肢体远隔缺血预适应联合双联抗血小板治疗对短暂性脑缺血发作患者的脑保护作用  

Effects of Remote Ischemic Preconditioning Combined with Dual Antiplatelet Therapy on Brain Protection in Patients with Transient Ischemic Attack

作　　者：陈艳洁[1] 赵紫烨[1] 朱丽霞[1] CHEN Yanjie;ZHAO Ziye;ZHU Lixia(Department One of Neurology,Tangshan People′s Hospital,Tangshan 063000,China)

机构地区：[1]唐山市人民医院神经内一科,河北唐山063000

出　　处：《医学综述》2023年第20期4341-4345,共5页Medical Recapitulate

基　　金：河北省卫计委医学科学研究重点课题计划项目(20150983)。

摘　　要：目的探讨肢体远隔缺血预适应(rIPC)联合双联抗血小板治疗(DAPT)对短暂性脑缺血发作(TIA)患者的脑保护作用。方法纳入2021年6月至2022年6月唐山市人民医院收治的100例TIA患者为研究对象,根据随机数字表法分为对照组和观察组,各50例。对照组在常规治疗基础上采用DAPT,观察组在对照组基础上给予rIPC训练。观察两组治疗前后血清脂蛋白相关磷脂酶A 2(Lp-PLA 2)、缺氧诱导因子-1α(HIF-1α)水平,应用单光子发射计算机断层成像术检查影像学参数[标准化摄取值(SUV)、局部脑血流量(rCBF)]变化情况,并随访6个月,记录两组不良结局发生情况。结果观察组治疗总有效率高于对照组[94.00%(47/50)比80.00%(40/50)](χ^(2)=4.332,P=0.037)。治疗前,两组血清Lp-PLA 2、HIF-1α水平比较差异无统计学意义(P>0.05);治疗后,观察组患者血清Lp-PLA 2、HIF-1α水平明显低于对照组[(148±25)μg/L比(164±25)μg/L、(98±43)ng/L比(121±65)ng/L](P<0.05或P<0.01)。治疗前,两组患者SUV、rCBF值比较差异无统计学意义(P>0.05);治疗后,观察组SUV、rCBF值明显高于对照组[3.17±0.39比4.52±0.33、(34.56±4.01)ml/(100 g·min)比(31.48±3.29)ml/(100 g·min)](P<0.01)。治疗后6个月,观察组不良结局发生率明显低于对照组[4.00%(2/50)比16.00%(8/50)](P<0.05)。结论rIPC联合DAPT治疗TIA患者的疗效显著,可明显改善患者的脑部血流代谢,避免不良结局的发生,改善患者预后。Objective To analyze the effect of remote ischemic preconditioning(rIPC)combined with dual antiplatelet therapy(DAPT)on brain protection in patients with transient ischemic attack(TIA).Methods A total of 100 patients with TIA admitted to Tangshan People′s Hospital from Jun.2021 to Jun.2022 were included in the study.According to the random number table method,they were divided into a control group and an observation group,with 50 cases each.On the basis of conventional treatment,the control group was treated with DAPT,and the observation group was given rIPC training on this basis.Before and after treatment,the levels of serum lipoprotein associated phospholipase A 2(Lp-PLA 2)and hypoxia-inducible factor-1α(HIF-1α)were observed,and the changes of cerebral blood flow parameters[standardized uptake value(SUV),regional cerebral blood flow(rCBF)]were examined with single photon emission computed tomography,and followed up for 6 months.The occurrence of adverse outcomes of the two groups was recorded.Results Compared with the control group,the total effective rate of treatment in the observation group was higher[94.00%(47/50)vs 80.00%(40/50)](χ^(2)=4.332,P=0.037).Before treatment,there was no statistically significant difference in the levels of serum Lp-PLA 2 and HIF-1α(P>0.05)between the two groups.After treatment,compared with the control group,the serum levels of Lp-PLA 2 and HIF-1αin the observation group were significantly lower[(148±25)μg/L vs(164±25)μg/L,(98±43)ng/L vs(121±65)ng/L](P<0.05 or P<0.01).Before treatment,there was no statistical significant difference in the SUV and rCBF values between the two groups(P>0.05).After treatment,compared with control group,the SUV and rCBF values in the observation group were significantly higher[3.17±0.39 vs 4.52±0.33,(34.56±4.01)ml/(100 g·min)vs(31.48±3.29)ml/(100 g·min)](P<0.01).Six months after treatment,compared with the control group,the incidence of adverse outcomes in the observation group was significantly lower[4.00%(2/50)vs 16.00%(8/50)](P<

关 键 词：短暂性脑缺血发作 肢体远隔缺血预适应 双联抗血小板 脑保护 

分 类 号：R743.3[医药卫生—神经病学与精神病学]