依达拉奉右莰醇联合长春西汀对急性脑梗死患者静脉溶栓疗效的改善作用  

Role of edaravone dexborneol and vinpocetine in intravenous thrombolytic therapy for acute cerebral infarction

作　　者：邹巧鸽 康梅娟[1] 杨银雪 周静[1] 司肖曼 温昌明[1] ZOU Qiaoge;KANG Meijuan;YANG Yinxue;ZHOU Jing;SI Xiaoman;WEN Changming(Department of Neurology,Nanyang Central Hospital,Nanyang,Henan 473001,China)

机构地区：[1]南阳市中心医院神经内科,河南南阳473001

出　　处：《中华实用诊断与治疗杂志》2024年第11期1159-1167,共9页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省2019年科技发展计划项目(192102310349)。

摘　　要：目的观察急性脑梗死(ACI)患者静脉溶栓治疗后应用依达拉奉右莰醇联合长春西汀对血管再通率和近期预后的改善作用,探讨其安全性。方法2020年12月—2023年12月南阳市中心医院诊治ACI患者100例,静脉溶栓后33例应用长春西汀者为长春西汀组,34例应用依达拉奉右莰醇者为依达拉奉组,33例应用依达拉奉右莰醇联合长春西汀者为联合组,疗程均为2周。记录3组治疗期间脑出血、恶心呕吐、肝功能损伤、腹泻发生情况。静脉溶栓后24 h采用改良脑梗死溶栓治疗分级(mTICI)评估3组血管再通率;3组治疗前及治疗2周后测定血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、Dickkopf-1(DKK1)、白细胞介素-6(IL-6)、转位因子蛋白(TSPO)、闭锁蛋白(OCLN)、基质金属蛋白酶-9(MMP-9)、水通道蛋白4(AQP4)、MMP-12水平;3组治疗前及治疗2周后采用美国国立卫生研究院卒中量表评分(NIHSS)、日常生活活动能力量表(BI)评估神经功能缺损程度及生活能力;采用改良Rankin量表评分(mRS)评估3组治疗28 d预后。结果(1)联合组、依达拉奉组、长春西汀组溶栓后24 h血管再通率(100.00%、82.35%、72.72%)比较差异有统计学意义(χ^(2)=9.909,P=0.007)。联合组溶栓后24 h血管再通率高于依达拉奉组、长春西汀组(P<0.05),依达拉奉组高于长春西汀组(P<0.05)。(2)联合组、依达拉奉组、长春西汀组治疗2周后血清CRP[(4.66±1.01)、(6.08±0.77)、(8.15±0.64)mg/L]、TNF-α[(1.03±0.24)、(1.95±0.36)、(2.60±0.41)μg/L]、DKK1[(350.22±19.66)、(389.36±22.48)、(447.15±20.25)ng/L]、IL-6[(35.20±8.39)、(41.66±10.12)、(49.38±9.44)ng/L]、TSPO[(0.31±0.10)、(0.42±0.12)、(0.53±0.11)μg/L]水平均低于治疗前[CRP:(16.82±3.96)、(17.14±3.85)、(17.05±4.23)mg/L;TNF-α:(4.30±0.78)、(4.51±0.82)、(4.47±0.69)μg/L;DKK1:(657.36±38.00)、(660.95±41.72)、(654.88±35.87)ng/L;IL-6:(68.52±12.45)、(70.58±14.30)、(67.39±16.21)ng/L;TSPO:(0.85±0.20)、(0.8Objective To observe the effect of edaravone dexborneol combined with vinpocetine on improving revascularization rate and short-term prognosis in patients with acute cerebral infarction(ACI)after intravenous thrombolysis therapy,and to explore its safety.Methods A total of 100 patients with ACI were treated with intravenous thrombolysis in Nanyang Central Hospital from December 2020 to December 2023,among whom 33 patients were treated with vinpocetine(vinpocetine group),34 patients were treated with edaravone dexborneol(edaravone group),and 33 patients were treated with vinpocetine combined with edaravone dexborneol(combination group),with 2 weeks as a course.The occurrences of cerebral hemorrhage,nausea and vomiting,liver function damage,and diarrhea during treatment were recorded in three groups.The revascularization rate was evaluated using the modified thrombolysis in cerebral infarction(mTICI)classification 24 h after thrombolysis.The levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),Dickkopf-1(DKK1),interleukin-6(IL-6),translocator protein(TSPO),occludin(OCLN),matrix metalloproteinase(MMP)-9,aquaporin 4(AQP4),and MMP-12 were detected in three groups before and after 2-week treatment.The National Institutes of Health Stroke Scale(NIHSS)and Barthel Index(BI)were used to assess the degree of neurological deficit and the daily activity ability in three groups before and after 2-week treatment.The modified Rankin Scale(mRS)was used to evaluate the prognosis 28 d after treatment.Results(1)The revascularization rate 24 h after thrombolysis showed significant differences among combination group,edaravone group and vinpocetine group(100.00%,82.35%,72.72%)(χ^(2)=9.909,P=0.007),was higher in combination group than that in edaravone group and vinpocetine group(P<0.05),and was higher in edaravone group than that in vinpocetine group(P<0.05).(2)After 2-week treatment,the levels of CRP[(4.66±1.01),(6.08±0.77),(8.15±0.64)mg/L],TNF-α[(1.03±0.24),(1.95±0.36),(2.60±0.41)μg/L],DKK1[(350.22±19.6

关 键 词：急性脑梗死 静脉溶栓 依达拉奉右莰醇 长春西汀 炎性因子 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]