多模式CT指导下动脉溶栓对急性致残性非大血管脑梗死患者氧化应激、炎症反应及神经功能的影响  

Effect of Multi-mode CT-guided Intra-arterial Thrombolysis on Oxidative Stress,Inflammatory Response and Neurological Function in Patients with Acute Disabling Non-macrovascular Cerebral Infarction

作　　者：张蕊[1] 陈后勤[1] 杨进平[1] 肖国栋[2] 张谨枫[1] 石冬燕[1] 徐丹[1] ZHANG Rui;CHEN Houqin;YANG Jinping;XIAO Guodong;ZHANG Jinfeng;SHI Dongyan;XU Dan(Department of Brain Disease,Taicang Affiliated Hospital,Nanjing University of Traditional Chinese Medicine,Taicang,Jiangsu 215400,China;Department of Neurology,the Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215004,China)

机构地区：[1]南京中医药大学太仓附属医院脑病科,江苏太仓215400 [2]苏州大学附属第二医院神经内科,江苏苏州215004

出　　处：《临床误诊误治》2024年第12期57-61,68,共6页Clinical Misdiagnosis & Mistherapy

基　　金：苏州市科技发展计划(医疗卫生科技创新-应用基础研究[第二批])项目(SKJYD2021012)。

摘　　要：目的探讨多模式CT指导下动脉溶栓在急性致残性非大血管脑梗死患者治疗中的应用价值。方法回顾性分析2022年1月至2023年12月收治的急性致残性非大血管脑梗死患者80例的临床资料,根据治疗方案分为观察组和对照组各40例。观察组行多模式CT指导下应用动脉溶栓,对照组行静脉溶栓。比较2组临床疗效、溶栓前后神经功能损伤程度(NIHSS评分)、氧化应激反应指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、炎症反应指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、血管再通情况及不良事件发生率。结果2组总有效率比较差异无统计学意义(P>0.05);溶栓后2 h、24 h、7 d及30 d,观察组NIHSS评分低于对照组(P<0.05);溶栓后7 d及30 d,观察组SOD、GSH-Px水平高于对照组,MDA、IL-6、hs-CRP、TNF-α水平低于对照组(P<0.01);2组血管再通率、不良事件发生率比较差异无统计学意义(P>0.05)。结论多模式CT指导下动脉溶栓与静脉溶栓效果及安全性相当,但动脉溶栓能减轻炎症反应及氧化应激损伤,改善神经功能。Objective To investigate the application value of intraarterial thrombolysis under the guidance of multi-mode CT in the treatment of acute disabling non-macrovascular cerebral infarction.Methods Clinical data of 80 patients with acute disabling non-macrovascular cerebral infarction treated from January 2022 to December 2023 were retrospectively analyzed,and they were divided into observation group(n=40)and control group(n=40)according to treatment plan.The observation group received intra-arterial thrombolysis under the guidance of multi-mode CT,and the control group received intravenous thrombolysis.The clinical efficacy,degree of nerve function injury[National Institute of Health stroke scale(NIHSS)score]before and after thrombolysis,oxidative stress index[superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),malondialdehyde(MDA)],inflammatory response index[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitivity C reactive protein(hs-CRP)],vascular recanalization and adverse events were compared between the two groups.Results There was no significant difference in total effective rate between the two groups(P>0.05).At 2 h,24 h,7 d and 30 d after thrombolysis,the NIHSS score of the observation group was lower than that of the control group(P<0.05).At 7 d and 30 d af-ter thrombolysis,SOD and GSH-Px levels in observation group were higher than those in control group,while MDA,IL-6,hs-CRP and TNF-αlevels were lower than those in control group(P<0.01).There was no significant difference in the rate of vascular revascularization and the incidence of adverse events between the two groups(P>0.05).Conclusion The efficacy and safety of intra-arterial thrombolysis under the guidance of multi-mode CT are comparable to those of intravenous thrombol-ysis,but intra-arterial thrombolysis can reduce inflammation and oxidative stress damage and improve nerve function.

关 键 词：脑梗死 体层摄影术 螺旋计算机 动脉溶栓技术 超氧化物歧化酶 谷胱甘肽过氧化酶 丙二醛 白细胞介素-6 肿瘤坏死因子-α 

分 类 号：R743.33[医药卫生—神经病学与精神病学]