阿替普酶联合法舒地尔治疗对急性脑梗死患者脑微循环灌注凋亡因子及TLR4/NF-κB信号通路的调节效应  

Regulatory effects of alteplase combined with fasudil on cerebral microcirculation perfusion,apoptosis factors and TLR4/NF-κB signaling pathway in patients with acute cerebral infarction

作　　者：崔炜[1] 王智勇[1] 高永强 孙倩[1] 李建设[1] Cui Wei;Wang Zhiyong;Gao Yongqiang;Sun Qian;Li Jianshe(Xinxiang Central Hospital,Xinxiang 453000,Henan,China)

机构地区：[1]新乡市中心医院,河南新乡453000

出　　处：《临床心身疾病杂志》2022年第4期20-25,共6页Journal of Clinical Psychosomatic Diseases

摘　　要：目的探讨阿替普酶联合法舒地尔治疗对急性脑梗死患者脑微循环灌注、凋亡因子、Toll样受体4/核因子-κB信号通路的调节效应。方法将95例急性脑梗死患者按照随机数字表法分为研究组48例与对照组47例,两组均给予阿替普酶静脉溶栓治疗,研究组在此基础上给予法舒地尔治疗。比较两组临床疗效,比较治疗前及治疗2周末两组美国国立卫生研究院卒中量表评分、Barthel指数量表评分、脑血流灌注指标(大脑前动脉、中动脉、后动脉血流速度)、凋亡相关因子(抗细胞凋亡因子、可溶性凋亡相关因子配体、可溶性凋亡相关因子)水平、Toll样受体4及核因子-κB水平,比较两组不良反应发生率。结果研究组治疗总有效率显著高于对照组(P<0.05)。治疗2周末两组美国国立卫生研究院卒中量表评分均较治疗前显著降低(P<0.01),Barthel指数量表评分均较治疗前显著升高(P<0.01),研究组较对照组变化更明显(P<0.01)。治疗2周末两组大脑前动脉、后动脉血流速度均较治疗前显著降低(P<0.01),中动脉血流速度均较治疗前显著升高(P<0.01),研究组较对照组变化更显著(P<0.01)。治疗2周末两组血清抗细胞凋亡因子水平均较治疗前显著升高(P<0.01),可溶性凋亡相关因子配体、可溶性凋亡相关因子水平均较治疗前显著降低(P<0.01),研究组较对照组变化更显著(P<0.01)。治疗2周末两组血清Toll样受体4、核因子-κB水平均较治疗前显著降低(P<0.01),研究组较对照组下降更显著(P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论阿替普酶联合法舒地尔治疗急性脑梗死患者效果显著,可改善脑微循环灌注、凋亡因子水平、Toll样受体4/核因子-κB信号通路,减轻患者神经功能损伤,安全性高。Objective To investigate the regulatory effect of alteplase combined with fasudil on cerebral microcirculation perfusion,apoptosis factors and Toll-like receptor 4(TLR4)/nuclear factor kappa B(NF-κB)signaling pathway in patients with acute cerebral infarction(ACI).Methods A total of 95 ACI patients were divided into the study group(48 cases)and the control group(47 cases)according to random number table method.Both groups were given alteplase intravenous thrombolysis,and the study group was given fasudil on this basis.The clinical efficacy of the two groups was compared.Before treatment and 2 weeks after treatment,the National Institutes of Health stroke scale(NIHSS)scores,Barthel index(BI)scores,cerebral blood perfusion indexes[blood flow velocity of anterior cerebral artery(ACA),medium sized artery(MCA),posterior cerebral artery(PCA)],apoptosis-related factor levels[defender against cell death 1(DAD1),soluble apoptosis-related factor ligand(sFasL),soluble apoptosis-related factors(sFas)],TLR4 and NF-κB levels were compared between the two groups.Results The total effective rate of treatment in the study group was significantly higher than that in the control group(P<0.05).After 2 weeks of treatment,the NIHSS scores of the two groups were significantly lower than those before treatment(P<0.01),and the BI scores were significantly higher than those before treatment(P<0.01),the changes in the study group were more significant than those in the control group(P<0.01).After 2 weeks of treatment,the blood flow velocity of ACA and PCA in the two groups were significantly decreased compared with those before treatment(P<0.01),and the blood flow velocity of MCA was significantly increased compared with that before treatment(P<0.01),the changes in the study group were more significant than those in the control group(P<0.01).After 2 weeks of treatment,the levels of serum DAD1 in the two groups were significantly higher than those before treatment(P<0.01),and the levels of sFasL and sFas were significantly lower than thos

关 键 词：急性脑梗死 阿替普酶 法舒地尔 静脉溶栓 脑血流灌注 

分 类 号：R743.3[医药卫生—神经病学与精神病学]