超时间窗溶栓治疗对急性脑梗死体积、微血管密度及黏附因子表达的影响  

Effects of thrombolytic therapy with broadened therapeutic window on infarct volume,microvessel density and adherence factors in acute cerebral infarction

作　　者：林艳[1] 刘金之[1] 刘杰[1] 杨倩倩[2] 司志华[1] 徐珊[1] 王爱华[1] 

机构地区：[1]山东大学附属千佛山医院神经内科,山东济南250014 [2]江苏省苏州市广济医院神经内科,江苏苏州215008

出　　处：《山东大学学报（医学版）》2014年第5期20-24,29,共6页Journal of Shandong University:Health Sciences

基　　金：山东省科技发展计划项目(2011GGB14095)

摘　　要：目的观察超时间窗溶栓治疗对急性脑梗死体积、微血管密度(MVD)及黏附因子(ICAM-1、VCAM-1)表达的影响。方法 SD大鼠216只随机分为对照组、梗死组、4.5 h溶栓组和6 h溶栓组,每组动物随机分为3个亚组,分别于1、3、7 d时取脑。采用TTC染色观察脑梗死面积,免疫组化染色观察梗死灶周围微血管密度,实时定量PCR法检测梗死灶周边ICAM-1、VCAM-1 mRNA表达量。结果 4.5 h和6 h溶栓组各时间点脑梗死体积较梗死组明显缩小(P均<0.01),随着溶栓时间延长,梗死体积逐渐增大,两者差异有统计学意义(P<0.05);脑梗死3 d,4.5 h和6 h溶栓组M VD表达较梗死组增加(P均<0.05),7 d时明显增加(P均<0.01)。4.5 h和6 h溶栓组M VD随溶栓时间延长M VD逐渐增加,7 d较3 d增加明显(P<0.05),但两溶栓组在1、3、7 d时M VD差异无统计学意义(P>0.05);梗死组、4.5 h和6 h溶栓组ICAM-1、VCAM-1 mRNA表达量1 d开始升高(P<0.01),3 d达高峰(P<0.01),7 d仍高于对照组(P<0.01),4.5 h和6 h溶栓组各时间点ICAM-1、VCAM-1 mRNA表达量较梗死组明显降低(P均<0.05),随着溶栓时间延长,ICAM-1、VCAM-1 mRNA表达量均进一步升高,两组差异有统计学意义(P<0.05)。结论超时间窗溶栓可降低急性梗死灶体积,增加梗死灶周围微血管密度,降低免疫黏附因子的表达,为临床脑梗死超时间窗的溶栓治疗提供可靠的理论依据。Objective To explore the effect of recombinant tissue plasminogen activator（r-tPA） thrombolytic therapy with broadened therapeutic window on the cerebral infarct volume,microvessel density（MVD）,and expression of adherence factors（ICAM-1 and VCAM-1） in acute cerebral infarction. Methods A total of 216 SD rats were randomly divided into the control group,stroke group,rtPA 4. 5 h group and rtPA 6 h group. Each group was randomly divided into three subgroups,and brains were drawn from the animals in each subgroup on the 1st,3rdand 7thday. TTC staining was employed to observe cerebral infarct volume,immunohistochemical staining was used to observe M VD around ischemic core,and real time-PCR was used to detect the expression quantity of ICAM-1 and VCAM-1 mRNA around cerebral infarcts. Results Compared with the stroke group,the cerebral infarct volume was obviously reduced in the rtPA 4. 5 h group and rtPA 6 h group at each time point（P ＆lt; 0. 01）. The cerebral infarct volume increased with the thrombolysis time,with statistical differences between the rtPA 4. 5 h group and rtPA 6 h group（P ＆lt; 0. 05）. MVD washigher in the rtPA 4. 5 h and rtPA 6 h groups compared with the stroke group on the 3rdday（P ＆lt; 0. 05）,which was significantly higher on the 7thday（P ＆lt; 0. 01）. MVD of the rtPA 4. 5 h group and rtPA 6 h group increased with time,and the increase was more significant on the 7thday than on the 3rdday（P ＆lt; 0. 05）. No change of MVD were found between rtPA 4. 5 h group and rtPA 6 h group on the 1st,3rdand 7thday（P ＆gt; 0. 05）. The ICAM-1 and VCAM-1 mRNA expressions of stroke,rtPA 4. 5 h and rtPA 6 h groups started to elevate（P ＆lt; 0. 01） on the 1stday after thrombolysis,which reached peak on the 3rdday（P ＆lt; 0. 01）,and remained significantly elevated on the 7thday（P ＆lt; 0. 01）. Compared to the stroke group, the ICAM-1 and VCAM-1 mRNA expressions of rtPA 4. 5 h group and rtPA 6 h group were lower at each time point（P ＆lt; 0. 05）. As the th

关 键 词：脑梗死 溶栓 时间窗 微血管密度 黏附因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]