作者：时宏娟1 ，张晓俊 2 ，陈菲 1 ，冯尧 1 ，王炎强 3 ，肖成华 1

单位：

1.221002 江苏省徐州市，徐州医科大学附属医院神经内科　；2.261031 山东省潍坊市，潍坊医学院　；3.261031 山东省潍坊市，潍坊医学院附属医院神经内二科；通信作者：王炎强，E-mail：Wangqiangdoctor@126.com

Units：

1.Department of Neurology，the Affiliated Hospital of Xuzhou Medical University，Xuzhou 221002，China；2.Weifang Medical University，Weifang 261031，China；3.The Second Department of Neurology，the Affiliated Hospital of Weifang Medical University，Weifang 261031，China；Corresponding author：WANG Yanqiang，E-mail： Wangqiangdoctor@126.com

关键词：

脑缺血发作，短暂性；卒中；颈内动脉颅外段狭窄；普罗布考；阿托伐他汀；治疗结果

Keywords：

Ischemic attack，transient；Stroke；Extracranial stenosis of internal carotid artery；Probucol；Atorvastatin；Treatment outcome

CLC：

R 743.31

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.020

Funds：

基金项目：国家自然科学基金（81870943）；山东省自然科学基金联合专项（ZR2018LH006）；潍坊医学院科技扶贫专项（FP1801004）

摘要：

目的　观察普罗布考联合阿托伐他汀强化治疗颈内动脉（ICA）颅外段狭窄所致短暂性脑缺血发作（TIA）患者的临床疗效及其对缺血性卒中的预防效果。方法　选取 2015 年 6 月—2018 年 6 月徐州医科大学附属医院神经内科收治的 ICA 颅外段狭窄所致 TIA 患者 86 例，随机分为对照组和治疗组，每组 43 例。在常规药物治疗基础上，对照组患者予以阿托伐他汀钙片，治疗组患者在对照组基础上给予普罗布考治疗，两组患者均持续治疗 4 周。比较两组患者治疗前后凝血功能指标、肝肾功能指标、血脂指标、炎性因子、颈动脉超声检查结果及临床疗效，并观察两组患者缺血性卒中及治疗期间不良反应发生情况。结果　（1）两组患者治疗前后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血小板计数（PLT）、纤维蛋白原（FIB）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、尿素氮（BUN）、血肌酐（Scr）比较，差异无统计学意义（P>0.05）。（2）两组患者治疗前总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、超敏 C 反应蛋白（hs-CRP）、脂蛋白相关磷脂酶 A2（LP-PLA2）、氧化低密度脂蛋白（ox-LDL）、基质金属蛋白酶 9（MMP-9）、颈动脉内膜中层厚度（IMT）、斑块面积、易损斑块数量比较，差异无统计学意义（P>0.05）；治疗组患者治疗后 TC、TG、LDL-C、hs-CRP、LP-PLA2、ox-LDL、MMP-9 低于对照组，HDL-C 高于对照组，颈动脉 IMT、斑块面积小于对照组，易损斑块数量少于对照组（P<0.05）。（3）治疗组患者临床疗效优于对照组，缺血性卒中发生率低于对照组（P<0.05）。（4）两组患者治疗期间不良反应发生率比较，差异无统计学意义（P>0.05）。结论　普罗布考联合阿托伐他汀强化治疗 ICA 颅外段狭窄所致 TIA 患者的临床疗效确切，其可有效改善患者血脂指标，减轻炎性反应，抑制颈动脉 IMT 增厚，有利于降低缺血性卒中发生风险，且安全性较高。

Abstract：

Objective　To observe the clinical effect of probucol combined with atorvastatin intensive treatmenton TIA caused by extracranial segment stenosis of internal carotid artery（ICA）and the preventive effect on ischemic stroke.Methods　From June 2015 to June 2018，a total of 86 patients with TIA caused by extracranial segment stenosis of ICA wereselected in the Department of Neurology，the Affiliated Hospital of Xuzhou Medical University，and they were randomly dividedinto control group and treatment group，with 43 cases in each group. Patients in control group were given atorvastatin intensivetreatment based on conventional medical treatment，while patients in treatment group were given probucol based on that ofcontrol group；both groups were continuously treated for 4 weeks. Pre- and post-treatment index of coagulation function，hepatic and renal function，blood lipid parameters，inflammatory cytokines and carotid ultrasound examination results，as wellas clinical effect were compared between the two groups，moreover incidence of ischemic stroke and adverse reactions duringtreatment was observed，respectively. Results　（1）There was no statistically significant difference in PT，APTT，PLT，FIB，ALT，AST，BUN or Scr between the two groups before or after treatment（P>0.05）.（2）There was no statisticallysignificant difference in TC，TG，LDL-C，HDL-C，hs-CRP，LP-PLA2，ox-LDL，MMP-9，carotid IMT，plaque area ornumber of vulnerable plaques between the two groups before treatment（P>0.05）；TC，TG，LDL-C，hs-CRP，LP-PLA2，ox-LDL and MMP-9 in treatment group were statistically significantly lower than those in control group after treatment，HDL-Cin treatment group was statistically significantly higher than that in control group，carotid IMT and plaque area in treatmentgroup were statistically significantly smaller than those in control group，number of vulnerable plaques in treatment group wasstatistically significantly less than that in control group（P<0.05）.（3）Clinical effect in treatment group was statisticallysignificantly better than that in control group，while incidence of ischemic stroke in treatment group was statistically significantlylower than that in control group（P<0.05）.（4）There was no statistically significant difference in incidence of adversereactions between the two groups during treatment（P>0.05）. Conclusion　Probucol combined with atorvastatin intensivetreatment has certain clinical effect in treating TIA caused by extracranial segment stenosis of ICA，which can effectively adjustthe blood lipid parameters，relieve the inflammatory reaction，inhibit the thickening of carotid IMT，is helpful to reduce the riskof ischemic stroke and relatively safety.

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