重组组织型纤溶酶原激活剂溶栓联合丁苯酞对心源性脑卒中的治疗效果、出血事件及内皮功能的影响  

Therapeutic effect,bleeding events and endothelial function of ultra-early application of recombinant tissue plasminogen activator thrombolysis combined with butylphthalide in patients with cardioembolic stroke

作　　者：尉建辉[1] 高李[1] 李蒙 邢麟[2] Wei Jian-hui;Gao Li;Li Meng;Xing Lin(Department of Neurology,Baoji Central Hospital,Baoji 721008,China;Baoji Vocational and Technical College Medical Branch,Baoji 721000,China)

机构地区：[1]宝鸡市中心医院神经内科,宝鸡721008 [2]宝鸡职业技术学院医学分院,宝鸡721000

出　　处：《中国药物应用与监测》2024年第4期399-402,411,共5页Chinese Journal of Drug Application and Monitoring

摘　　要：目的 探究超早期应用重组组织型纤溶酶原激活剂(rt-PA)溶栓联合丁苯酞对心源性脑卒中患者的治疗效果、出血事件及内皮功能的影响。方法 选取2022年1月至2023年8月于宝鸡市中心医院进行诊治的168例超早期心源性脑卒中患者,采用随机数字表法将其分为联合组(84例,接受rt-PA溶栓联合丁苯酞治疗)和对照组(84例,仅接受rt-PA溶栓治疗)。治疗14 d后,比较两组的疗效,14 d内出血性转化(HT)发生率,并对两组治疗前后的神经元特异性烯醇化酶(NSE)、基质金属蛋白酶9(MMP-9)、细胞纤连蛋白(c-FN)、血管内皮生长因子(VEGF)水平进行检测并加以对比。结果 联合组和对照组治疗前美国国立卫生院卒中量表(NIHSS)评分差异无统计学意义(t=0.723,P>0.05);治疗14 d后,两组患者NIHSS评分均下降,且联合组NIHSS评分(15.69±3.32)分低于对照组(8.61±1.87)分(t=8.286,P<0.05)。联合组治疗总有效率(91.67%)高于对照组(79.76%)(χ^(2)=4.861,P<0.05)。联合组HT发生率(9.52%)低于对照组(24.43%)(χ^(2)=4.550,P<0.05),两组不良反应发生率差异无统计学意义(χ^(2)=0.083,P>0.05)。治疗前,联合组和对照组的NSE、MMP-9、c-FN、VEGF差异无统计学意义(t=1.085,1.243,0.142,均P>0.05);治疗后,两组患者治疗后NSE、MMP-9、c-FN水平低于治疗前,且联合组VEGF水平[(288.04±79.84) ng·L^(-1)]高于对照组[(246.82±61.05) ng·L^(-1)](t=3.760,P<0.05),NSE水平、MMP-9水平、c-FN水平[分别为(12.26±2.26)μg·L^(-1)、(100.16±27.42)μg·L^(-1)、(1.50±0.48) mg·L^(-1)]低于对照组[分别为(13.27±2.5)μg·L^(-1)、(126.34±34.11)μg·L^(-1)、(1.71±0.73) mg·L^(-1)](t=5.483,2.203,3.760,均P<0.05)。结论 超早期rt-PA溶栓联合丁苯酞治疗方案可提高心源性脑卒中患者的治疗效果,降低HT发生率,并改善血管内皮功能。Objective To explore the therapeutic effect,bleeding events and endothelial function of ultra-early application of recombinant tissue plasminogen activator(rt-PA)thrombolysis combined with butylphthalide in patients with cardioembolic stroke.Methods One hundred and sixty-eight patients with ultra-early cardiogenic stroke attending the Baoji Central Hospital from January 2022 to August 2023 were enrolled,and randomly assigned into two groups by lottery method,with 84 cases in each group.Combination group was given rt-PA thrombolysis combined with butylphthalide,while control group received intravenous rt-PA thrombolytic therapy.Treatment in both groups lasted for 14 days.Then the clinical efficacy,the incidence of hemorrhagic transformation(HT)within 14 days,serum levels of neuron-specific enolase(NSE),matrix metalloproteinase(MMP-9),cellular fibronectin(c-FN)and vascular endothelial growth factor(VEGF)were detected and compared between two groups.Results There was no significant difference in NIHSS scores between the combined medication group and the control group before treatment(t=0.723,P>0.05).The NIHSS scores of both groups of patients were significantly reduced after 14 days of treatment,and the NIHSS score of the combination group(15.69±3.32)points was lower than that of the control group(8.61±1.87)points(t=8.286,P<0.05).The overall success rate of therapy in the combined drug group(91.67%)showed a noteworthy increase compared to the control group(79.76%)(χ^(2)=4.861,P<0.05).The frequency of HT in the combined group(9.52%)significantly decreased in contrast to the control group(24.43%)(χ^(2)=4.550,P<0.05),with no notable variance in side effects between the two groups(χ^(2)=0.083,P>0.05).Before treatment,the differences in NSE,MMP-9,c-FN,and VEGF between the combination group and the control group were not significant and comparable(t=1.085,1.243,0.142,all P>0.05).The levels of NSE,MMP-9,and c-FN in the two groups of patients after treatment were significantly lower than those before treatment,and the

关 键 词：心源性脑卒中 出血性转化 重组组织型纤溶酶原激活剂 静脉溶栓 丁苯酞 血管内皮功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]