阿替普酶对急性脑梗死神经功能损伤及血清神经元特异性烯醇化酶、高敏C反应蛋白影响研究
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摘要
目的探讨阿替普酶对急性脑梗死神经功能损伤及血清神经元特异性烯醇化酶(NSE)、高敏C反应蛋白(hs-CRP)的影响。方法选取华中科技大学同济医学院附属武汉市中心医院自2013年4月至2018年5月收治的80例急性脑梗死患者为研究对象,将患者随机分为A组(n=38)与B组(n=42)。A组采用替罗非班治疗;B组在A组的基础上,给予阿替普酶进行溶栓治疗。比较两组患者的临床疗效及不良反应发生率。记录并比较两组患者的NSE、S100β蛋白、胶质纤维酸性蛋白(GFAP)、hs-CRP、白细胞介素-1β(IL-1β)及肿瘤坏死因子-α(TNF-α)水平。结果 B组患者治疗总有效率为90.5%(38/42),明显高于A组的73.7%(28/38),两组间比较,差异有统计学意义(P<0.05)。与治疗前比较,治疗后两组患者的NSE、S100β蛋白、GFAP及hs-CRP、IL-1β、TNF-α均明显降低,且B组明显低于A组,两组间比较,差异有统计学意义(P<0.05)。A、B两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿替普酶治疗急性脑梗死患者,可以明显降低炎性反应,改善患者的神经功能,提高临床疗效。
Objective To investigate the effect of alteplase on nerve function injury in acute cerebral infarction(ACI),serum neuron-specific enolase(NSE)and high sensitivity C-reactive protein(hs-CRP).Methods A retrospective study was performed on 80 cases of patients with ACI who were admitted from April 2013 to May 2018.Patients were randomly divided into the Group A(n=38)and Group B(n=42).Patients of Group A were treated with tirofiban,the others of Group B were added alteplase on the basis of treatment in Group A.The clinical efficacy and incidence of adverse reactions were compared between the two groups.NSE,S100β,glial fibrillar acidic protein(GFAP),hs-CRP,interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)levels were recorded and compared between the two groups.Results The total effective rate of Group B was 90.5%(38/42),significantly higher than 73.7%(28/38)of Group A,with statistically significant difference between the two groups(P<0.05).The NSE,S100β,GFAP,hs-CRP,IL-1βand TNF-α of the two groups were significantly lower than those of the two groups before and after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between Group A and Group B(P>0.05).Conclusion Alteplase can significantly reduce the inflammatory status of patients with acute cerebral infarction,improve the neurological impairment of patients and the clinical efficacy.
Objective To investigate the effect of alteplase on nerve function injury in acute cerebral infarction(ACI),serum neuron-specific enolase(NSE)and high sensitivity C-reactive protein(hs-CRP).Methods A retrospective study was performed on 80 cases of patients with ACI who were admitted from April 2013 to May 2018.Patients were randomly divided into the Group A(n=38)and Group B(n=42).Patients of Group A were treated with tirofiban,the others of Group B were added alteplase on the basis of treatment in Group A.The clinical efficacy and incidence of adverse reactions were compared between the two groups.NSE,S100β,glial fibrillar acidic protein(GFAP),hs-CRP,interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)levels were recorded and compared between the two groups.Results The total effective rate of Group B was 90.5%(38/42),significantly higher than 73.7%(28/38)of Group A,with statistically significant difference between the two groups(P<0.05).The NSE,S100β,GFAP,hs-CRP,IL-1βand TNF-α of the two groups were significantly lower than those of the two groups before and after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between Group A and Group B(P>0.05).Conclusion Alteplase can significantly reduce the inflammatory status of patients with acute cerebral infarction,improve the neurological impairment of patients and the clinical efficacy.
引文
[1] 吴松,王大明,金肇权.急性脑梗死患者血清C反应蛋白/脂联素和T细胞亚群与临床预后及神经功能的关系[J].东南大学学报(医学版),2018,37(1):101-106.
[2] 戈琦,罗佩仪,李悦斐,等.重组人组织纤溶酶原衍生物用于急性脑梗死溶栓治疗的临床观察[J].实用医学杂志,2018,34(19):3280-3282.
[3] 周雪梅.急性脑梗死的动、静脉溶栓疗法应用效果比较[J].临床军医杂志,2010,38(2):249-251.
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[6] 重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J].中华内科杂志,2012,51(12):1006-1010.
[7] 丁琪,陈旭.静脉溶栓对中老年急性脑梗死合并脑微出血的影响[J].中国老年学杂志,2018,38(21):5147-5149.
[8] 杨晓玲,李飞,冯佳梁.阿替普酶溶栓治疗急性脑梗死致休克1例[J].临床神经病学杂志,2018,31(4):263.
[9] Kohno N,Okada K,Yamagata S,et al.Distinctive patterns of three-dimensional arterial spin-labeled perfusion magnetic resonance imaging in subtypes of acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2016,25(7):412-414.
[10] 孟佳雪,贺帅,谢惠芳,等.阿替普酶治疗急性脑梗死患者的出血不良反应影响因素分析[J].中国临床药理学杂志,2018,34(14):1595-1597.
[11] 占达良,王晟,张耿.影响急性脑梗死患者预后的入院前相关因素分析[J].中国卫生统计,2018,35(4):569-571.
[12] 魏东,杨宗军,王晓晶.急性脑梗死患者血清超敏C-反应蛋白和纤维蛋白原检测的临床意义[J].山东医药,2018,58(33):77-79.
[13] 李育英,陈英道,张岐平,等.急性脑梗死患者脑动脉狭窄的分布特点及其影响因素[J].中国老年学杂志,2017,37(4):869-871.
[14] 李安民,陈合成,关文标,等.阿替普酶溶栓治疗对老年急性脑梗死患者神经功能、颅内血流动力学及生活质量的影响[J].中国老年学杂志,2017,37(19):4786-4788.
[15] 戴德孟,马维斌.阿替普酶治疗急性脑梗死的疗效及对患者血清炎性因子的影响[J].中国老年学杂志,2016,36(1):67-68.
[16] 谢江文,吕国菊,郑珍婕,等.不同年龄对阿替普酶静脉溶栓治疗急性脑梗死的临床疗效和预后的影响[J].中国临床药理学杂志,2016,32(6):486-488.
[2] 戈琦,罗佩仪,李悦斐,等.重组人组织纤溶酶原衍生物用于急性脑梗死溶栓治疗的临床观察[J].实用医学杂志,2018,34(19):3280-3282.
[3] 周雪梅.急性脑梗死的动、静脉溶栓疗法应用效果比较[J].临床军医杂志,2010,38(2):249-251.
[4] 邓立军.重组组织型纤溶酶原激活剂治疗急性脑梗死患者的临床研究[J].中国临床药理学杂志,2018,34(12):1398-1400.
[5] 刘鸣,张苏明,郝子龙.中国急性缺血性卒中诊治指南2010版的制定及解读[J].中华神经科杂志,2011,44(6):369-374.
[6] 重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J].中华内科杂志,2012,51(12):1006-1010.
[7] 丁琪,陈旭.静脉溶栓对中老年急性脑梗死合并脑微出血的影响[J].中国老年学杂志,2018,38(21):5147-5149.
[8] 杨晓玲,李飞,冯佳梁.阿替普酶溶栓治疗急性脑梗死致休克1例[J].临床神经病学杂志,2018,31(4):263.
[9] Kohno N,Okada K,Yamagata S,et al.Distinctive patterns of three-dimensional arterial spin-labeled perfusion magnetic resonance imaging in subtypes of acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2016,25(7):412-414.
[10] 孟佳雪,贺帅,谢惠芳,等.阿替普酶治疗急性脑梗死患者的出血不良反应影响因素分析[J].中国临床药理学杂志,2018,34(14):1595-1597.
[11] 占达良,王晟,张耿.影响急性脑梗死患者预后的入院前相关因素分析[J].中国卫生统计,2018,35(4):569-571.
[12] 魏东,杨宗军,王晓晶.急性脑梗死患者血清超敏C-反应蛋白和纤维蛋白原检测的临床意义[J].山东医药,2018,58(33):77-79.
[13] 李育英,陈英道,张岐平,等.急性脑梗死患者脑动脉狭窄的分布特点及其影响因素[J].中国老年学杂志,2017,37(4):869-871.
[14] 李安民,陈合成,关文标,等.阿替普酶溶栓治疗对老年急性脑梗死患者神经功能、颅内血流动力学及生活质量的影响[J].中国老年学杂志,2017,37(19):4786-4788.
[15] 戴德孟,马维斌.阿替普酶治疗急性脑梗死的疗效及对患者血清炎性因子的影响[J].中国老年学杂志,2016,36(1):67-68.
[16] 谢江文,吕国菊,郑珍婕,等.不同年龄对阿替普酶静脉溶栓治疗急性脑梗死的临床疗效和预后的影响[J].中国临床药理学杂志,2016,32(6):486-488.
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