不同剂量阿替普酶静脉溶栓对急性缺血性脑卒中患者脑血管储备、凝血功能及血清PON-1水平的影响  

Effects of intravenous thrombolysis with different doses of alteplase on cerebrovascular reserve,coagulation function and serum PON-1 level in patients with acute ischemic stroke

作　　者：王梓晗[1] 储成艳 赵红玲[2] 李淑敏[1] 王璐[1] 殷艳[3] 蔺建文[1] WANG Zihan;ZU Chengyan;ZHAO Hongling;LI Shumin;WANG Lu;YIN Yan;LIN Jianwen(First Department of Neurology,Dalian Central Hospital,Dalian,Liaoning 116089,China;Forth Department of Neurology,Dalian Central Hospital,Dalian,Liaoning 116089,China;Department of Emergency Medicine,Dalian Central Hospital,Dalian,Liaoning 116089,China)

机构地区：[1]辽宁省大连市中心医院神经内一科,辽宁大连116089 [2]辽宁省大连市中心医院神经内四科,辽宁大连116089 [3]辽宁省大连市中心医院急诊科,辽宁大连116089

出　　处：《检验医学与临床》2025年第4期501-505,511,共6页Laboratory Medicine and Clinic

基　　金：辽宁省自然科学基金计划项目(2022-MS-442)。

摘　　要：目的探讨不同剂量阿替普酶静脉溶栓对急性缺血性脑卒中(AIS)患者脑血管储备(CVR)功能、凝血功能及血清对氧磷酶(PON)-1水平的影响。方法选择2021年1月至2022年12月该院收治的AIS患者150例作为研究对象,依据随机数字表法分为2组,每组75例。A组采用低剂量(0.6 mg/kg)阿替普酶静脉溶栓治疗,B组采用标准剂量(0.9 mg/kg)阿替普酶静脉溶栓治疗。比较2组的神经功能、CVR功能指标[CVR、搏动指数(PI)]、凝血功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]、治疗后24 h颅内出血情况、90 d病死率,以及血清PON-1水平。结果治疗后2组美国国立卫生研究院脑卒中量表评分、PI,以及FIB水平低于治疗前,PT、APTT、TT长于治疗前,CVR、血清PON-1水平高于治疗前,差异均有统计学意义(P<0.05),但治疗后以上指标组间比较差异均无统计学意义(P>0.05)。2组治疗后24 h颅内出血发生率、90 d病死率比较,差异均无统计学意义(P>0.05)。结论低剂量阿替普酶静脉溶栓治疗在改善AIS患者的神经功能、CVR功能、凝血功能,调节血清PON-1水平方面与标准剂量相当,且治疗后24 h颅内出血发生率、90 d病死率与标准剂量均相近。建议在临床中具体使用何种剂量阿替普酶需结合AIS患者的发病时间窗、出血风险等确定。Objective To investigate the effects of intravenous thrombolysis with different doses of alteplase on cerebrovascular reserve(CVR)function,coagulation function and serum paraoxonase(PON)-1 level in patients with acute ischemic stroke(AIS).Methods A total of 150 patients with AIS admitted to the hospital from January 2021 to December 2022 were selected as the study subjects and randomly assigned into two groups using a random number table method,with 75 patients in each group.Group A received low-dose(0.6 mg/kg)intravenous thrombolysis with alteplase,while Group B received the standard dose(0.9 mg/kg)intravenous thrombolysis with alteplase.The neurological function,CVR indicators[CVR,pulsatility index(PI)],coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)],intracranial hemorrhage within 24 h after treatment,90-day mortality and serum PON-1 level were compared between the two groups.Results The National Institutes of Health Stroke Scale(NIHSS)score,PI,and FIB level of the two groups were lower than those before treatment,while PT,APTT and TT were longer than those before treatment,and CVR,serum PON-1 level were higher than those before treatment,with all differences being statistically significant(P<0.05).However,the differences between the two groups for these indices after treatment were not statistically significant(P>0.05).The incidence of intracranial hemorrhage at 24 h after treatment and the 90-day morbidity rate were not statistically significant between the two groups(P>0.05).Conclusion Low-dose intravenous thrombolysis with alteplase is as effective as the standard dose in improving neurological function,CVR function,coagulation function and regulating serum PON-1 level in patients with AIS.Furthermore,the incidence of intracranial hemorrhage at 24 h after treatment and the 90-day mortality rate are comparable to those observed with the standard dose.It is recommended that the specific dose of alteplase used in clinical practice be dete

关 键 词：阿替普酶 静脉溶栓 急性缺血性脑卒中 脑血管储备功能 凝血功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R446.1[医药卫生—临床医学]