丁苯酞辅助瑞替普酶溶栓治疗急性脑梗死的效果及对细胞凋亡因子、mRS评分的影响  

Clinical Efficacy of Butylphthalide-assisted Reteplase Thrombolysis in Treatment of Patients with Acute Cerebral Infarction and Its Effects on Apoptosis Factors and mRS Score

作　　者：鲍利改 董谦[2] BAO Li-gai;DONG Qian(Department of General Medicine,Liangxiang Hospital of Fangshan District,Beijing 102488,China;Department of Internal Medicine,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100069,China)

机构地区：[1]北京市房山区良乡医院全科医学科,北京102488 [2]首都医科大学附属北京朝阳医院内科,北京100069

出　　处：《解放军医药杂志》2022年第3期90-95,共6页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：北京市科学技术委员会科研课题(D141100000114003)。

摘　　要：目的探讨丁苯酞辅助瑞替普酶溶栓治疗急性脑梗死(ACI)的效果及对细胞凋亡因子、改良Rankin量表(mRS)评分的影响。方法选取2018年4月—2020年6月我院收治的128例ACI,根据治疗方法的不同分为研究组64例和对照组64例。对照组在常规治疗基础上予瑞替普酶治疗,研究组在对照组基础上加用丁苯酞联合治疗,均治疗14 d。对比2组疗效、不良反应,治疗前、治疗14 d后凝血功能指标[凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)],血液流变学指标(全血低切黏度、全血高切黏度、红细胞沉降率、血浆黏度),血管内皮功能指标[血管性假血友病因子(vWF)、内皮素-1(ET-1)、一氧化氮(NO)],细胞凋亡因子[B淋巴细胞瘤-2(Bcl-2)、可溶性凋亡相关因子配体(sFASL)、可溶性凋亡相关因子(sFAS)]水平,美国国立卫生研究院卒中量表(NIHSS)、mRS评分及梗死灶体积。结果研究组治疗14 d后总有效率显著高于对照组(P<0.05)。2组治疗14 d后TT、APTT、PT、NO、Bcl-2水平均升高,且研究组升高更明显(P<0.05)。2组治疗14 d后全血高切黏度、全血低切黏度、红细胞沉降率、血浆黏度、vWF、ET-1、sFASL、sFAS水平及NIHSS、mRS评分均降低,且研究组降低更明显(P<0.05)。2组治疗14 d后梗死灶体积均减小,且研究组减小程度大于对照组(P<0.05)。2组不良反应比较差异无统计学意义(P>0.05)。结论丁苯酞辅助瑞替普酶溶栓治疗能改善ACI患者凝血功能、血液流变学状态与血管内皮功能,减少神经细胞凋亡,缩小梗死灶体积,减轻神经功能缺损程度,进而增强疗效、改善预后,且安全性良好。Objective To investigate clinical efficacy of Butylphthalide-assisted Reteplase thrombolysis in treatment of patients with acute cerebral infarction(ACI)and its effects on apoptosis factor and modified Rankin Scale(MRS)score.Methods A total of 128 patients with ACI admitted between April 2018 and June 2020 were selected and divided into research group(n=64)and control group(n=64)according to different therapeutic methods.Control group was treated with Reteplase on the basis of routine treatment,while research group was treated with Butylphthalide on the basis of treatment for control group.Both groups were treated for 14 d.Clinical efficacy and adverse reactions were compared between two groups.Before and after treatment for 14 d,coagulation function indexes[thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT)],hemorheological indexes(whole blood low shear viscosity,whole blood high shear viscosity,erythrocyte sedimentation rate,plasma viscosity),vascular endothelial function indexes[von Willebrand factor(vWF)endothelin-1(ET-1),nitric oxide(NO)],apoptosis factors[B-lymphoma-2(Bcl-2),soluble apoptosis related factor ligand(sFASL),soluble apoptosis related factor(sFAS)],National Institutes of Health Stroke Scale(NIHSS),mRS score and infarct volume were also compared between two groups.Results After treatment for 14 d,the total effective rate in research group was significantly higher than that in control group(P<0.05).After treatment for 14 d,levels of TT,APTT,PT,NO and Bcl-2 were significantly increased in two groups,and the increased levels were more obvious in research group(P<0.05).After treatment for 14 d,values of the whole blood high shear viscosity,whole blood low shear viscosity,erythrocyte sedimentation rate,plasma viscosity,vWF,ET-1,sFASL,sFAS,NIHSS and mRS scores were significantly decreased in two groups,and the decreased values were more obvious in research group(P<0.05).After treatment for 14 d,the infarct areas were significantly decreased in two groups,and the reductio

关 键 词：脑梗死 丁苯酞 瑞替普酶 凝血酶时间 凝血酶原时间 B淋巴细胞瘤-2 可溶性凋亡相关因子配体 改良Rankin量表 

分 类 号：R743.33[医药卫生—神经病学与精神病学]