尿激酶颅内注射治疗急性脑出血临床疗效及对辅助性T细胞因子和凝血功能的影响  

Clinical Efficacy of Intracranial Injection of Urokinase in the Treatment of Acute Cerebral Hemorrhage and Its Impact on Helper T Cell Factors and Coagulation Function

作　　者：钱宣辰 王永 鲍翰墨 吴雨璇 QIAN Xuanchen;WANG Yong;BAO Hanmo;WU Yuxuan(Neurosurgical Intensive Care Unit,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院神经外科重症监护室,江苏徐州221000

出　　处：《转化医学杂志》2024年第10期1784-1790,共7页Translational Medicine Journal

基　　金：江苏省卫生健康委科研项目(H2023099)。

摘　　要：目的观察尿激酶颅内注射治疗急性脑出血的临床疗效及其对辅助性T细胞(Th)因子、凝血功能、炎症因子、神经功能及生命体征的影响。方法采用回顾性分析研究,纳入2021年3月至2024年4月徐州医科大学附属医院收治的急性脑出血患者80例。根据治疗方式分为观察组(40例,接受颅骨钻孔引流术后尿激酶颅内注射联合常规治疗)和对照组(40例,接受常规治疗)。比较2组血肿体积、Th细胞因子、凝血功能、炎症因子、神经功能及生命体征变化。结果治疗后第3、7、14 d观察组和对照组血肿体积均逐渐缩小(P<0.05),且观察组小于对照组(P<0.05)。治疗后14 d,2组干扰素γ(IFN-γ)水平下降(P<0.05),白细胞介素4(IL-4)水平升高(P<0.05),且观察组IFN-γ水平低于对照组(P<0.05),IL-4水平高于对照组(P<0.05)。治疗后第3、7、14 d,2组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)无明显变化(P>0.05)。治疗后,2组纤维蛋白原(FIB)和D-二聚体(D-D)水平逐渐降低(P<0.05),且治疗后7、14 d,观察组FIB、D-D水平低于对照组(P<0.05)。治疗第3、7、14 d,2组C反应蛋白(CRP)和白细胞介素1β(IL-1β)水平均较本组治疗前显著降低(P<0.05),且观察组CRP和IL-1β水平均低于对照组(P<0.05)。治疗后第7、14 d观察组和对照组美国国立卫生研究院卒中量表(NIHSS)评分均低于本组治疗前(P<0.05),且观察组均低于对照组(P<0.05)。治疗后,2组患者各项生命体征指标均较治疗前改善(P<0.05),且治疗后第7、14 d及出院时观察组各项生命体征指标改善优于对照组(P<0.05)。结论尿激酶颅内注射联合常规治疗急性脑出血疗效显著,可有效清除血肿、调节Th细胞因子平衡、改善炎症反应及凝血功能,促进神经功能恢复,稳定生命体征。Objective To observe the clinical efficacy of intracranial injection of urokinase in the treatment of acute cerebral hemorrhage and its impacts on helper T(Th)cell factors,coagulation function,inflammatory factors,neurological function and vital signs.Methods A retrospective analysis was conducted.Eighty patients with acute cerebral hemorrhage admitted to the Affiliated Hospital of Xuzhou Medical University from March 2021 to April 2024were included.According to the treatment methods,they were divided into the observation group(40 cases,receiving intracranial injection of urokinase after cranial drilling and drainage combined with conventional treatment)and the control group(40 cases,receiving conventional treatment).The changes in hematoma volume,Th cell factors,coagulation function,inflammatory factors,neurological function and vital signs were compared between the two groups.Results On the 3rd,7th and 14th days after treatment,the hematoma volumes of both the observation group and the control group gradually decreased(P<0.05),and that of the observation group was smaller than that of the control group(P<0.05).On the 14th day after treatment,the interferon-γ(IFN-γ)level decreased(P<0.05)and the interleukin-4(IL-4)level increased(P<0.05)in both groups,and the IFN-γlevel in the observation group was lower than that in the control group(P<0.05),while the IL-4 level was higher than that in the control group(P<0.05).On the 3rd,7th and 14th days after treatment,there were no significant changes in prothrombin time(PT)and activated partial thromboplastin time(APTT)in both groups(P>0.05).After treatment,the fibrinogen(FIB)and D-dimer(D-D)levels of both groups gradually decreased(P<0.05),and on the 7th and 14th days after treatment,the FIB and D-D levels in the observation group were lower than those in the control group(P<0.05).On the 3rd,7th and 14th days after treatment,the C-reactive protein(CRP)and interleukin-1β(IL-1β)levels of both groups were significantly lower than those before treatment(P<0.05),and the C

关 键 词：脑出血 尿激酶 颅内注射 辅助性T细胞因子 凝血功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]