目的 探讨注射用丹参多酚酸联合阿托伐他汀治疗缺血性脑卒中合并冠心病的疗效及对患者血脂、血管内皮功能和炎症因子的影响。方法 回顾性纳入2018年6月—2020年6月于濮阳市安阳地区医院心内科收治的缺血性脑卒中合并冠心病患者124例，根据治疗方法不同将患者分为对照组和观察组，每组各62例。两组患者入院均采取抗血小板聚集、调脂、扩张冠状动脉、吸氧、控制脑水肿、降颅内压、改善微循环、维持水电解质平衡及保护脑神经等常规治疗。对照组在常规治疗基础上给予阿托伐他汀钙片，20 mg/次，每日1次；观察组在对照组基础上给予注射用丹参多酚酸0.13 g溶于250 mL0.9%氯化钠注射液中，静脉滴注，每日1次。两组治疗疗程均为14 d。比较两组临床疗效；对比治疗前与治疗14 d后两组患者日常生活能力（ADL）评分和美国国立卫生研究院卒中量表（NIHSS）评分、血脂、血管内皮功能相关指标和炎症因子的变化。结果 观察组总有效率（93.55%）显著高于对照组（70.97%），组间差异显著（P<0.05）。治疗后两组ADL评分、高密度脂蛋白-胆固醇（HDL-C）水平、血清一氧化氮（NO）和血管内皮生长因子（VEGF）水平均较治疗前显著升高（P<0.05），而NIHSS评分、低密度脂蛋白-胆固醇（LDL-C）、三酰甘油（TG）和总胆固醇（TC）水平、内皮素-1（ET-1）水平、肿瘤坏死因子α（TNF-α）、高敏C-反应蛋白（hs-CRP）和白细胞介素-6（IL-6）水平较治疗前显著降低（P<0.05）；观察组治疗14 d后ADL评分、HDL-C水平显著高于对照组（P<0.05），而NIHSS评分、LDL-C、TG和TC水平均显著低于对照组（P<0.05）；观察组治疗14 d后血清NO和VEGF水平显著高于对照组（P<0.05），而ET-1水平显著低于对照组（P<0.05）；观察组治疗14 d后血清TNF-α、hs-CRP和IL-6水平显著低于对照组（P<0.05）。结论 注射用多酚酸联合阿托伐他汀治疗缺血性脑卒中合并冠心病疗效良好，且可改善患者血脂紊乱及血管内皮功能紊乱状态，并减轻炎症反应。

Objective To investigate the efficacy of Salvianolic Acid for Injection combined with atorvastatin in the treatment of ischemic stroke complicated with coronary heart disease and its effects on blood lipid, vascular endothelial function and inflammatory factors. Methods Total 124 patients with ischemic stroke and coronary heart disease treated in the department of internal medicine-cardiovascular of Anyang District Hospital of Puyang City from June 2018 to June 2020 were retrospectively included. According to different treatment methods, the patients were divided into control group and observation group, with 62 cases in each group. Patients in both groups were treated with routine treatment such as anti platelet aggregation, lipid-lowering, coronary artery expansion, oxygen inhalation, control of brain edema, reduction of intracranial pressure, improvement of microcirculation, maintenance of water electrolyte balance and protection of cerebral nerves. On the basis of routine treatment, patients in the control group were given Atorvastatin Calcium Tablets, 20 mg/time, once a day. On the basis of the control group, patients in the observation group were given 0.13 g Salvianolic Acid for Injection dissolved in 250 mL of 0.9% sodium chloride injection, intravenous drip once a day. The treatment course of both groups was 14 days. The clinical effects of the two groups were compared, the changes of activity of daily living (ADL) score, National Institutes of Health Stroke Scale (NIHSS) score, blood lipid, vascular endothelial function and inflammatory factors were compared between the two groups before treatment and 14 days after treatment. Results The total effective rate of the observation group (93.55%) was significantly higher than that of the control group (70.97%). There was significant difference between the groups (P<0.05). After treatment, ADL score, high density lipoprotein cholesterol (HDL-C), serum nitric oxide (NO) and vascular endothelial growth factor (VEGF) in two groups were significantly higher than those before treatment (P<0.05), while NIHSS score, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and total cholesterol (TC), endothelin-1 (ET-1) and tumor necrosis factor α (TNF-α), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in two groups were significantly lower than those before treatment (P<0.05). The ADL score and HDL-C level in the observation group were significantly higher than those in the control group after 14 days of treatment (P<0.05), while the NIHSS score, LDL-C, TG and TC levels were significantly lower than those in the control group (P<0.05). The levels of serum NO and VEGF in the observation group were significantly higher than those in the control group after 14 days of treatment (P<0.05). The level of ET-1 in the observation group was significantly lower than that in the control group (P<0.05). The levels of hsCRP and IL-6 in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Salvianolic Acid for Injection combined with atorvastatin is effective in the treatment of ischemic stroke complicated with coronary heart disease, and can improve the disorder of blood lipid and vascular endothelial function, and reduce the inflammatory reaction.

R971