMT(1.65±0.50 mm vs. 1.30±0.52 mm,P<0.05)、carotid intimal plaque area(0.96±0.33cm2 vs. 0.80±0.21cm2,P<0.05)、low echo plaques(71vs.44 P<0.05)、hyperechoic plaques(43vs.67 P<0.05)、cholesterol(6.20±0.88mmol/L vs. 4.23±0.65mmol/L P<0.05)、glycerin three fat(2.07±0.61mmol/L vs. 1.41±0.42mmol/L P<0.05)、low density lipoprotein(3.80±0.92mmol/L vs. 1.90±0.61mmol/L P<0.05)、high density lipoprotein(1.17±0.37mmol/L vs. 1.51±0.38mmol/L P < 0.05) 、ox LDL-Ab( 783.53±34.86u/ml vs. 757.75±203.76u/ml P < 0.05)、hs-CRP(14.4±3.4mg/Lvs. 4.6±0.7mg/L P<0.05)、MMP-9(310.42±112.65ug/L vs. 207.44±108.65ug/L P<0.05)、IL-6(102.6±10.65 ug/L vs. 88.78±9.65 ug/L P<0.05)、TNF-α(5.47±1.18 mg/ml vs. 3.12±0.24 mg/ml P<0.05)、nerve function deficit score(19.51±3.34 vs. 15.06±2.02 P<0.05).2 Comparison of carotid intima-media thickness(IMT) comparison and carotid intimal plaque area, blood lipid level, ox LDL-Ab, hs-CRP, MMP-9, IL-6, TNF- alpha, nerve function deficit score 6 months before and after treatment of the probucol group: IMT(1.68±0.48 mm vs. 1.21±0.35 mm,P<0.05)、carotid intimal plaque area(0.97±0.32cm2 vs. 0.55±0.29cm2,P<0.05)、low echo plaques(72vs.40 P<0.05)、hyperechoic plaques(37vs.68 P<0.05)、cholesterol(6.16±0.88mmol/L vs. 3.68±0.43mmol/L P<0.05)、glycerin three fat(2.11±0.60mmol/L vs. 1.38±0.43mmol/L P<0.05)、low density lipoprotein(3.69±0.90mmol/L vs. 1.43±0.46mmol/L P<0.05)、high density lipoprotein(1.23±0.45mmol/L vs. 0.99±0.41mmol/L P < 0.05) 、ox LDL-Ab( 778.89±29.65u/ml vs. 602.76±180.43u/ml P < 0.05)、hs-CRP(14.3±3.6mg/L vs. 2.4±0.5mg/L P<0.05)、MMP-9(315.71±63.45ug/L vs. 177.65±70.21ug/L P<0.05)、IL-6(101.12±9.89ug/L vs. 75.87±8.42ug/L P< 0.05) 、 TNF-α(5.56±0.22mg/ml vs. 2.97±0.15mg/ml P < 0.05) 、 nerve function deficit score(22.57±2.58 vs. 10.13±1.33 P<0.05).3 Comparison of carotid intima-media thickness(IMT) comparison and carotid intimal plaque area, blood lipid level, ox LDL-Ab, hs-CRP, MMP-9, IL-6, TNF- alpha, nerve function deficit score 6 months before and after treatment of the control group and probucol group:IMT(1.30±0.52 mm vs. 1.21±0.35 mm P < 0.05)、 carotid intimal plaque area( 0.80±0.21cm2 vs.0.55±0.29cm2 P<0.05)、low echo plaques(44vs.40 P<0.05)、hyperechoic plaques( 67 vs.68 P < 0.05)、 cholesterol( 4.23±0.65mmol/L VS. 3.68±0.43mmol/L P < 0.05)、 glycerin three fat(1.41±0.42mmol/L vs. 1.38±0.43mmol/L P<0.05)、low density lipoprotein(3.69±0.90mmol/L vs. 1.90±0.61mmol/L P<0.05)、high density lipoprotein(1.51±0.38mmol/L vs. 0.99±0.41mmol/L P > 0.05) 、 ox LDL-Ab( 757.75±203.76u/ml vs. 602.76±180.43u/ml P<0.05)、hs-CRP(4.6±0.7mg/L vs. 2.4±0.5mg/L P<0.05) 、 MMP-9(207.44±108.65ug/L vs. 177.65±70.21ug/L P < 0.05) 、IL-6(88.78±9.65ug/L vs. 75.87±8.42ug/L P<0.05)、TNF-α(3.12±0.24mg/ml vs. 2.97±0.15mg/ml P<0.05)、nerve function deficit score(15.06±2.02 vs. 10.13±1.33 P<0.05).4 Comparison the change of differernce of carotid intima-media thickness(IMT) comparison and carotid intimal plaque area, blood lipid level, ox LDL-Ab, hs-CRP, MMP-9, IL-6, TNF- alpha, nerve function deficit score 6 months before and after treatment of the control group and probucol group:IMT(0.35 mm vs. 0.47 mm P<0.05)、carotid intimal plaque area(0.16cm2 vs. 0.42cm2 P<0.05)、low echo plaques(27vs.32 P<0.05)、hyperechoic plaques(24vs.31 P<0.05)、cholesterol(1.97mmol/L vs. 2.48mmol/L P<0.05)、glycerin three fat(0.66mmol/L vs. 0.73mmol/L P < 0.05) 、 low density lipoprotein(1.9mmol/L vs. 2.26mmol/L P<0.05)、high density lipoprotein(0.34mmol/L vs.-0.24mmol/L P > 0.05) 、 ox LDL-Ab( 25.78u/ml vs. 176.13u/ml P < 0.05)、 hs-CRP(9.8mg/L vs. 11.9mg/L P < 0.05) 、MMP-9(102.98ug/L vs. 138.06ug/L P<0.05)、IL-6(13.82ug/L vs. 25.25ug/L P<0.05)、TNF-α(2.35mg/ml vs. 2.59mg/ml P<0.05)、nerve function deficit score(4.45 vs. 12.44 P<0.05).Conclusion: Rosuvastatin and probucol all have stability and can reduce the carotid atherosclerotic plaque, hypolipidemic, antioxidant, anti-inflammatory, improving the role of neurological deficit. Meanwhile, rosuvastatin and probucol combined application effect is obviously better than the single application of rosuvastatin. |
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