机械介入取栓术联合重组组织型纤溶酶原激活剂治疗急性脑梗死的疗效观察  

Observation on the therapeutic effect of mechanical interventional thrombectomy combined with recombinant tissue plasminogen activator on acute cerebral infarction

作　　者：师媛[1] 王柳毅[1] 惠辉[1] 屈文英[1] 师宁[1] 王乐[2] SHI Yuan;WANG Liuyi;HUI Hui;QU Wenying;SHI Ning;WANG Le(不详;Department of Cerebrovascular Disease,Affiliated Hospital of Yan'an University Yan'an 716000,China)

机构地区：[1]延安大学附属医院脑血管科,716000 [2]陕西省人民医院神经内科,710068

出　　处：《中国神经免疫学和神经病学杂志》2024年第3期204-209,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：延安市科学技术研究发展计划项目(2016KS-03)。

摘　　要：目的观察机械介入取栓术联合重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)治疗急性脑梗死(ACI)的疗效。方法选取作者医院2020年1月至2021年12月收治的107例ACI患者作为回顾性队列研究对象,按治疗方法将患者分为rt-PA静脉溶栓组(以下简称对照组,n=49)和机械介入取栓术联合rt-PA静脉溶栓组(以下简称观察组,n=58)。比较两组患者临床疗效、血清炎症因子、血清脂蛋白相关磷脂酶A2(Lp-PLA2)、血清总超氧化物歧化酶(T-SOD)、血清锰超氧化物歧化酶(Mn-SOD)、血清血管内皮功能指标以及脑血流灌注水平的差异。结果观察组临床总有效率高于对照组(96.55%比81.63%;χ^(2)=5.179,P=0.023);观察组治疗后肿瘤坏死因子α(TNF-α)、白细胞介素-1α(IL-1α)、IL-1β、IL-6、C反应蛋白(CRP)、Lp-PLA2、内皮素-1(ET-1)和血管内皮生长因子(VEGF)水平显著低于对照组(P<0.05),而T-SOD、Mn-SOD、一氧化氮水平及脑血容量(CBV)和脑血流量(CBF)水平明显高于对照组(P<0.05)。结论机械介入取栓术联合rt-PA治疗能够有效改善ACI患者神经功能、炎症状态及Lp-PLA2、T-SOD、Mn-SOD水平,增强脑组织血流灌注及血管内皮功能,整体提高临床疗效。Objective To observe the therapeutic effect of mechanical interventional thrombectomy combined with recombinant tissue plasminogen activator(rt-PA)on acute cerebral infarction(ACI).Methods One hundred and seven patients with ACI treated in our hospital from January 2020 to December 2021 were selected as the subjects of retrospective cohort study.They were divided into two groups according to the treatment.Forty-nine cases in the control group were treated with rt-PA intravenous thrombolysis,and 58 cases in the observation group were treated with mechanical interventional thrombolysis combined with rt-PA intravenous thrombolysis.The clinical efficacy,serum inflammatory factors,serum lipoprotein associated phospholipase A2(Lp-PLA 2),serum total superoxide dismutase(T-SOD),serum manganese superoxide dismutase(Mn-SOD),serum vascular endothelial function indicators and cerebral blood flow perfusion levels were compared between the two groups.Results The total clinical effective rate of the observation group was higher than that of the control group(96.55%vs.81.63%;χ^(2)=5.179,P=0.023).The levels of tumor necrosis factorα(TNF-α),interleukin-1α(IL-1α),IL-1β,IL-6,C-reactive protein(CRP),Lp-PLA2,endothelin-1(ET-1)and vascular endothelial growth factor(VEGF)after treatment in the observation group were significantly lower than those in the control group(P<0.05),while the levels of T-SOD,Mn-SOD,NO,cerebral blood volume(CBV)and cerebral blood flow(CBF)were significantly higher than those in the control group(P<0.05).Conclusions Mechanical interventional thrombectomy combined with rt-PA therapy could effectively improve the neurological function,inflammatory state and Lp-PLA2,T-SOD and Mn-SOD levels,enhance cerebral blood perfusion and vascular endothelial function,as well as improve the overall clinical efficacy in patients with ACI.

关 键 词：脑梗死 卒中 机械介入取栓术 组织型纤溶酶原激活物 炎症因子 脂蛋白相关磷脂酶A2 

分 类 号：R743.3[医药卫生—神经病学与精神病学]