丹参多酚酸联合双联抗血小板治疗非心源性急性非大面积脑梗死的临床效果及安全性  

Clinical Efficacy and Safety of Salvianolate Combined with Dual Antiplatelet Therapy for Acute Non-cardiogenic Non-massive Cerebral Infarction

作　　者：孟晓敏 田莉 贾强 郭志丽 MENG Xiaomin;TIAN Li;JIA Qiang;GUO Zhili(The Fourth Department of Internal Medicine,Zhangjiakou Maternal and Child Health Hospital,Zhangjiakou,Hebei 075000,China;Department of Neurology,Department of Internal Medicine and Critical Care Medicine,Zhangjiakou,Hebei 075000,China;Department of Internal Medicine and Critical Care Medicine,the First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China;Department of Emergency,the Second Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市妇幼保健院内四科,河北张家口075000 [2]张家口市第一医院神经内科,河北张家口075000 [3]张家口市第一医院内科重症医学科,河北张家口075000 [4]张家口市第二医院急诊科,河北张家口075000

出　　处：《临床误诊误治》2024年第6期89-94,共6页Clinical Misdiagnosis & Mistherapy

基　　金：张家口市重点研发计划项目(2322148D)。

摘　　要：目的探究丹参多酚酸联合双联抗血小板治疗非心源性急性非大面积脑梗死的临床效果及安全性。方法选取2022年2月—2023年3月收治的60例非心源性急性非大面积脑梗死,随机数字表法分为2组,每组30例。对照组采取双联抗血小板治疗,观察组采取注射用丹参多酚酸盐联合双联抗血小板治疗。观察2组临床疗效、不良反应,以及治疗前后纤维蛋白原(FIB)、凝血酶原时间(PT)、同型半胱氨酸(Hcy)、可溶性凋亡相关因子配体(sFasL)、抗凋亡因子(Livin)、可溶性凋亡相关因子(sFas)、脑血流灌注情况、Kelch样环氧氯丙胺相关蛋白1(Keap1)-核因子-E_(2)相关因子2(Nrf2)/抗氧化反应原件(ARE)信号通路[Keap1、Nrf2、醌氧化还原酶(NQO1)、(ARE)]蛋白表达、美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)评分。结果观察组总有效率93.33%(28/30)高于对照组73.33%(22/30)(P<0.05)。治疗1、2周后,观察组FIB、Hcy、sFas、sFasL以及Keap1蛋白表达低于对照组,PT长于对照组,Nrf2、NQO1、ARE蛋白表达以及Livin水平高于对照组,大脑前动脉、中动脉、后动脉血流速度较对照组快(P<0.05)。2组不良反应发生总发生率比较,无显著差异(P>0.05)。治疗2周后及治疗后3个月,观察组mRS、NIHSS评分低于对照组(P<0.05)。结论丹参多酚酸联合双联抗血小板治疗非心源性急性非大面积脑梗死效果确切,可通过调控凝血功能、脑微循环、Keap1-Nrf2/ARE信号通路而改善神经功能和预后,且具备一定安全性。Objective To explore the clinical efficacy and safety of Salvianolate(SAL)combined with dual antiplatelet therapy in the treatment of acute non-cardiogenic non-massive cerebral infarction.Methods Sixty patients with acute non-cardiogenic non-massive cerebral infarction treated from February 2022 to March 2023 were randomly divided into two groups,with 30 cases in each group,by random number table method.The control group was treated with dual antiplatelet therapy,and the observation group was treated with SAL for injection combined with dual antiplatelet therapy.The clinical efficacy and adverse reactions of the two groups were observed.Fibrinogen(FIB),prothrombin time(PT),homocysteine(Hcy),soluble apoptosis-related factor ligand(sFasL),anti-apoptosis-related factor(Livin),soluble apoptosis-related factor(sFas),cerebral blood perfusion,Kelch-like epichloropropylamine associated protein 1(Keap1)-nuclear factor E_(2) associated factor 2(Nrf2)/antioxidant component(ARE)signaling pathway[Keap1,Nrf2,quinone oxidoreductase(NQO1),ARE]protein expression,National Institutes of Health Stroke Scale(NIHSS)score,and Modified Rankin Scale(mRS)score before and after treatment were observed.Results The total effective rate of observation group was 93.33%(28/30),which was higher than that of control group[73.33%(22/30)](P<0.05).At 1 and 2 weeks after treatment,the expression of FIB,Hcy,sFas,sFasL and Keap1 protein in observation group was lower than that in control group,the PT was longer than that in control group,the expression of Nrf2,NQO1,ARE protein and Livin level were higher than that in control group,and the blood flow velocity of anterior cerebral artery,middle artery and posterior artery was greater than that in control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).At 2 weeks and 3 months after treatment,mRS And NIHSS scores in the observation group were lower than those in the control group(P<0.05).Conclusion SAL combined with dual antiplate

关 键 词：脑梗死 双联抗血小板治疗 丹参多酚酸 纤维蛋白原 凝血酶原时间 凋亡诱导因子 微循环 Keap1-Nrf2/ARE信号通路 

分 类 号：R743.33[医药卫生—神经病学与精神病学]