阿加曲班联合阿替普酶治疗缺血性脑卒中的疗效及其对Lp-PLA_2、FIB和神经相关因子水平的影响  

Clinical Effects of the Combination of Argatroban and Alteplase in the Treatment of Ischemic Stroke and Their Influence on the Levels of Lp-PLA_2,FIB and Nerve Related Factors

作　　者：吴娟[1] 刘爱东[2] 蒋娟莉 陈力[1] 陈灿[1] 

机构地区：[1]成都医学院第一附属医院药剂科,610500 [2]成都医学院第一附属医院神经内科,610500

出　　处：《医学研究杂志》2017年第1期67-70,共4页Journal of Medical Research

基　　金：四川省卫生和计划生育委员会科研项目(150048)

摘　　要：目的探讨阿加曲班联合阿替普酶治疗缺血性脑卒中(ischemic stroke,IS)的疗效及其对脂蛋白磷脂酶A_2(lipoprotein associated phospholipase A_2,Lp-PLA_2)、纤维蛋白原(fibrinogen,FIB)、S100钙结合蛋白A8/A9(S100A8/A9)和神经肽Y(neuropeptide Y,NPY)水平的影响。方法选取2012年9月~2015年12月期间于成都医学院附属第一医院神经内科诊治的78例IS患者为研究对象,依据治疗方法的不同将患者分为单独组(阿替普酶组)和联合组(阿加曲班+阿替普酶组),每组各39例。分别利用脑卒中量表评分、Barthel指数和长谷川简易智能量表(Hasegawa dementia scale,HDS)评估两组患者的治疗效果,比较两组患者S100A8/A9、NPY、Lp-PLA_2和FIB的变化水平。结果治疗后,两组患者的NIHSS评分均较治疗前明显降低(P<0.05),而Barthel指数和HDS量表得分值则均较治疗前显著升高(P<0.05);并且,联合组患者的NIHSS得分、Barthel指数和HDS量表评分的变化幅度均显著优于单独组(P<0.05)。治疗后,两组患者S100A8/A9、NPY、Lp-PLA_2和FIB含量均较治疗前显著降低(P<0.05),而且,联合组患者NPY和FIB水平的下降幅度明显高于单独组(P<0.05),但其余指标与单独组比较差异无统计学意义(P>0.05)。结论阿加曲班联合阿替普酶对IS患者具有显著临床疗效,可改善其自理生活能力和认知功能,促进NPY和FIB水平的恢复。Objective To explore the clinical effects of the combination of argatroban and aheplase in the treatment of ischemic stroke （IS） and their influence on the levels of lipoprotein associated phospholipase A2 （Lp -PLA2 ）, fibrinogen （FIB）, S100 calcium binding protein A8/A9 （S100A8/A9） and neuropeptide Y （NPY）. Methods The 78 cases of IS in the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College were selected as the research objective from September 2012 to December 2015, and they were randomly divided into single group （alteplase group） and combined group （argatroban plus aheplase group） according to differ- ent treatments, with 39 cases in each group. The clinical effects of two groups were evaluated by stroke scale score, Barthel index and ha- segawa mini mental （HDS） scale and the levels of S100A8/A9, NPY, Lp - PLA2 and FIB were compared between two groups. Results After treatment, the NIHSS of two groups were significantly decreased as compared with those before treatment （ P 〈 0.05 ）, while Barthel index and HDS were significantly increased when compared with those before treatment （P 〈 0.05 ）. Moreover, the changes of NIHSS, Barthel index and HDS in the combined group were significantly superior to those in the single group （P 〈 0.05 ）. After treatment, the levels of S100A8/A9, NPY, Lp - PLA2 and FIB of two groups were significantly reduced as compared with those before treatment （P 〈 0. 05）. Moreover, the changes of NPY and FIB in the combined group were significantly higher than those of single group （P 〈 O. 05 ）. However, the other indicators showed no significant difference between two groups （P 〈 0.05）. Conclusion The combination of argatro- ban and aheplase in the treatment of patients with IS had significant clinical effects, and they can improve the self - care ability and cogni- tive function of patients, and promote the recovery of NPY and FIB.

关 键 词：阿加曲班 阿替普酶 缺血性脑卒中 脂蛋白磷脂酶A2 纤维蛋白原 LIPOPROTEIN associated PHOSPHOLIPASE A2 

分 类 号：R743.3[医药卫生—神经病学与精神病学]