尿激酶与重组组织型纤溶酶原激活剂联合用于静脉溶栓治疗急性脑梗塞对患者死亡蛋白激酶1、血管内皮功能影响  

Effect for Intravenous Thrombolytic Therapy of Urokinase combined with Rt-PA on DAPK1 and Vascular Endothelial Function in Acute Cerebral Infarction Patients

作　　者：周慧杰[1] 刘丽[1] 董志军[1] Zhou Huijie;Liu Li;Dong Zhijun(Department of Neurology,Chifeng Hospital,Chifeng,Inner Mongolia 024000,China)

机构地区：[1]赤峰市医院神经内科

出　　处：《四川医学》2019年第10期1050-1054,共5页Sichuan Medical Journal

摘　　要：目的分析尿激酶与重组组织型纤溶酶原激活剂(rt-PA)联合用于静脉溶栓治疗急性脑梗塞对患者血清死亡蛋白激酶1(DAPK1)、血管内皮功能影响。方法选取2016年4月至2018年1月我院收治的急性脑梗塞患者98例,采用随机数字法分为对照组和观察组。对照组患者采用常规对症治疗+rt-PA溶栓,观察组患者常规对症治疗+尿激酶联合rt-PA溶栓,分析两组患者治疗后的临床效果。结果治疗前,两组患者凝血纤溶变化(TEG)指标、血管内皮功能指标、氧化应激指标、DAPK1水平比较,差异无统计学意义(P>0.05)。治疗后,观察组患者一氧化氮(NO)、谷胱甘肽过氧化物酶(GSH-PX)水平高于对照组,内皮素(ET)、8-羟化脱氧鸟苷(8-oHdG)、DAPK1水平低于对照组,但TEG指标与对照组比较,差异无统计学意义(P>0.05)。治疗前,两组患者美国国立卫生院神经功能缺损量表(NIHSS)评分比较,差异无统计学意义(P>0.05)。治疗后,观察组患者NIHSS评分低于对照组,差异有统计学意义(P<0.05)。观察组患者脑出血发生率高于对照组,但再发脑梗死和死亡发生率与对照组比较,差异无统计学意义(P>0.05)。结论尿激酶联合rt-PA静脉溶栓治疗急性脑梗塞可减轻患者血管内皮损伤,改善氧化应激指标,降低DAPK1水平,减少脑出血的发生。Objective To analyze the effect for intravenous thrombolytic therapy of urokinase combined with recombinant tissue plasminogen activator(rt-PA)on serum death protein kinase 1(DAPK1)and vascular endothelial function in acute cerebral infarction patients.Methods Ninety-eight patients with acute cerebral infarction admitted to our hospital from April 2016 to January 2018 were randomly divided into control group and observation group.Patients were treated with conventional symptomatic treatment + rt-PA thrombolysis in control group.Moreover,patients in observation group were treated with conventional symptomatic treatment + urokinase combined with rt-PA thrombolysis.Then,clinical effects of two groups were analyzed.Results Before treatment,there were no significant differences in the levels of coagulation and fibrinolysis(TEG),vascular endothelial function,oxidative stress and DAPK1 between two groups(P>0.05).After treatment,the levels of nitric oxide(NO)and glutathione peroxidase(GSH-PX)in the observation group were higher than those in the control group,the levels of endothelin(ET),8-hydroxydeoxyguanosine(8-oHdG)and DAPK1 was lower than those of the control group,but there was no significant difference in TEG between the two groups(P>0.05).Before treatment,there was no significant difference in the National Institutes of Health Neurological Deficit Scale(NIHSS)score between the two groups(P>0.05).After treatment,the NIHSS score of the observation group was lower than that of the control group with statistical significance(P<0.05).The incidence of cerebral hemorrhage in the observation group was higher than that in the control group,but there was no significant difference in the incidence of recurrent cerebral infarction and death between the two groups(P>0.05).Conclusion Intravenous thrombolytic therapy of urokinase combined with rt-PA can alleviate vascular endothelial injury,improve oxidative stress,reduce DAPK1 level and reduce cerebral hemorrhage to treat acute cerebral infarction.

关 键 词：尿激酶 重组组织型纤溶酶原激活剂 静脉溶栓 急性脑梗塞 血管内皮损伤 

分 类 号：R743.33[医药卫生—神经病学与精神病学]