依达拉奉右莰醇联合阿托伐他汀治疗缺血性脑血管病合并颈动脉粥样硬化的机制与临床疗效探讨

Mechanisms and clinical efficacy of edaravone dexborneol combined with atorvastatin in the treatment of ischemic cerebrovascular disease with carotid atherosclerosis

摘要:

目的 探讨依达拉奉右莰醇联合阿托伐他汀治疗缺血性脑血管病（ICVD）合并颈动脉粥样硬化（CAS）的机制与临床疗效。方法 回顾性分析2021年12月—2024年12月贵航贵阳三〇〇医院收治的98例ICVD合并CAS患者的临床资料，按治疗方法分为阿托伐他汀组和联合组，各49例。阿托伐他汀组采用阿托伐他汀治疗，联合组在阿托伐他汀组的基础上联合依达拉奉右莰醇治疗。比较两组的一般资料、临床疗效、美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数（BI）、CAS程度，以及可溶性CD40配体（sCD40L）、脂蛋白相关磷脂酶A2（Lp-PLA2）、糖化白蛋白（GA）水平。结果 两组一般资料比较，差异无统计学意义（P >0.05）。联合组的临床总有效率高于阿托伐他汀组（P <0.05）；治疗后，联合组的NIHSS评分低于阿托伐他汀组，BI评分高于阿托伐他汀组（P <0.05）；联合组治疗前后NIHSS评分、BI评分的差值均大于阿托伐他汀组（P <0.05）。治疗后，联合组的颈动脉内膜中层厚度（IMT）、粥样斑块直径、斑块数量均低于阿托伐他汀组（P <0.05）；联合组治疗前后IMT、粥样斑块直径、斑块数量的差值均大于阿托伐他汀组（P <0.05）。治疗后，联合组的sCD40L、Lp-PLA2、GA水平均低于阿托伐他汀组（P <0.05）；联合组治疗前后sCD40L、Lp-PLA2、GA水平的差值均大于阿托伐他汀组（P <0.05）。结论 依达拉奉右莰醇联合阿托伐他汀能够显著提升ICVD合并CAS患者的临床疗效，改善神经功能，并有效减轻动脉粥样硬化负荷和系统性炎症反应，其作用机制可能与协同抗氧化、抗炎、降脂、改善代谢等多重路径有关。

Abstract:

Objective To evaluate the impact of edaravone dexborneol combined with atorvastatin on patients with ischemic cerebrovascular disease (ICVD) complicated by carotid atherosclerosis (CAS).Methods A total of 98 patients with ICVD complicated by CAS admitted to Guihang Guiyang 300 Hospital from December 2021 to December 2024 were selected as study subjects. According to the treatment method, they were divided into an atorvastatin group (n = 49) and a combination group (n = 49). The atorvastatin group was treated with atorvastatin, while the combination group received edaravone dexborneol in addition to the treatment given to the atorvastatin group. Post-treatment comparisons were made between the two groups in terms of general characteristics, clinical efficacy, National Institutes of Health Stroke Scale (NIHSS) scores, Barthel Index (BI), carotid artery status, and laboratory markers.Results No statistically significant differences were observed in baseline characteristics between the groups (P > 0.05). The combination group demonstrated a higher overall clinical efficacy rate than the atorvastatin group (P < 0.05). Following treatment, the combination group exhibited significantly lower NIHSS scores and higher BI scores compared to the atorvastatin group (P < 0.05). The differences in NIHSS scores and BI scores before and after treatment in the combination group were greater than those in the atorvastatin group (P < 0.05). The intima-media thickness (IMT), plaque diameter, and number of atherosclerotic plaques were all reduced to a greater extent in the combination group (P < 0.05). The differences in IMT, atherosclerotic plaque diameter, and plaque number before and after treatment in the combination group were greater than those in the atorvastatin group (P < 0.05). Laboratory analyzes revealed that levels of soluble CD40 ligand (sCD40L), lipoprotein-associated phospholipase A2 (Lp-PLA2), and glycated albumin (GA) were significantly lower in the combination group (P < 0.05). The differences in sCD40L, Lp-PLA2, and GA levels before and after treatment in the combination group were greater than those in the atorvastatin group (P < 0.05).Conclusion The combination of edaravone dexborneol and atorvastatin can significantly enhance clinical efficacy, improve neurological function, and effectively reduce atherosclerotic burden and systemic inflammatory response in patients with ICVD complicated by CAS. Its mechanism of action may be closely related to synergistic pathways involving antioxidation, anti-inflammation, lipid-lowering, and metabolic improvement.