丁苯酞联合尤瑞克林对大面积脑梗死患者神经损害病理进程的影响
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摘要
目的:研究丁苯酞联合尤瑞克林对大面积脑梗死患者神经损害病理进程的影响。方法:选择在我院接受治疗的大面积脑梗死患者,在常规治疗的基础上随机分为接受丁苯酞治疗的A组、接受尤瑞克林治疗的B组、接受丁苯酞联合尤瑞克林治疗的C组。治疗后14 d,测定血清神经标志物、凝血指标、生长因子、氧化应激指标的含量。结果:3组治疗后的视锥蛋白样蛋白-1(VILIP-1)、神经元特异性烯醇化酶(NSE)、S100B蛋白(S100B)、血栓素A2(TXA2)、溶血磷脂酸(LPA)、D-二聚体(D-D)、8-异前列腺素F2α(8-iso-PGF2α)、丙二醛(MDA)含量均明显降低,一氧化氮(NO)、一氧化氮合酶(NOS)、血管内皮生长因子(VEGF)、脑源性神经营养因子(BDNF)、胰岛素样生长因子-I(IGF-I)、超氧化物歧化酶(SOD)、总抗氧化力(T-AOC)含量均明显升高且C组治疗后的VILIP-1、NSE、S100B、TXA2、LPA、D-D、8-iso-PGF2α、MDA含量均明显低于A组和B组,NO、NOS、VEGF、BDNF、IGF-1、SOD、T-AOC含量均明显高于A组和B组。结论:丁苯酞联合尤瑞克林对大面积脑梗死患者神经损害病理进程的改善作用优于单药治疗。
Objective:To study the effect of Butylphthalide combined with Urinary Kallidinogenase on the pathological course of nerve damage in patients with massive cerebral infarction. Methods: The patients with massive cerebral infarction who received treatment in our hospital between January 2016 and December 2017 were selected and randomly divided into the group A receiving Butylphthalide treatment, the group B receiving Urinary Kallidinogenase treatment and the group C receiving Butylphthalide combined with Urinary Kallidinogenase treatment on the basis of conventional treatment. 14 days after treatment, serum levels of nerve markers, coagulation indexes, growth factors and oxidative stress indexes were determined. Results: After treatment, visinin-like protein-1(VILIP-1), neuron-specific enolase(NSE), S100 B protein(S100 B), thromboxane A2(TXA2), lysophosphatidic acid(LPA), D-dimer(D-D), 8-isoprostanes F2α(8-iso-PGF2α) and malondialdehyde(MDA) levels of 3 groups significantly decreased whereas nitric oxide(NO), nitric oxide synthase(NOS), vascular endothelial growth factor(VEGF), brain-derived neurotrophic factor(BDNF), insulin-like growth factor-I(IGF-I), superoxide dismutase(SOD) and total antioxidant capacity(T-AOC) levels significantly increased, and VILIP-1, NSE, S100 B, TXA2, LPA, D-D, 8-iso-PGF2α and MDA levels of the group C after treatment were significantly lower than those of the group A and group B whereas NO, NOS, VEGF, BDNF, IGF-I, SOD and T-AOC levels were significantly higher than those of the group A and group B. Conclusion: Butylphthalide combined with Urinary Kallidinogenase is better than monotherapy in improving the pathological course of nerve damage in patients with massive cerebral infarction.
Objective:To study the effect of Butylphthalide combined with Urinary Kallidinogenase on the pathological course of nerve damage in patients with massive cerebral infarction. Methods: The patients with massive cerebral infarction who received treatment in our hospital between January 2016 and December 2017 were selected and randomly divided into the group A receiving Butylphthalide treatment, the group B receiving Urinary Kallidinogenase treatment and the group C receiving Butylphthalide combined with Urinary Kallidinogenase treatment on the basis of conventional treatment. 14 days after treatment, serum levels of nerve markers, coagulation indexes, growth factors and oxidative stress indexes were determined. Results: After treatment, visinin-like protein-1(VILIP-1), neuron-specific enolase(NSE), S100 B protein(S100 B), thromboxane A2(TXA2), lysophosphatidic acid(LPA), D-dimer(D-D), 8-isoprostanes F2α(8-iso-PGF2α) and malondialdehyde(MDA) levels of 3 groups significantly decreased whereas nitric oxide(NO), nitric oxide synthase(NOS), vascular endothelial growth factor(VEGF), brain-derived neurotrophic factor(BDNF), insulin-like growth factor-I(IGF-I), superoxide dismutase(SOD) and total antioxidant capacity(T-AOC) levels significantly increased, and VILIP-1, NSE, S100 B, TXA2, LPA, D-D, 8-iso-PGF2α and MDA levels of the group C after treatment were significantly lower than those of the group A and group B whereas NO, NOS, VEGF, BDNF, IGF-I, SOD and T-AOC levels were significantly higher than those of the group A and group B. Conclusion: Butylphthalide combined with Urinary Kallidinogenase is better than monotherapy in improving the pathological course of nerve damage in patients with massive cerebral infarction.
引文
1张娴,张应宏.不同时间窗rt-PA静脉溶栓治疗椎-基底动脉系统脑梗死的疗效观察[J].中风与神经疾病杂志,2018,35(7):595-598.
2汤海潮,许晓丹,姚懿函,等.动静脉联合应用重组组织型纤溶酶原激活剂治疗超时间窗急性脑梗死患者近期预后影响因素分析[J].临床军医杂志,2017,45(8):784-786.
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4李小裴,周盛年.马来酸桂哌齐特联合尤瑞克林治疗急性脑梗死的疗效及对血液流变学和血清IL-10、TNF-α、hs-CRP的影响[J].中西医结合心脑血管病杂志,2018,16(6):785-788.
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6齐秀彦,吕燕,狄钊,等.丁苯酞软胶囊联合基础治疗对老年急性脑梗死患者颈动脉内膜中层厚度及神经功能的影响[J].河北医科大学学报,2018,39(7):757-759,791.
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8蔡楠,何飞,王芳,等.急性脑梗死患者血清神经元特异性烯醇化酶水平与梗死部位、体积及神经功能缺损的相关性[J].山东医药,2018,58(1):73-75.
9 Lai PM,Du R.Association between S100Blevels and long-term outcome after aneurysmal subarachnoid hemorrhage:systematic review and pooled analysis[J].PLoS One,2016,11(3):e0151853.
10 Bradley-Whitman MA,Roberts KN,Abner EL,et al.A novel method for the rapid detection of post-translationally modified visinin-like protein 1in rat models of brain injury[J].Brain Inj,2018,32(3):363-380.
11 Yi XY,Lin J,Luo H,et al.Genetic variants of PTGS2,TXA2Rand TXAS1are associated with carotid plaque vulnerability,platelet activation and TXA2levels in ischemic stroke patients[J].PLoSOne,2017,12(7):e0180704.
12 Wang C,Zhang J,Tang JC,et al.Lysophosphatidic acid induces neuronal cell death via activation of asparagine endopeptidase in cerebral ischemia-reperfusion injury[J].Exp Neurol,2018,306:1-9.
13 You LR,Tang M.The association of high D-dimer level with high risk of ischemic stroke in nonvalvular atrial fibrillation patients:A retrospective study[J].Medicine(Baltimore),2018,97(43):e12622.
14 Bath PM,Krishnan K,Appleton JP.Nitric oxide donors(nitrates),L-arginine,or nitric oxide synthase inhibitors for acute stroke[J].Cochrane Database Syst Rev,2017,21(4):CD000398.
15李美珠,朱嫦琳,梁指荣,等.血清8-羟基脱氧鸟苷酸在急性脑梗死诊断中的应用[J].广东医学,2015,36(20):3191-3193.
16张颖.急性脑梗死患者急性期血清OPN、氧化应激水平的变化及其与神经损伤和预后的关系[J].广东医学,2017,38(9):1386-1389.
17 Lorenzano S,Rost NS,Khan M,et al.Oxidative stress biomarkers of brain damage:hyperacute plasma F2-isoprostane predicts infarct growth in stroke[J].Stroke,2018,49(3):630-637.
18 Mr2i'c-Pelˇc i'c J,Pilipovi'c K,Pelˇc i'c G,et al.Decrease in oxidative stress parameters after post-ischaemic recombinant human erythropoietin administration in the hippocampus of rats exposed to focal cerebral ischaemia[J].Basic Clin Pharmacol Toxicol,2017,121(6):453-464.
19王薇,付长友,臧兆萍,等.脑梗死后患者认知障碍与血清脑源性神经营养因子和神经元特异性烯醇化酶表达的关系[J].中国老年学杂志,2017,37(13):3219-3220.
20 Yueniwati Y,Darmiastini NK,Arisetijono E.Thicker carotid intima-media thickness and increased plasma VEGF levels suffered by post-acute thrombotic stroke patients[J].Int J Gen Med,2016,9:447-452.
21 Liegl R,L9fqvist C,Hellstr9m A,et al.IGF-1in retinopathy of prematurity,a CNS neurovascular disease[J].Early Hum Dev,2016,102:13-19.
2汤海潮,许晓丹,姚懿函,等.动静脉联合应用重组组织型纤溶酶原激活剂治疗超时间窗急性脑梗死患者近期预后影响因素分析[J].临床军医杂志,2017,45(8):784-786.
3马荣,李瑞卿.丁苯酞在超早期脑梗死患者溶栓治疗中的作用[J].山东医药,2018,58(21):80-82.
4李小裴,周盛年.马来酸桂哌齐特联合尤瑞克林治疗急性脑梗死的疗效及对血液流变学和血清IL-10、TNF-α、hs-CRP的影响[J].中西医结合心脑血管病杂志,2018,16(6):785-788.
5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2018[J].中华神经科杂志,2018,51(9):666-682.
6齐秀彦,吕燕,狄钊,等.丁苯酞软胶囊联合基础治疗对老年急性脑梗死患者颈动脉内膜中层厚度及神经功能的影响[J].河北医科大学学报,2018,39(7):757-759,791.
7余敏燕.尤瑞克林联合依达拉奉对ACI的临床疗效及神经功能的影响[J].西南国防医药,2018,28(3):239-241.
8蔡楠,何飞,王芳,等.急性脑梗死患者血清神经元特异性烯醇化酶水平与梗死部位、体积及神经功能缺损的相关性[J].山东医药,2018,58(1):73-75.
9 Lai PM,Du R.Association between S100Blevels and long-term outcome after aneurysmal subarachnoid hemorrhage:systematic review and pooled analysis[J].PLoS One,2016,11(3):e0151853.
10 Bradley-Whitman MA,Roberts KN,Abner EL,et al.A novel method for the rapid detection of post-translationally modified visinin-like protein 1in rat models of brain injury[J].Brain Inj,2018,32(3):363-380.
11 Yi XY,Lin J,Luo H,et al.Genetic variants of PTGS2,TXA2Rand TXAS1are associated with carotid plaque vulnerability,platelet activation and TXA2levels in ischemic stroke patients[J].PLoSOne,2017,12(7):e0180704.
12 Wang C,Zhang J,Tang JC,et al.Lysophosphatidic acid induces neuronal cell death via activation of asparagine endopeptidase in cerebral ischemia-reperfusion injury[J].Exp Neurol,2018,306:1-9.
13 You LR,Tang M.The association of high D-dimer level with high risk of ischemic stroke in nonvalvular atrial fibrillation patients:A retrospective study[J].Medicine(Baltimore),2018,97(43):e12622.
14 Bath PM,Krishnan K,Appleton JP.Nitric oxide donors(nitrates),L-arginine,or nitric oxide synthase inhibitors for acute stroke[J].Cochrane Database Syst Rev,2017,21(4):CD000398.
15李美珠,朱嫦琳,梁指荣,等.血清8-羟基脱氧鸟苷酸在急性脑梗死诊断中的应用[J].广东医学,2015,36(20):3191-3193.
16张颖.急性脑梗死患者急性期血清OPN、氧化应激水平的变化及其与神经损伤和预后的关系[J].广东医学,2017,38(9):1386-1389.
17 Lorenzano S,Rost NS,Khan M,et al.Oxidative stress biomarkers of brain damage:hyperacute plasma F2-isoprostane predicts infarct growth in stroke[J].Stroke,2018,49(3):630-637.
18 Mr2i'c-Pelˇc i'c J,Pilipovi'c K,Pelˇc i'c G,et al.Decrease in oxidative stress parameters after post-ischaemic recombinant human erythropoietin administration in the hippocampus of rats exposed to focal cerebral ischaemia[J].Basic Clin Pharmacol Toxicol,2017,121(6):453-464.
19王薇,付长友,臧兆萍,等.脑梗死后患者认知障碍与血清脑源性神经营养因子和神经元特异性烯醇化酶表达的关系[J].中国老年学杂志,2017,37(13):3219-3220.
20 Yueniwati Y,Darmiastini NK,Arisetijono E.Thicker carotid intima-media thickness and increased plasma VEGF levels suffered by post-acute thrombotic stroke patients[J].Int J Gen Med,2016,9:447-452.
21 Liegl R,L9fqvist C,Hellstr9m A,et al.IGF-1in retinopathy of prematurity,a CNS neurovascular disease[J].Early Hum Dev,2016,102:13-19.