马来酸桂哌齐特联合单唾液酸四己糖神经节苷脂钠治疗急性脑梗死的效果及对血清扣针蛋白5和胆碱酯酶水平的影响
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摘要
目的探讨马来酸桂哌齐特联合单唾液酸四己糖神经节苷脂钠治疗急性脑梗死的效果及对血清扣针蛋白5和胆碱酯酶水平的影响。方法选择2015年1月至2018年1月在江苏省海安市中医院就诊的急性脑梗死患者130例,应用随机数字表法分为观察组和对照组,各65例。对照组在常规治疗基础上给予马来酸桂哌齐特治疗,观察组在对照组基础上给予单唾液酸四己糖神经节苷脂钠治疗;比较2组患者的临床疗效以及治疗前后Barthel评分、血清胆碱酯酶和扣针蛋白5水平的变化。结果治疗2周后,观察组的总有效率高于对照组[89. 2%(58/65)比76. 9%(50/65)],差异有统计学意义(P <0. 05)。治疗前,2组患者的Barthel评分、血清胆碱酯酶和扣针蛋白5水平比较差异均无统计学意义(均P> 0. 05)。治疗2周后,2组患者Barthel评分和血清胆碱酯酶水平均高于治疗前,且观察组高于对照组[(76±7)分比(54±8)分,(4 784±226) U/L比(3 307±236) U/L]; 2组患者血清扣针蛋白5水平均低于治疗前,且观察组低于对照组[(70±31)μg/L比(90±32)μg/L],差异均有统计学意义(均P <0. 05)。结论马来酸桂哌齐特联合单唾液酸四己糖神经节苷脂钠治疗急性脑梗死患者的效果较好,可改善脑组织的缺氧缺血,从而降低血清扣针蛋白5水平,升高胆碱酯酶水平,改善预后,提高患者的生活能力。
Objective To investigate the effect of cinepazide maleate combined with monosialotetrahexosylganglioside sodium on serum fibulin-5 and cholinesterase in patients with acute cerebral infarction. Methods Totally130 patients with acute cerebral infarction were enrolled from January 2015 to January 2018 in Haian Hospital of Traditional Chinese Medicine,Jiangsu Province. They were randomly divided into observation group and control group,with 65 cases in each group. On the basis of conventional therapy,the control group was treated with cinepazide maleate and the observation group was treated with monosialotetrahexosylganglioside sodium plus cinepazide maleate. Clinical efficacy,Barthel index,levels of serum cholinesterase and fibulin-5 were analyzed.Results After 2 weeks of treatment,the total effective rate in observation group was higher than that in control group [89. 2%( 58/65) vs 76. 9%( 50/65) ]( P < 0. 05). There was no significant difference of Barthel index,serum levels of cholinesterase and fibulin-5 between groups before treatment( P > 0. 05). After 2 weeks of treatment,Barthel index and serum cholinesterase level increased and showed significant differences between observation group and control group[( 76 ± 7) vs( 54 ± 8),( 4 784 ± 226) U/L vs( 3 307 ± 236) U/L]; serum fibulin-5 level decreased after treatment and the level in observation group was lower than that in control group[( 70 ± 31) μg/L vs( 90 ± 32) μg/L]( P < 0. 05). Conclusions Monosialotetrahexosylganglioside sodium combined with cinepazide maleate has good therapeutic effect on acute cerebral infarction. It can improve the hypoxic-ischemia of brain tissue,reduce serum fibulin-5,increase cholinesterase level and improve the prognosis and living ability.
Objective To investigate the effect of cinepazide maleate combined with monosialotetrahexosylganglioside sodium on serum fibulin-5 and cholinesterase in patients with acute cerebral infarction. Methods Totally130 patients with acute cerebral infarction were enrolled from January 2015 to January 2018 in Haian Hospital of Traditional Chinese Medicine,Jiangsu Province. They were randomly divided into observation group and control group,with 65 cases in each group. On the basis of conventional therapy,the control group was treated with cinepazide maleate and the observation group was treated with monosialotetrahexosylganglioside sodium plus cinepazide maleate. Clinical efficacy,Barthel index,levels of serum cholinesterase and fibulin-5 were analyzed.Results After 2 weeks of treatment,the total effective rate in observation group was higher than that in control group [89. 2%( 58/65) vs 76. 9%( 50/65) ]( P < 0. 05). There was no significant difference of Barthel index,serum levels of cholinesterase and fibulin-5 between groups before treatment( P > 0. 05). After 2 weeks of treatment,Barthel index and serum cholinesterase level increased and showed significant differences between observation group and control group[( 76 ± 7) vs( 54 ± 8),( 4 784 ± 226) U/L vs( 3 307 ± 236) U/L]; serum fibulin-5 level decreased after treatment and the level in observation group was lower than that in control group[( 70 ± 31) μg/L vs( 90 ± 32) μg/L]( P < 0. 05). Conclusions Monosialotetrahexosylganglioside sodium combined with cinepazide maleate has good therapeutic effect on acute cerebral infarction. It can improve the hypoxic-ischemia of brain tissue,reduce serum fibulin-5,increase cholinesterase level and improve the prognosis and living ability.
引文
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[5]张楠楠,陈会生.依达拉奉对脑梗死大鼠神经保护作用最佳治疗时间窗的探讨[J].解放军医药杂志,2016,28(3):18-21.DOI:10.3969/j.issn.2095-140X.2016.03.005.Zhang NN,Chen HS.Golden hour of edaravone neuroprotective effect in treatment of cerebral infarction in rats[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2016,28(3):18-21.DOI:10.3969/j.issn.2095-140X.2016.03.005.
[6]吴逊.全国第四届脑血管病学术会议纪要[J].卒中与神经疾病,1997(2):51-55.Wu X.Summary of the fourth national academic conference on cerebrovascular diseases[J].Stroke and Nervous Diseases,1997(2):51-55.
[7]Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.DOI:10.1111/ane.12477.
[8]仲浩,吴德芹.马来酸桂哌齐特注射液治疗急性脑梗死的临床疗效及安全性[J].临床合理用药杂志,2017,10(24):8-9.DOI:10.15887/j.cnki.13-1389/r.2017.24.004.Zhong H,Wu DQ.Clinical effect and safety of cinepazide maleate injection in the treatment of acute cerebral infarction[J].Chinese Journal of Clinical Rational Drug Use,2017,10(24):8-9.DOI:10.15887/j.cnki.13-1389/r.2017.24.004.
[9]黄寿勇.急诊眩晕症经马来酸桂哌齐特联合盐酸异丙嗪治疗的效果观察[J].临床医学研究与实践,2017,2(4):100-101.DOI:10.19347/j.cnki.2096-1413.201704054.Huang SY.Effect observation of acute vertigo by cinepazide maleate combined with promethazine hydrochloride treatment[J].Clinical Research and Practice,2017,2(4):100-101.DOI:10.19347/j.cnki.2096-1413.201704054.
[10]吴丹红,周红,孙姬,等.马来酸桂哌齐特对大脑中动脉缺血再灌注小鼠的脑保护作用及神经生长相关蛋白43早期表达的影响[J].临床内科杂志,2014,31(12):849-852.DOI:10.3969/j.issn.1001-9057.2014.12.020.Wu DH,Zhou H,Sun J,et al.Treatment of cinepazide maleate protects against transient middle cerebral artery occlusion and influences early GAP-43 in mice[J].Journal of Clinical Internal Medicine,2014,31(12):849-852.DOI:10.3969/j.issn.1001-9057.2014.12.020.
[11]张荷慧,张庆元,吴森翔,等.单唾液酸四己糖神经节苷脂钠联合依达拉奉对急性脑梗死患者血清Hcy和hs-CRP的影响[J].中国生化药物杂志,2017,37(10):144-146,149.DOI:10.3969/j.issn.1005-1678.2017.10.058.Zhang HH,Zhang QY,Wu SX,et al.Effects of monosialonic acid tetrahexose ganglioside sodium and edaravone on serum Hcy and hs-CRP in patients with acute cerebral infarction[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(10):144-146,149.DOI:10.3969/j.issn.1005-1678.2017.10.058.
[12]王锦华,陈强,汪东良.等.老年急性脑梗死患者依达拉奉联合神经节苷脂治疗的临床效果及对炎症因子的影响[J].中华医院感染学杂志,2015,25(10):2179-2181.DOI:10.11816/cn.ni.2015-150353.Wang JH,Chen Q,Wang DL,et al.Clinical effect of edaravone combined with ganglioside on treatment of elderly patients with acute cerebral infarction and influence on inflammatory cytokines[J].Chinese Journal of Nosocomiology,2015,25(10):2179-2181.DOI:10.11816/cn.ni.2015-150353.
[13]Park JH,Han YM,Jang KS,et al.Angiographic and clinical factors related with good functional outcome after mechanicalthrombectomy in acute cerebral artery occlusion[J].J Korean Neurosurg Soc,2015,58(3):192-196.DOI:10.3340/jkns.2015.58.3.192.
[14]Arbel Y,Shenhar-Tsarfaty S,Waiskopf N,et al.Decline in serum cholinesterase activities predicts 2-year major adverse cardiac events[J].Mol Med,2014(20):38-45.DOI:10.2119/molmed.2013.00139.
[15]张峰,王卫国,谢燕,等.血清胆碱酯酶水平与急性脑梗死患者病情严重程度及预后的关系研究[J].实用心脑肺血管病杂志,2017,25(8):24-27.DOI:10.3969/j.issn.1008-5971.2017.08.006.Zhang F,Wang WG,Xie Y,et al.Correlations of serum cholinesterase level with severity and prognosis in patients with acute cerebral infarction[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2017,25(8):24-27.DOI:10.3969/j.issn.1008-5971.2017.08.006.
[16]Guadall A,Orriols M,Rodríguez-Calvo R,et al.Fibulin-5 is up-regulated by hypoxia in endothelial cells through a hypoxiainducible factor-1(HIF-1α)-dependent mechanism[J].J Biol Chem,2011,286(9):7093-7103.DOI:10.1074/jbc.M110.162917.
[2]顾群.依达拉奉联合神经节苷脂治疗老年急性脑梗死的临床疗效及安全性评价[J].中国临床药理学杂志,2015,31(12):1079-1081.DOI:10.13699/j.cnki.1001-6821.2015.12.001.Gu Q.Effect and safety of edaravone combined with ganglioside in treatment of acute cerebral infarction of elderly patients[J].The Chinese Journal of Clinical Pharmacology,2015,31(12):1079-1081.DOI:10.13699/j.cnki.1001-6821.2015.12.001.
[3]赵辉,徐广会,秦新月,等.急性期脑梗死患者血清fibulin-5水平及其与病情的关系[J].中国全科医学,2013,16(33):3920-3922.DOI:10.3969/j.issn.1007-9572.2013.33.010.Zhao H,Xu GH,Qin XY,et al.The serum level of fibulin-5 in patients with acute cerebral infarction and its relationship with severity of illness[J].Chinese General Practice,2013,16(33):3920-3922.DOI:10.3969/j.issn.1007-9572.2013.33.010.
[4]范小勇.丁酰胆碱酯酶活性评估院前急性有机磷农药中毒患者病情及预后的应用研究[J].重庆医学,2014,43(30):4028-4029,4033.DOI:10.3969/j.issn.1671-8348.2014.30.016.Fan XY.Research on application of BuChE assess prehospital acute organophosphorus pesticide poisoning and the prognosis of patients with the disease[J].Chongqing Medicine,2014,43(30):4028-4029,4033.DOI:10.3969/j.issn.1671-8348.2014.30.016.
[5]张楠楠,陈会生.依达拉奉对脑梗死大鼠神经保护作用最佳治疗时间窗的探讨[J].解放军医药杂志,2016,28(3):18-21.DOI:10.3969/j.issn.2095-140X.2016.03.005.Zhang NN,Chen HS.Golden hour of edaravone neuroprotective effect in treatment of cerebral infarction in rats[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2016,28(3):18-21.DOI:10.3969/j.issn.2095-140X.2016.03.005.
[6]吴逊.全国第四届脑血管病学术会议纪要[J].卒中与神经疾病,1997(2):51-55.Wu X.Summary of the fourth national academic conference on cerebrovascular diseases[J].Stroke and Nervous Diseases,1997(2):51-55.
[7]Naess H,Kurtz M,Thomassen L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.DOI:10.1111/ane.12477.
[8]仲浩,吴德芹.马来酸桂哌齐特注射液治疗急性脑梗死的临床疗效及安全性[J].临床合理用药杂志,2017,10(24):8-9.DOI:10.15887/j.cnki.13-1389/r.2017.24.004.Zhong H,Wu DQ.Clinical effect and safety of cinepazide maleate injection in the treatment of acute cerebral infarction[J].Chinese Journal of Clinical Rational Drug Use,2017,10(24):8-9.DOI:10.15887/j.cnki.13-1389/r.2017.24.004.
[9]黄寿勇.急诊眩晕症经马来酸桂哌齐特联合盐酸异丙嗪治疗的效果观察[J].临床医学研究与实践,2017,2(4):100-101.DOI:10.19347/j.cnki.2096-1413.201704054.Huang SY.Effect observation of acute vertigo by cinepazide maleate combined with promethazine hydrochloride treatment[J].Clinical Research and Practice,2017,2(4):100-101.DOI:10.19347/j.cnki.2096-1413.201704054.
[10]吴丹红,周红,孙姬,等.马来酸桂哌齐特对大脑中动脉缺血再灌注小鼠的脑保护作用及神经生长相关蛋白43早期表达的影响[J].临床内科杂志,2014,31(12):849-852.DOI:10.3969/j.issn.1001-9057.2014.12.020.Wu DH,Zhou H,Sun J,et al.Treatment of cinepazide maleate protects against transient middle cerebral artery occlusion and influences early GAP-43 in mice[J].Journal of Clinical Internal Medicine,2014,31(12):849-852.DOI:10.3969/j.issn.1001-9057.2014.12.020.
[11]张荷慧,张庆元,吴森翔,等.单唾液酸四己糖神经节苷脂钠联合依达拉奉对急性脑梗死患者血清Hcy和hs-CRP的影响[J].中国生化药物杂志,2017,37(10):144-146,149.DOI:10.3969/j.issn.1005-1678.2017.10.058.Zhang HH,Zhang QY,Wu SX,et al.Effects of monosialonic acid tetrahexose ganglioside sodium and edaravone on serum Hcy and hs-CRP in patients with acute cerebral infarction[J].Chinese Journal of Biochemical Pharmaceutics,2017,37(10):144-146,149.DOI:10.3969/j.issn.1005-1678.2017.10.058.
[12]王锦华,陈强,汪东良.等.老年急性脑梗死患者依达拉奉联合神经节苷脂治疗的临床效果及对炎症因子的影响[J].中华医院感染学杂志,2015,25(10):2179-2181.DOI:10.11816/cn.ni.2015-150353.Wang JH,Chen Q,Wang DL,et al.Clinical effect of edaravone combined with ganglioside on treatment of elderly patients with acute cerebral infarction and influence on inflammatory cytokines[J].Chinese Journal of Nosocomiology,2015,25(10):2179-2181.DOI:10.11816/cn.ni.2015-150353.
[13]Park JH,Han YM,Jang KS,et al.Angiographic and clinical factors related with good functional outcome after mechanicalthrombectomy in acute cerebral artery occlusion[J].J Korean Neurosurg Soc,2015,58(3):192-196.DOI:10.3340/jkns.2015.58.3.192.
[14]Arbel Y,Shenhar-Tsarfaty S,Waiskopf N,et al.Decline in serum cholinesterase activities predicts 2-year major adverse cardiac events[J].Mol Med,2014(20):38-45.DOI:10.2119/molmed.2013.00139.
[15]张峰,王卫国,谢燕,等.血清胆碱酯酶水平与急性脑梗死患者病情严重程度及预后的关系研究[J].实用心脑肺血管病杂志,2017,25(8):24-27.DOI:10.3969/j.issn.1008-5971.2017.08.006.Zhang F,Wang WG,Xie Y,et al.Correlations of serum cholinesterase level with severity and prognosis in patients with acute cerebral infarction[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease,2017,25(8):24-27.DOI:10.3969/j.issn.1008-5971.2017.08.006.
[16]Guadall A,Orriols M,Rodríguez-Calvo R,et al.Fibulin-5 is up-regulated by hypoxia in endothelial cells through a hypoxiainducible factor-1(HIF-1α)-dependent mechanism[J].J Biol Chem,2011,286(9):7093-7103.DOI:10.1074/jbc.M110.162917.