The Study About Influence Of Probucol And Atorvastatin Calcium In Blood Lipid Level Of Patients With Ischemic Cerebrovascular Disease

Objective:The morbidity and mortality of atherosclerosis related diseasessuch as cardiovascular and cerebrovascular disease are high.With the in-depthresearch progress of AS,it is generally recognized that AS is a progressiveinflammatory process that blood lipid and many kinds of cell factorsparticipate.Blood lipid has been the most important risk factor so thatlipid-lowering therapy is urgently needed.China ischemic stroke and transientischemic attack secondary prevention guide2010(referred as the guide) alsodoes a detail about blood lipid control in this paper.From the guide, we canrealize: the treatment of ischemic cerebrovascular disease has set more strictrequirements on blood lipid control.But for now, clinical cholesterol drugs arevariety.And the problems about their effect on lipid-lowering and if clinicalbenefit of combination therapy is significant with the increased cost should getmore and more attention.Probucol is initiatively used as a kind of cholesterol drugs in clinic, and itmainly reduces cholesterol in serum.However, some studies found that it couldalso reduce the high density lipoprotein (HDL) cholesterol.For the latter'sprotection is already sure, the application of probucol is restricted for a longtime in clinic.In recent years, more pharmacological research confirmed that short-termuse (less than3months), can generally reduce total cholesterol (CHOL)10%-20%, can reduce low-density lipoprotein cholesterol (LDL) nearly for10%-20%, but for triglycerides (TG), reports have disagreed opinions.As one kind of the statins, atorvastatin calcium is widely used inclinic.Its main mechanism is inhibiting the activity of HMGCoA,one of keyenzymes in the synthesis of cells cholesterol,reducing synthesis of free cholesterol. Through the feedback adjustment function, LDL receptor quantityin the liver cell surface increases,and the absorption of plasma LDL in livercells speeds up. Finally, the intake and decomposition about the LDL andother apolipoprotein lipoprotein accelerates,thus serum CHOL and LDLreduce.This study aims that observe the therapeutic difference between patientsdeveloping ischemic cerebrovascular disease who are using different kinds ofcholesterol drugs and determine their individual and combination therapeuticeffects in lipid lowering.And it will have important clinical instructive value inthe secondary prevention of ischemic cerebrovascular disease.In the process ofmedicine taking, the analysis of adverse reactions such as liver enzymesheighten and drug correlated myopathy can help instruct prescription.Methods: We collected39patients with ischemic cerebrovascular diseasecharging in second hospital of hebei medical university from February2011toFebruary2012. Their lipid have reached suggestive level which should beintervened.A total of39cases (aged:49-77years; mean age:60.20±7.11; Theratio of male to female is1.16:1; male:21cases,53.85percent) randomlyassigned to three experimental groups, with13cases in each group. Getbiochemical blood samples of all patients in morning hollow beforeintravenous fluids injection and treatment and send testing instantly,includinglow density lipoprotein cholesterol(LDL), cereal third transaminase(ALT),creatine kinase(CK) and total cholesterol (CHOL). According to Strokepatients with clinical neurological defect in scoring standards (1995),mark thecomplication diseases and historical diseases.Specific experimental groups are as follows:(1)Atorvastatin calciumgroup:the average age of58.69±7.21years old with the complication diseasesscoring5.61±2.18points, history scoring4.07±1.49points. Give patientsatorvastatin calcium with a dose of20mg per day (2) Probucol group:theaverage age of60.69±5.78years old, with the score5.00±1.62points,and4.38±1.76points.Give patients probucol with a dose of0.25g twice one day.(3)Combination group:the average age of61.23±8.44years old, with the score 4.23±2.00points, and4.00±1.65points. Give them probucol0.25g2/dayand atorvastatin calcium20mg per day.Take medicine for one month, andreview the relevant indicators in our hospital.In the experimental process,follow up drug adverse reaction rate.With the application of SPSSl3.0statistical analysis package,we got thestatistical analysis. All measurement datas were analyzed by Two-Samplet-test and non-parameter test. Mean differences between groups were analyzedby the single factor analysis of variance. The numeration datas were analyzedby chi-square test.Results:1Atorvastatin calcium group: The level of CHOL is significantly lowerthan that of pre-medicine taking.(P<0.01)(Table2and Fig.1) The level ofLDL is significantly lower than that of pre-medicine taking.(P<0.01)(Table2and Fig.2)2Probucol group: The level of CHOL is significantly lower than that ofpre-medicine taking.(P<0.05)(Table3and Fig.1) The level of LDL issignificantly lower than that of pre-medicine taking.(P<0.05)(Table3andFig.2)3Combination group: The level of CHOL is significantly lower than thatof pre-medicine taking.(P<0.01)(Table4and Fig.1), The level of LDL issignificantly lower than that of pre-medicine taking.(P<0.01)(Table4andFig.2)4Three treatment groups in CHOL:There is statistacial difference ofCHOL changes between the three groups(P<0.05). There is not statistacialdifference of CHOL changes between the group of atorvastatin calcium andcombination group.Any two groups of the rest in CHOL have significantlystatistical difference.(Table5)5Three treatment groups in LDL:There is statistacial difference of LDLchanges between the three groups(P<0.05).There is not statistacial differenceof LDL changes between the group of atorvastatin calcium group andprobucol group.Any two groups of the rest in LDL have significantly statistical difference.(Table5)6Drug adverse reaction: During medicine taking period,there is notrhabdomyolysis case; There is one case with liver enzymes increasing as highas four times in the combination treatment group; There is one case withdiarrhea in the probucol treatment group.Conclusion:1Probucol and atorvastatin calcium can both reduce the level of CHOLand LDL in patients with ischemic cerebrovascular disease.The combinationtherapy is also useful in those aspects.2Atorvastatin calcium and combination therapy may have superiortherapeutic effects than probucol in reducing CHOL level. There is notsignificant difference between atorvastatin calcium and combination therapygroup in this aspect.3There is not significant difference between atorvastatin calcium andprobucol in reducing LDL level.Combination therapy may has superiortherapeutic effects than each of them in this aspect.4Short period of atorvastatin calcium taking can also reduce the level ofCHOL and LDL in patients with ischemic cerebrovascular disease.5Lower dose of probucol taking can also reduce the level of CHOL andLDL in patients with ischemic cerebrovascular disease.6The incidence of drug related adverse reaction in this study is very rare,probably accounting for the amounts of sample.We do not do statisticalconclusion about this aspect.