| It have been clearly known recently that the carotid atherosclerosis is an importantreason of the cerebral infarction. Its the unstable plaque (soft plaque and mixed plaque) is oneof the main reason of the progressive cerebral infartion and the recurrence of the cerebralinfarction. Hence, how to stabilize plaque and evanish plaque and extenuate the narrow degreeof artery is the key point to decrease the incidence rate of the cerebral infarction. Variousfunctional colour ultrasound has been used in heart and the blood vessel of the surface of theskin as a effective means of non-wound, handy, the good iteration, all-round zoom. Partically, recent years, various functional colour ultrasound has been entered into the research of carotidatherosclerosis.The study of relative information may observe the shape of vascular anatomy, the information of internal membrane, the formation whether it has plaque, the morphologistand dimensions and habitude of plaque, whether the blood vessel is narrow and the degree ofnarrow. The relative studys indicate that the atherosclerosis is a chronic proliferativeinflammation of vessel and the inflammation plays a crucial important role in the originationand development of atherosclerosis. The patients with atherosclerosis, especially the patientswith unstable plaque, the levels of their serum CRP, sVCAM-1 and IL-6 are evidently higherthan the normal person's, the level of the serum markers of inflammation follows changingwith the development of atherosclerosis of different periods and stages.The foreign studydiscoverys that RAS system and the AngⅡof as main bioactive substances play a key role inthe origination and development of the atherosclerosis.The interrupting RAS system shouldbecome a target to resist the atherosclerosis. The relative studys indicate that angiotensinreceptor blocker(ARB) is not only a drug of the abasing blood pressure by rapidly used in thetherapeutist extensively but also is a good role to resist inflammation and atherosclerosis. Atpresent, it does not discover that the ARB drug have a infuence on the carotid unstable plaque, the recurrence of the cerebral infarction and the inflammation markers in our country. The study in this paper, with the help of the cervical vascular ultrasound andbiochemistry examination, aims to observe ARB(Valsartan)to the infuence of carotid unstableplaque, the serum CRP, sVCAM-1, IL-6 and the interfering clinical effecct of ischemic strokerecurrence.Materials and methods1. Experimental group According to the history of disease, sex, age and the pathologyproperty of unstable plaque, the sixty-five patients choosed of carotid unstable plague weredivided randomly into the treatment group of valsartan and the control group, the treatmentgroup with 33 examples, the control group with 32 examples, the serum CRP, sVCAM-1, IL-6and blood glucose were detected before treatment, according to the venousblood of withoutbreakfast and moniter the BP synchrometively. The controlling goal of the BP and the bloodglucose of the treatment group and the control group: BP 120-140/70-90mmHg, fasting bloodglucose(FBG)≤7.00mmol/L, the ways of other treatment are similar to the control group. Thetreatment group: Valsartan, 80mg, qd, p.o. The control group: the diuretic drug of the abasingblood pressure, p.o. The time of observation: June 2003～August 20062.The methods of observation: (1)the CRP, sVCAM-1, IL-6 and blood glucose were detectedby the separated serum that were preserved to -20℃according to about 5ml thevenousblood of without breakfast at before treatment, 1, 2 and 38 months and moniter theBP synchrometively. The blood glucose and CRP adopt Eppendorf. ECOM-F6124 andrelactive reagent. The normal reference value of CRP: 0-6mg/L, sVCAM-1 and IL-6 adoptthe method of ELI SA according to stat-Fax-2100(the reagent is supplied by Beijing CrystalBeautity Biology Engineering Limited Corporation), these operations follow the reagentinstruction. The normal reference value of sVCAM-1 and IL-6 respectively: 774±269ng/mland 25±13pg/L.(2). To re-examine cervical colour ultrasound at 38 months and observe thevariation of pathological property within plaque at the same Iocation.(3).To statistic therecurrence rate of cerebral infarction of the treatment group and the control group atterminal(38 month) according to the level of the appearing new infarction site of CT orMRI.(4).To statistic the death rate of treatment group and the control group at 38 months.3.Statistical methods: The metering information adopt the expression of ((?)±S). the two groupcomparison adopts t verification, All the using drug before and after internal group adoptclick t verification, the comparison of rate adopts the verification of x~2, theirs is based ona=0.05 as a verification standard of the evident difference, all the statistical analysis adoptSPSS 12.0 statistical software, the similar misjudgement of the colour ultrasound on carotid plaque adopts Kappa verification.Results1. The 11 examples of the treatment group convert into the stiff plaques, the transformingrate is 35.5％; the 3 examples of the control group convert into the stiff plaques, thetransforming rate is 11.1％. The former transforming rate is evidently higher than the later.The comparison of these two group has evident statistical meaning(P＜0.05).2. The values of CRP and sVCAM-1 and IL-6 before treatment of the treatment group andthe control group are evidently higher than the ones of normalization, the serum level ofCRP and sVCAM-1 and IL-6 of the treatment group after of treating 1 and 2 and 38months are gradually decreased, the patients of the transformed stiff plaque particularlydecreased much more evidently, the comparison of internal group has obvious statisticalsignificance(P＜0.05). The control group is not changing except the transformed stiffplaque, without statistical meaning. The comparison of the treatment group and the controlgroup has apparently changed, with evident statistical significance(P＜0.05).3. The BP and the blood glucose of the treatment group and the control group althoughhave not attained the anticipant controlling goal at 1 and 2 and 38 months. But, through thereasonable treatment and supervising, it has evidently decreased with the contrast of beforetreatment. The comparison of intemal group has evident statistical significance(P＜0.05).The comparison of two groups is not alterant, without statistical meaning.4. At the time of 38 months, the new cerebral infarction of the treatment group and the control groupconfirmed by CT or MRI, the recurrence is 7 and 15 examples, the death is 2 and 5 examples, the rate ofthe recurrence is 21.2％and 46.9％, the rate of death is 6.1％and 15.6％respectively, these rates of thetreatment group is evidently lower than the control group, the comparison of two groups has evidentstatistical significance(P＜0.05).Conelusion1. Valsartan can evidently decrease the serum level of CRP and sVCAM-1 and IL-6 ofthe patients with carotid atherosclerosis.2. Valsartan may stabilize the arterial plaque of the patient with carotid atherosclerosis.3. The stabilizing carotid plaque of valsartan have a intimately relation with the decreasingof the inflammation mediators of in the serum of CRP and sVCAM-1 and IL-6, thedecreasing rupture of unstable plaque may decrease the recurrence and death of ischemicstroke and play a role in two grade prevention.
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