目的 探讨阿托伐他汀强化治疗急性脑梗死的临床疗效及对血清基质金属蛋白酶-2、3和9的影响。方法 选择2018年7月-2019年7月上海市杨浦区市东医院收治的急性脑梗死患者84例，随机分为常规组和强化组，每组各42例。常规组口服阿托伐他汀钙片20 mg/次，1次/d；强化组口服阿托伐他汀钙片40 mg/次，1次/d。两组患者连用4周。观察两组患者临床疗效，同时比较治疗前后两组患者血清基质金属蛋白酶-2（MMP-2）、MMP-3和MMP-9水平和脑梗死病灶面积。结果 治疗后，常规组临床总有效率为78.57%，显著低于强化组的95.24%。两组比较差异有统计学意义（P<0.05）。治疗后，两组血清MMP-2、MMP-3和MMP-9水平较治疗前显著下降（P<0.05），且强化组下降幅度与常规组比较更显著（P<0.05）。治疗后，两组脑梗死病灶面积较治疗前显著缩小（P<0.05），且强化组缩小幅度比常规组更显著（P<0.05）。结论 阿托伐他汀强化治疗急性脑梗死患者效果确切，安全性好，减轻血管壁炎症，抑制细胞外基质及基底膜的降解。

Objective To investigate the curative effect observation of atorvastatin intensive treatment in patients with acute cerebral infarction and the effect on serum MMP-2, MMP-3, and MMP-9. Methods Patients (84 cases) with acute cerebral infarction in Shanghai Yangpu Shidong Hospital from July 2018 to July 2019 were randomly divided into routine and intensive groups, and each group had 42 cases. Patients in the routine group were po with Atorvastatin Calcium Tablets, 20 mg/time, once daily. Patients in the intensive group were po administered with Atorvastatin Calcium Tablets, 40 mg/time, once daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacy was evaluated, and the serum levels of MMP-2, MMP-3 and MMP-9, the area of cerebral infarction in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the routine group was 78.57%, which was significantly lower than 95.24% in the intensive group, and there were differences between two groups (P<0.05). After treatment, the serum levels of MMP-2, MMP-3, and MMP-9 in two groups were significantly decreased (P<0.05), and which in the intensive group were significantly lower than those in the routine group (P<0.05). After treatment, the area of cerebral infarction in two groups was significantly decreased (P<0.05), and which in the intensive group was significantly smaller than that in the routine group (P<0.05). Conclusions The clinical effect of atorvastatin intensive treatment in patients with acute cerebral infarction is exact and safe, can reduce the inflammation of vascular wall and inhibit the degradation of extracellular matrix and basement membrane.

R971

上海市卫生和计划生育委员会科研课题计划项目（2017450）