基于MAPK/ERK信号通路、NIHSS评分、侧支循环评分探究rt-PA静脉溶栓联合神经介入治疗缺血性脑卒中的效果  

Efficacy of rt-PA Intravenous Thrombolysis Combined with Neurointervention forIschaemic Stroke in the Real World Based on MAPK/ERK Signalling Pathway,NIHSS Score, and Collateral Circulation Score

作　　者：刘海涛 侯国勇 宋帅召 LIU Haitao;HOU Guoyong;SONG Shuaizhao(Department of Neurology,Pingmei Shenma Medical Group General Hospital,Pingdingshan 467000,China)

机构地区：[1]平煤神马医疗集团总医院神经内科,河南平顶山467000

出　　处：《河南医学研究》2024年第24期4494-4499,共6页Henan Medical Research

摘　　要：目的 基于丝裂原活化蛋白激酶(MAPK)/细胞外调节蛋白激酶(ERK)信号通路、美国国立卫生研究院卒中量表(NIHSS)评分、侧支循环评分探究重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合神经介入治疗缺血性脑卒中的效果。方法 选取2020年1月至2023年1月平煤神马医疗集团总医院收治的90例CIS患者为研究对象,采用奇偶数分组法分为单一组(45例)、联合组(45例)。单一组接受rt-PA静脉溶栓治疗,联合组接受rt-PA静脉溶栓联合神经介入治疗。统计对比两组临床疗效、血管再通率、NIHSS、日常生活能力(ADL)评分、侧支循环评分。对比两组治疗前后脑血流动力学[脑血管外周阻力(Rv)、脉搏速度(Wv)]、血清学指标[S100钙结合蛋白A12/钙粒蛋白C(S100A12)、高迁移率族蛋白B1(HMGB1)、超敏C反应蛋白(hs-CRP)]及MAPK/ERK信号通路相关因子[MAPK/ERK激酶(MEK)、ERK1-β、ERK2-β]水平。对比两组不良反应发生情况。结果 联合组总有效率、血管再通率高于单一组(P<0.05);溶栓后,联合组Rv、Wv及NIHSS评分低于单一组,ADL评分、侧支循环评分高于单一组(P<0.05);溶栓后,联合组血清S100A12、HMGB1、hs-CRP水平低于单一组(P<0.05);溶栓后,联合组MEK、ERK1-β、ERK2-β蛋白水平低于单一组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 rt-PA溶栓联合神经介入治疗CIS的效果确切且具有一定安全性,可提高血管再通率、日常生活能力,改善神经功能、侧支循环能力,减轻炎症反应程度,可能与调节MAPK/ERK信号通路有关。Objective To investigate the efficacy of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis combined with neurointervention in the treatment of ischemic stroke in the real world based on the mitogen-activated protein kinase(MAPK)/extracellularly regulated protein kinase(ERK)signaling pathway,the National Institutes of Health stroke scale(NIHSS)score,and the collateral circulation score.Methods A total of 90 CIS patients admitted to Pingmei Shenma Medical Group General Hospital from January 2020 to January 2023 were selected as research objects,and were divided into single group(45 cases)and combined group(45 cases)by odd-even grouping method.The single group was given rt-PA thrombolytic therapy,and the combined group was given rt-PA thrombolytic therapy combined with nerve interventional therapy.The clinical efficacy,vascular revascularization rate,NIHSS,ADL score and collateral circulation score of the two groups were statistically compared.Cerebral hemodynamics[peripheral vascular resistance(Rv),pulse wave velocity(Wv)],serological indexes[S100 calcin-binding protein A12/Calgranin C(S100A12),high mobility group box-1 protein(HMGB1),hypersensitive C-reactive protein(hs-CRP)]and MAPK/ERK signaling pathway related factors[MAPK/ERK kinase(MEK),ERK1-β,ERK2-β]levels before and after treatment were compared between the two groups.The occurrence of adverse reactions was compared between the two groups.Results The total effective rate and vascular revascularization rate of combined group were higher than those of single group(P<0.05).After thrombolysis,Rv,Wv and NIHSS scores in combination group were lower than those in single group,ADL scores and collateral circulation scores were higher than those in single group(P<0.05).After thrombolysis,serum levels of S100A12,HMGB1 and hs-CRP in combination group were lower than those in single group(P<0.05).After thrombolysis,the protein levels of MEK,ERK1-βand ERK2-βin combination group were lower than those in single group(P<0.05).There was no significa

关 键 词：缺血性脑卒中 重组组织型纤溶酶原激活剂 神经介入 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]