降纤酶与阿加曲班对急性缺血性脑卒中患者脑血流动力学凝血/纤溶系统及血清GFAP OPN的影响  

Effects of defibrase combined with argatroban on cerebral hemodynamics,coagulation/fibrinolysis system and serum GFAP and OPN expression in patients with acute ischemic stroke

作　　者：于洋 项广宇 李涛 钱哲 YU Yang;XIANG Guangyu;LI Tao;QIAN Zhe(Xuchang Central Hospital,Xuchang 461000,China)

机构地区：[1]许昌市中心医院,河南许昌461000

出　　处：《中国实用神经疾病杂志》2020年第23期2061-2067,共7页Chinese Journal of Practical Nervous Diseases

基　　金：许昌市重大科技专项(转型升级创新专项)(编号:20180113031)。

摘　　要：目的分析降纤酶结合阿加曲班对急性缺血性脑卒中(AIS)患者脑血流动力学、凝血/纤溶系统及血清神经胶质纤维酸性蛋白(GFAP)、骨桥蛋白(OPN)表达的影响。方法选取2018-03—2020-05许昌市中心医院AIS患者124例,以随机数字表分为研究组(n=62)、对照组(n=62)。在常规治疗基础上,对照组予以降纤酶,研究组予以降纤酶及阿加曲班,均治疗1周。对比分析2组疗效与治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力量表(BI)评分、大脑中动脉血流动力学收缩期峰值血流速度(Vmax)、阻力指数(PI)、平均血流速度(Vmean)、凝血/纤溶系统凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤溶酶原活性(PLG)、纤维蛋白原(FIB)、血清炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、GFAP、OPN水平。结果研究组治疗1周后总有效率95.16%,高于对照组的79.03%(P<0.05);2组治疗1周后NIHSS评分与PI水平较治疗前降低,且研究组低于对照组,BI评分与Vmax、Vmean水平均较治疗前提高,且研究组高于对照组(P<0.05);2组治疗1周后PT、APTT、FIB与血清IL-6、TNF-α、hs-CRP、GFAP、OPN水平较治疗前降低,且研究组低于对照组,PLG水平较治疗前提高,且研究组高于对照组(P<0.05)。结论降纤酶联合阿加曲班治疗AIS患者可改善脑血流动力学与凝血/纤溶系统,减轻炎症反应,下调GFAP、OPN表达,降低神经功能缺损程度,提升日常生活能力。Objective To analyze the effects of defibrase combined with argatroban on cerebral hemodynamics,coagulation/fibrinolysis system,and serum glial fibrillary acidic protein(GFAP)and osteopontin(OPN)expressions in patients with acute ischemic stroke(AIS).Methods A prospective randomized controlled study method was used to select 124 AIS patients in our hospital from March 2018 to May 2020.They were divided into study group(n=62)and control group(n=62)by random number table.On the basis of conventional treatment,the control group was treated with defibrase,and the study group was treated with defibrase combined with argatroban for 1 week.The efficacy,the National Institutes of Health stroke scale(NIHSS),Barthel index(BI)scores,and hemodynamic indexes of the middle cerebral artery(peak systolic blood flow velocity(Vmax),resistance index(PI),average blood flow velocity(Vmean)),the coagulation/fibrinolysis system indicators(prothrombin time(PT),activated partial thromboplastin time(APTT),plasminogen activity(PLG),fibrinogen(FIB)),serum inflammatory factors(interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)),GFAP,OPN levels before and after treatment of the two groups were compared.Results The total effective rate of the study group after 1 week of treatment was 95.16%higher than that of the control group 79.03%(P<0.05).The NIHSS score and PI levels of the two groups after 1 week of treatment were lower than before treatment,and the study group was lower than the control group.The levels of BI score and Vmax and Vmean were higher than before treatment,and the study group was higher than the control group(P<0.05).After 1 week of treatment,the levels of PT,APTT,FIB and serum IL-6,TNF-α,hs-CRP,GFAP,and OPN in the two groups were lower than before treatment,and the study group was lower than the control group.The level of PLG was higher than before treatment,and the study group was higher than the control group(P<0.05).Conclusion Defibrase combined with argatroban in the treatmen

关 键 词：急性缺血性脑卒中 降纤酶 阿加曲班 脑血流动力学 凝血/纤溶系统 神经胶质纤维酸性蛋白 骨桥蛋白 

分 类 号：R743.3[医药卫生—神经病学与精神病学]