静脉溶栓前应用他汀类药物在脑梗死患者中的应用效果研究
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摘要
目的:探索静脉溶栓前应用他汀类药物在脑梗死患者中的应用效果。方法:选取2017年3月—2018年3月于本院接受治疗的86例脑梗死患者为研究对象,按照随机数表法分为静脉溶栓前组(n=43)和静脉溶栓后组(n=43),分别在患者静脉溶栓前后给予瑞舒伐他汀治疗。采用RANKIN量表(mRS)评价患者溶栓后预后良好情况,根据患者颅脑CT结果评价患者颅内出血情况。采用美国国立卫生研究院卒中量表(NIHSS)、日常生活质量评价Barthel(ADL-Barthel)量表评价患者神经功能损伤程度和日常生活质量。采集患者血液并检测血清基质金属蛋白酶-9(MMP-9)、高迁移率族蛋白1(HMGB1)、白介素-17(IL-17)水平。结果:静脉溶栓前组预后良好率为81. 40%,显著高于静脉溶栓后组的60. 47%,数据对比具有统计学意义(P <0. 05);静脉溶栓前组颅内出血发生率稍高于静脉溶栓后组,但两组数据对比不具有统计学意义(P> 0. 05)。两组脑梗死患者治疗前NIHSS及ADL-Barthel评分对比不具有统计学意义(P> 0. 05),治疗后静脉溶栓前组NIHSS评分为(2. 19±0. 30)分,显著低于静脉溶栓后组的(6. 89±0. 46)分,静脉溶栓前组ADL-Barthel评分为(79. 62±23. 40)分,明显高于静脉溶栓后组的(60. 11±21. 08)分,数据对比具有统计学意义(P <0. 05)。两组脑梗死患者治疗前血清学指标对比不具有统计学意义(P> 0. 05),治疗后静脉溶栓前组MMP-9、HMGB1、IL-17指标水平显著低于静脉溶栓后组,数据对比具有统计学意义(P <0. 05)。结论:静脉溶栓前给予瑞舒伐他汀治疗较静脉溶栓后治疗能够显著改善脑梗死患者预后及颅内出血情况,促进患者神经功能恢复和生活质量的提高,且改善患者MMP-9、HMGB1、IL-17等血清学指标水平,适合临床推广。
Objective: To explore the effect of statins before intravenous thrombolysis in patients with cerebral infarction. Methods: 86 patients with cerebral infarction treated in our hospital from March 2017 to March 2018 were selected and randomly divided into the pre-thrombolytic group(n = 43) and the post-thrombolytic group(n = 43),rosuvastatin was given before or after intravenous thrombolysis,respectively. RANKIN scale(mRS) was used to evaluate the prognosis of patients after thrombolysis,and intracranial hemorrhage was evaluated according to the results of brain CT scanning. The national institutes of health stroke scale(NIHSS) and daily life quality assessment Barthel(ADL-Barthel) scale were used to evaluate the degree of neurological impairment and daily life quality of patients. Blood samples for patients in both group were collected and serum levels of matrix metalloproteinase-9(MMP-9),high mobility group protein 1(HMGB1) and interleukin-17(IL-17) were measured. Results: The good prognosis rate of the pre-thrombolytic group was 81. 40%,which was significantly higher than that of the post-thrombolysis group(60. 47%),and the data comparison was statistically significant(P < 0. 05). The incidence of intracranial hemorrhage in pre-thrombolytic group was slightly higher than that in post-thrombolytic group,but the data comparison between the two groups was not statistically significant(P > 0. 05). There was no statistically significant difference in the scores of NIHSS and ADL-Barthel between the two groups(P > 0. 05). The NIHSS score in the pre-thrombolytic group was 2. 19 ± 0. 30,which was significantly lower than that of the post-thrombolytic group 6. 89 ± 0. 46. The ADL-Barthel score of the prethrombolytic group was79. 62 ± 23. 40,which was significantly higher than that of post-thrombolytic group(60. 11 ± 21. 08),and the data were statistically significant(P < 0. 05). Before the treatment,there was no statistically significant difference in serum scores between the two groups(P > 0. 05). The levels of MMP-9,HMGB1 and IL-17 in the pre-thrombolytic group were significantly lower than those in the post-thrombolytic group after the treatment,and the data were statistically significant(P < 0. 05). Conclusion: The treatment of rosuvastatin before intravenous thrombolytic therapy can significantly improve the prognosis and intracranial hemorrhage in patients with cerebral infarction,promote the recovery of neurological functions and quality of life,and improve the level of MMP-9,HMGB1,IL-17 and other serological indexes,which is suitable for clinical application.
Objective: To explore the effect of statins before intravenous thrombolysis in patients with cerebral infarction. Methods: 86 patients with cerebral infarction treated in our hospital from March 2017 to March 2018 were selected and randomly divided into the pre-thrombolytic group(n = 43) and the post-thrombolytic group(n = 43),rosuvastatin was given before or after intravenous thrombolysis,respectively. RANKIN scale(mRS) was used to evaluate the prognosis of patients after thrombolysis,and intracranial hemorrhage was evaluated according to the results of brain CT scanning. The national institutes of health stroke scale(NIHSS) and daily life quality assessment Barthel(ADL-Barthel) scale were used to evaluate the degree of neurological impairment and daily life quality of patients. Blood samples for patients in both group were collected and serum levels of matrix metalloproteinase-9(MMP-9),high mobility group protein 1(HMGB1) and interleukin-17(IL-17) were measured. Results: The good prognosis rate of the pre-thrombolytic group was 81. 40%,which was significantly higher than that of the post-thrombolysis group(60. 47%),and the data comparison was statistically significant(P < 0. 05). The incidence of intracranial hemorrhage in pre-thrombolytic group was slightly higher than that in post-thrombolytic group,but the data comparison between the two groups was not statistically significant(P > 0. 05). There was no statistically significant difference in the scores of NIHSS and ADL-Barthel between the two groups(P > 0. 05). The NIHSS score in the pre-thrombolytic group was 2. 19 ± 0. 30,which was significantly lower than that of the post-thrombolytic group 6. 89 ± 0. 46. The ADL-Barthel score of the prethrombolytic group was79. 62 ± 23. 40,which was significantly higher than that of post-thrombolytic group(60. 11 ± 21. 08),and the data were statistically significant(P < 0. 05). Before the treatment,there was no statistically significant difference in serum scores between the two groups(P > 0. 05). The levels of MMP-9,HMGB1 and IL-17 in the pre-thrombolytic group were significantly lower than those in the post-thrombolytic group after the treatment,and the data were statistically significant(P < 0. 05). Conclusion: The treatment of rosuvastatin before intravenous thrombolytic therapy can significantly improve the prognosis and intracranial hemorrhage in patients with cerebral infarction,promote the recovery of neurological functions and quality of life,and improve the level of MMP-9,HMGB1,IL-17 and other serological indexes,which is suitable for clinical application.
引文
1吉凤,徐小林.三种他汀类药物治疗老年动脉粥样硬化性急性脑梗死合并高血脂效果对比观察[J].山东医药,2014,32(28):50-52
2 黄立宏,冯小芳,黄流清,等.脑梗死二级预防中他汀类药物的应用情况及中断他汀类药物治疗对预后和复发的影响[J].中国老年学杂志,2017,37(3):631-633
3 王春雨,王海鹏,刘洁,等.脑梗死患者应用阿司匹林联合他汀类药物对颈动脉斑块的影响评价[J].中国实验诊断学,2014,21(7):1087-1089
4 倪晓珺,逄晓云,刘阳熙,等.肝移植术后急性脑梗死病人调脂治疗的病例分析[J].药学服务与研究,2017,17(5):351,365,400
5 杨烨,黄小明,程磊,等.脑梗死患者服用他汀类药物现状和疗效[J].中华老年医学杂志,2013,32(6):618-620
6 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
7 Kamano H,Yoshiura,T Hiwatashi A,et al. Arterial spin labeling in patients with chronic cerebral artery steno-occlusive disease:Correlation with 15O-PET[J]. Acta Radiologica,2013,54(1):99-106
8 Lee J H,Choi H-C,Kim C,et al. Fulminant cerebral infarction of anterior and posterior cerebral circulation after ascending type of facial necrotizing fasciitis[J]. Journal of stroke and cerebrovascular diseases:The official journal of National Stroke Association,2014,23(1):173-175
9 Chu H X,Kim H A,Lee S,et al. Immune cell infiltration in malignant middle cerebral artery infarction:Comparison with transient cerebral ischemia[J]. Journal of Cerebral Blood Flow and Metabolism:Official Journal of the International Society of Cerebral Blood Flow and Metabolism,2014,34(3):450-459
10 沈卫,林东.中药心脑血脉宁联合他汀类药物对脑梗死患者颈动脉粥样硬化斑块的影响[J].中国生化药物杂志,2017,37(9):65-66,69
11陈刚,陈玲,张辉,等.他汀类药物联合荷丹片治疗老年脑梗死患者颈动脉中重度狭窄的有效性和安全性[J].中国老年学杂志,2015,35(20):5785-5787
12 兰清莲,周成业,王小同,等.脑梗死后出血转化的危险因素分析[J].温州医科大学学报,2014,19(12):877-881
13 Amorim R L,De Andrade A F,Gattás G S,et al. Improved hemodynamic parameters in middle cerebral artery infarction after decompressive craniectomy[J]. Stroke:A Journal of Cerebral Circulation,2014,45(5):1375-1380
14 Nakamura K,Sekijima Y,Hattori K,et al. p. E66Q mutation in the GLA gene is associated with a high risk of cerebral small-vessel occlusion in elderly Japanese males[J]. European journal of neurology:the official journal of the European Federation of Neurological Societies,2014,21(1):49-56
15 李凤莲,刘景旭,侯亚梅,等.他汀类药物对青年急性脑梗死患者血清IL-10、IL-17含量影响研究[J].国际检验医学杂志,2013,34(17):2318-2319
2 黄立宏,冯小芳,黄流清,等.脑梗死二级预防中他汀类药物的应用情况及中断他汀类药物治疗对预后和复发的影响[J].中国老年学杂志,2017,37(3):631-633
3 王春雨,王海鹏,刘洁,等.脑梗死患者应用阿司匹林联合他汀类药物对颈动脉斑块的影响评价[J].中国实验诊断学,2014,21(7):1087-1089
4 倪晓珺,逄晓云,刘阳熙,等.肝移植术后急性脑梗死病人调脂治疗的病例分析[J].药学服务与研究,2017,17(5):351,365,400
5 杨烨,黄小明,程磊,等.脑梗死患者服用他汀类药物现状和疗效[J].中华老年医学杂志,2013,32(6):618-620
6 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
7 Kamano H,Yoshiura,T Hiwatashi A,et al. Arterial spin labeling in patients with chronic cerebral artery steno-occlusive disease:Correlation with 15O-PET[J]. Acta Radiologica,2013,54(1):99-106
8 Lee J H,Choi H-C,Kim C,et al. Fulminant cerebral infarction of anterior and posterior cerebral circulation after ascending type of facial necrotizing fasciitis[J]. Journal of stroke and cerebrovascular diseases:The official journal of National Stroke Association,2014,23(1):173-175
9 Chu H X,Kim H A,Lee S,et al. Immune cell infiltration in malignant middle cerebral artery infarction:Comparison with transient cerebral ischemia[J]. Journal of Cerebral Blood Flow and Metabolism:Official Journal of the International Society of Cerebral Blood Flow and Metabolism,2014,34(3):450-459
10 沈卫,林东.中药心脑血脉宁联合他汀类药物对脑梗死患者颈动脉粥样硬化斑块的影响[J].中国生化药物杂志,2017,37(9):65-66,69
11陈刚,陈玲,张辉,等.他汀类药物联合荷丹片治疗老年脑梗死患者颈动脉中重度狭窄的有效性和安全性[J].中国老年学杂志,2015,35(20):5785-5787
12 兰清莲,周成业,王小同,等.脑梗死后出血转化的危险因素分析[J].温州医科大学学报,2014,19(12):877-881
13 Amorim R L,De Andrade A F,Gattás G S,et al. Improved hemodynamic parameters in middle cerebral artery infarction after decompressive craniectomy[J]. Stroke:A Journal of Cerebral Circulation,2014,45(5):1375-1380
14 Nakamura K,Sekijima Y,Hattori K,et al. p. E66Q mutation in the GLA gene is associated with a high risk of cerebral small-vessel occlusion in elderly Japanese males[J]. European journal of neurology:the official journal of the European Federation of Neurological Societies,2014,21(1):49-56
15 李凤莲,刘景旭,侯亚梅,等.他汀类药物对青年急性脑梗死患者血清IL-10、IL-17含量影响研究[J].国际检验医学杂志,2013,34(17):2318-2319