阿替普酶静脉溶栓联合丁苯酞对急性脑梗死患者出血性转化的影响及神经保护作用机制  

Effect of intravenous thrombolytic therapy with alteplase combined with butylphthalide on hemorrhagic transformation in patients with acute cerebral infarction and its neuroprotective mechanism

作　　者：吕洲[1] 朱海生[1] 刘青蕊[2] Lyu Zhou;Zhu Haisheng;Liu Qingrui(Department of Neruolog Handan Central Hospital Internal Medicine-Neurology,Hebei 056008,China)

机构地区：[1]邯郸市中心医院神经内三科,河北056008 [2]河北医科大学第四医院神经内科

出　　处：《脑与神经疾病杂志》2023年第4期230-234,共5页Journal of Brain and Nervous Diseases

基　　金：2019年度河北省医学科学研究课题计划(20190201-20191866)。

摘　　要：目的探讨阿替普酶静脉溶栓联合丁苯酞对急性脑梗死(ACI)患者出血性转化(HT)的影响及其神经保护作用机制.方法将102例具有溶栓条件的ACI随机分为两组:对照组51例接受阿替普酶静脉溶栓和常规对症支持治疗,观察组51例在此基础上加用丁苯酞.比较两组HT发生率,评价NIHSS评分,检测血清炎症因子、氧化应激指标和血管内皮细胞水平变化.结果治疗3d、7d和14d后,观察组的NIHSS评分显著低于对照组(P<0.05).治疗14d后,观察组的血清炎症因子、MDA、ET-1、MMP-9、c-Fn和GFAP水平显著下降且显著低于对照组(P<0.05);SOD、NO显著升高且高于对照组(P<0.05).观察组的HT发生率显著低于对照组(P<0.05).结论阿替普酶静脉溶栓联合丁苯酞治疗ACI能降低HT发生率并促进神经功能康复,机制与抗炎、抗氧化应激及保护血管内皮细胞功能等有关.Objective To investigate the effect of intravenous thrombolytic therapy with alteplase combined with butylphthalide on hemorrhagic transformation(HT)in patients with acute cerebral infarction(ACI)and its neuroprotective mechanism.Methods 102 ACI patients with thrombolytic conditions were randomly divided into two groups:51 cases in the control group received alteplase intravenous thrombolysis and conventional symptomatic supportive treatment,51 cases in the the observation group was treated with butylphthalide injection on this basis.The occurrence of HT was compared between the two groups.The National Institutes of Health Stroke Scale(NIHSS)score was evaluated,the serum inflammatory factors,indicators of oxidative stress and vascular endothelial cells were measured.Results After treatment for 24h,3d,7d and 14d,the NIHSS scores of the observation group were significantly decreased and lower than the control group(P<0.05).After 14 days of treatment,serum inflammatory factors,malondialdehyde(MDA),endothelin-1(ET-1),matrix metalloproteinase-9(MMP-9),cellular fibronectin(c-Fn)and glial fibrillary acidic protein(GFAP)levels of observation group were significantly decreased and lower than control group,the levels of nitric superoxide dismutase(SOD)and oxide(NO)of observation group were significantly increased and higher than control group(P<0.05).The incidence of HT in the observation group was significantly lower than the control group(P<0.05).Conclusion Alteplase intravenous thrombolytic therapy with alteplase combined with butylphthalide in the treatment of ACI can reduce the incidence of HT and promote neurological rehabilitation.The mechanism may be related to anti-inflammatory,anti-oxidative stress and protection of vascular endothelial function.

关 键 词：急性脑梗死 阿替普酶 静脉溶栓 丁苯酞 出血性转化 神经功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]