丁苯酞联合阿替普酶治疗急性缺血性脑卒中的临床效果及对患者血清炎性因子及神经递质水平的影响
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摘要
目的探讨丁苯酞联合阿替普酶治疗急性缺血性脑卒中的临床效果及对患者血清炎性因子及神经递质水平的影响。方法选取2015年5月至2018年3月大连大学附属中山医院收治的急性缺血性脑卒中患者95例为研究对象。采用前瞻性研究的方法,完全随机分为观察组(48例)和对照组(47例)。在常规治疗基础上,对照组给予阿替普酶静脉溶栓治疗,观察组给予丁苯酞静脉滴注联合阿替普酶治疗。治疗2周后,比较2组患者美国国立卫生研究院卒中量表(NIHSS)评分、临床疗效、炎性因子和神经递质水平、不良反应等指标。结果治疗2周后,2组NIHSS评分均低于治疗前,且观察组低于对照组[(6. 2±1. 0)分比(9. 2±1. 2)分],差异均有统计学意义(均P <0. 01)。观察组总有效率明显高于对照组[93. 8%(45/48)比78. 7%(37/47)],差异有统计学意义(P <0. 05)。治疗2周后,观察组患者血清白细胞介素2、白细胞介素6、C反应蛋白、肿瘤坏死因子α水平明显低于对照组(均P <0. 01),血清5-羟色胺、多巴胺含量明显高于对照组(P <0. 05或P <0. 01),谷氨酸、天冬氨酸含量明显低于对照组(P <0. 05或P <0. 01)。结论丁苯酞联合阿替普酶有助于缓解缺血性脑卒中患者神经功能缺损程度,提高临床疗效,可能与抑制炎症反应、调节神经递质水平等因素有关。
Objective To explore the effect of butylphthalide combined with alteplase on acute ischemic stroke,serum inflammatory factors and neurotransmitters. Methods A total of 95 patients with acute ischemic stroke were prospectively enrolled from May 2015 to March 2018 in Affiliated Zhongshan Hospital of Dalin University.They were randomly divided into observation group( n = 48) and control group( n = 47). On the basis of conventional treatments,the control group had alteplase intravenous thrombolysis; the observation group had intravenous administration of butyphthalide combined with alteplase. After 2 weeks of treatment,National Institutes of Health Stroke Scale( NIHSS) score,clinical efficacy,inflammatory factors,neurotransmitters and adverse reactions were analyzed. Results After treatment,NIHSS score significantly decreased and the score in the observation group was lower than that in the control group[( 6. 2 ± 1. 0) vs( 9. 2 ± 1. 2) ]( P < 0. 01). Clinical effective rate in the observation group was significantly higher than that in the control group[93. 8%( 45/48) vs 78. 7%( 37/47) ]( P < 0. 05). Serum levels of interleukin-2,interleukin-6,C-reactive protein and tumor necrosis factor-α in the observation group were significantly lower than those in the control group( P < 0. 01). Serum levels of5-hydroxytryptamine and dopamine in the observation group were significantly higher while glutamate and aspartate levels were lower than those in the control group( P < 0. 05 or P < 0. 01). Conclusion Butyphthalide combined with alteplase helps to alleviate neurological deficit of ischemic stroke patient and improve the clinical efficacy,which may be related to inhibiting inflammatory response and regulating neurotransmitter level.
Objective To explore the effect of butylphthalide combined with alteplase on acute ischemic stroke,serum inflammatory factors and neurotransmitters. Methods A total of 95 patients with acute ischemic stroke were prospectively enrolled from May 2015 to March 2018 in Affiliated Zhongshan Hospital of Dalin University.They were randomly divided into observation group( n = 48) and control group( n = 47). On the basis of conventional treatments,the control group had alteplase intravenous thrombolysis; the observation group had intravenous administration of butyphthalide combined with alteplase. After 2 weeks of treatment,National Institutes of Health Stroke Scale( NIHSS) score,clinical efficacy,inflammatory factors,neurotransmitters and adverse reactions were analyzed. Results After treatment,NIHSS score significantly decreased and the score in the observation group was lower than that in the control group[( 6. 2 ± 1. 0) vs( 9. 2 ± 1. 2) ]( P < 0. 01). Clinical effective rate in the observation group was significantly higher than that in the control group[93. 8%( 45/48) vs 78. 7%( 37/47) ]( P < 0. 05). Serum levels of interleukin-2,interleukin-6,C-reactive protein and tumor necrosis factor-α in the observation group were significantly lower than those in the control group( P < 0. 01). Serum levels of5-hydroxytryptamine and dopamine in the observation group were significantly higher while glutamate and aspartate levels were lower than those in the control group( P < 0. 05 or P < 0. 01). Conclusion Butyphthalide combined with alteplase helps to alleviate neurological deficit of ischemic stroke patient and improve the clinical efficacy,which may be related to inhibiting inflammatory response and regulating neurotransmitter level.
引文
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[2]刘春梅,周俊山,施洪超,等.阿替普酶静脉溶栓治疗急性缺血性脑卒中后出血性转化的影响因素分析[J].中国神经免疫学和神经病学杂志,2018,25(3):188-192. DOI:10. 3969/j. issn.1006-2963. 2018. 03. 008.Liu CM,Zhou JS,Shi HC,et al. Analysis of influencing factors of hemorrhagic transformation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke[J]. Chinese Journal of Neuroimmunology and Neurology,2018,25(3):188-192. DOI:10. 3969/j. issn. 1006-2963. 2018. 03. 008.
[3]饶艳玲,黄威.丁苯酞联合依达拉奉对急性脑梗死患者的临床疗效分析[J].临床内科杂志,2018,35(11):783-784. DOI:10. 3969/j. issn. 1001-9057. 2018. 11. 019.Rao YL,Huang W. Clinical efficacy of butylphthalide combined with edaravone in the treatment of acute cerebral infarction[J].Journal of Clinical Internal Medicine,2018,35(11):783-784.DOI:10. 3969/j. issn. 1001-9057. 2018. 11. 019.
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[5]赵晶,赵辉,孔文基,等.阿替普酶联合丁苯酞治疗急性缺血性脑卒中的临床观察[J].中国药房,2016,27(35):4962-4965.DOI:10. 6039/j. issn. 1001-0408. 2016. 35. 21.Zhao J,Zhao H,Kong WJ,et al. Clinical observation of alteplase combined with butylphthalide in the treatment of acute ischemic stroke[J]. China Pharmacy,2016,27(35):4962-4965. DOI:10. 6039/j. issn. 1001-0408. 2016. 35. 21.
[6] de Sousa Parreira J,Kallaur AP,Lehmann MF,et al. Erratum to:tumor necrosis factor beta Nco I polymorphism(rs909253)is associated with inflammatory and metabolic markers in acute ischemic stroke[J]. Metab Brain Dis,2015,30(1):169. DOI:10. 1007/s11011-014-9607-3.
[7]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257. DOI:10. 3760/cma. j. issn.1006-7876. 2015. 04. 002.Chinese Society of Neurology, Chinese Medical Association,Cerebrovascular disease group of Chinese Society of Neurology,Chinese Medical Association. Guidelines for diagnosis and treatment of acute ischemic stroke in China 2014[J]. Chinese Journal of Neurology,2015,48(4):246-257. DOI:10. 3760/cma. j. issn.1006-7876. 2015. 04. 002.
[8]王伊龙,赵凡.脑卒中诊疗技术规范研究———首都十大疾病科技攻关工作重大项目[J].科技成果管理与研究,2013(11):83-84. DOI:10. 3772/j. issn. 1673-6516. 2013. 11. 029.Wang YL,Zhao F. Research on technical guidelines for diagnosis and treatment of stroke--major projects of tackling key scientific and technological problems in ten major diseases in Beijing[J].Management and Research on Scientific&Technological Achievements,2013(11):83-84. DOI:10. 3772/j. issn. 1673-6516.2013. 11. 029.
[9]全国第四届脑血管学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-382.The fourth national conference on cerebrovascular disease. Scoring criteria for clinical neurological deficit in patients with stroke(1995)[J]. Chinese Journal of Neurology,1996,29(6):381-382.
[10] Wang W,Jiang B,Sun H,et al. Prevalence,incidence,and mortality of stroke in China:results from a nationwide populationbased survey of 480 687 adults[J]. Circulation,2017,135(8):759-771. DOI:10. 116/CIRCULATIONATA. 116. 025250.
[11]赵宏,汪立松,童巧文.阿替普酶静脉溶栓对急性脑梗死患者神经功能、炎症及氧化应激反应的影响[J].中华全科医学,2017,15(8):1345-1347. DOI:10. 16766/j. cnki. issn. 1674-4152. 2017. 08. 021.Zhao H,Wang LS,Tong QW. Effects of intravenous thrombolysis with alteplase on neurological function,inflammation and oxidative stress in patients with acute cerebral infarction[J]. Chinese Journal of General Practice,2017,15(8):1345-1347. DOI:10. 16766/j.cnki. issn. 1674-4152. 2017. 08. 021.
[12]郭东,金勇,蒋智林,等.不同剂量瑞舒伐他汀联合注射用阿替普酶治疗急性脑梗死的临床效果[J].中国医药,2017,12(10):1511-1514. DOI:10. 3760/cma. j. issn. 1673-4777. 2017. 10. 018.Guo D,Jin Y,Jiang ZL,et al. Clinical effects of different doses of rosuvastatin combined with recombinant human tissue plasminogen activator for injection on acute cerebral infarction[J]. China Medicine,2017,12(10):1511-1514. DOI:10. 3760/cma. j.issn. 1673-4777. 2017. 10. 018.
[13]王自然,赵广健,任熙文,等.小剂量与标准剂量静脉阿替普酶治疗急性缺血性卒中:有效性和安全性比较[J].国际脑血管病杂志,2016,24(8):694-698. DOI:10. 3760/cma. j. issn.1673-4165. 2016. 08. 002.Wang ZR,Zhao GJ,Ren XW,et al. Low-dose versus standarddose intravenous alteplase for acute ischemic stroke:comparison of efficacy and safety[J]. International Journal of Cerebrovascular Diseases,2016,24(8):694-698. DOI:10. 3760/cma. j. issn.1673-4165. 2016. 08. 002.
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