重组组织型纤溶酶原激活剂联合依达拉奉右莰醇对缺血性脑卒中患者的临床疗效

doi:10.3760/cma.j.issn.1007-1245.2024.07.015

摘要/Abstract

摘要：

目的　评估重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓疗法联合依达拉奉右莰醇对缺血性脑卒中（IS）患者神经功能和氧化应激的影响。方法　选取2020年1月至2023年10月在宝鸡高新医院接受治疗的78例IS患者进行随机对照试验，按随机数表法分为两组，各39例。对照组男23例、女16例，年龄（63.03±6.42）岁，病程（31.12±6.43）h，接受rt-PA静脉溶栓治疗；观察组男22例、女17例，年龄（62.88±6.29）岁，病程（30.74±6.39）h，在对照组基础上配合依达拉奉右莰醇治疗（依达拉奉右莰醇15 ml加入100 ml生理盐水中静脉给药，2次/d）。两组均治疗2周。对比两组治疗前后的疗效、神经功能评分［美国国立卫生研究院脑卒中量表（NIHSS）和改良Rankin量表（mRS）］、氧化应激指标［谷胱甘肽过氧化物酶（GSH-Px）、超氧化物歧化酶（SOD）、丙二醛（MDA）、活性氧（ROS）］和炎症因子指标［白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）］。统计学方法采用χ²检验、t检验。结果　治疗2周后，观察组总有效率高于对照组［79.49%（31/39）比56.41%（22/39）］，差异有统计学意义（χ²=4.77，P<0.05）；治疗2周后，观察组NIHSS和mRS评分均低于对照组［（7.87±0.96）分比（9.88±1.83）分、（1.78±0.14）分比（2.04±0.21）分］，差异均有统计学意义（t=6.07、6.43，均P<0.05）。治疗2周后，观察组GSH-Px、SOD均高于对照组［（219.78±24.13）mg/L比（189.88±23.12）mg/L、（154.78±11.95）U/ml比（138.67±13.16）U/ml］、MDA、ROS均低于对照组［（47.01±5.64）μmol/L比（51.94±6.34）μmol/L、（508.57±36.34）μmol/L比（576.34±38.44）μmol/L］，差异均有统计学意义（t=5.59、5.66、3.63、8.00，均P<0.05）。治疗2周后，观察组血清中IL-6、TNF-α及hs-CRP水平均低于对照组［（8.45±3.12）ng/L比（13.67±3.96）ng/L、（0.72±0.28）ng/L比（1.23±0.34）ng/L、（9.67±4.28）ng/L比（14.78±4.55）ng/L］，差异均有统计学意义（t=6.47、7.23、5.11，均P<0.05）。结论　rt-PA静脉溶栓联合依达拉奉右莰醇可改善IS患者的治疗疗效、神经功能，且降低氧化应激水平和炎症因子水平，较单独使用rt-PA具有更好的治疗效果。

关键词:

重组组织型纤溶酶原激活剂, 依达拉奉右莰醇, 缺血性脑卒中, 神经功能, 氧化应激

Abstract:

Objective　To evaluate the effect of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) combined with edaravone dexborneol on neurologic function and oxidative stress in patients with ischemic stroke (IS). Methods　Seventy-eight patients with IS treated in Baoji Gaoxin Hospital from January 2020 to October 2023 were selected for the randomized controlled trial. They were divided into a control group and an observation group by the random number table method, with 39 cases in each group. There were 23 males and 16 females in the control group; they were (63.03±6.42) years old; their disease course was (31.12±6.43) h. There were 22 males and 17 females in the observation group; they were (62.88±6.29) years old; their disease course was (30.74±6.39) h. The control group took intravenous thrombolysis by rt-PA; in addition, the observation group were treated with edaravone dexborneol. The treatment efficacies, scores of neurological function [National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS)], and levels of oxidative stress indicators [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), malondialdehyde (MDA), and reactive oxygen species (ROS)] and inflammatory markers [interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and high-sensitivity c-reactive protein (hs-CRP)] were compared between the two groups. χ² and t tests were applied. Results　After two weeks' treatment, the overall efficacy in the observation group was higher than in the control group [79.49% (31/39) vs. 56.41% (22/39)], with a statistical difference (χ²=4.77; P<0.05). After two weeks' treatment, the scores of NIHSS and mRS in the observation group were lower than those in the control group [(7.87±0.96) vs. (9.88±1.83) and (1.78±0.14) vs. (2.04±0.21)], with statistical differences (t=6.07 and 6.43; both P<0.05). After two weeks' treatment, the levels of GSH Px, SOD, MDA, and ROS in the observation group were better than those in the control group [(219.78±24.13) mg/L vs. (189.88±23.12) mg/L, (154.78±11.95) U/ml vs. (138.67±13.16) U/ml, (47.01±5.64) μmol/L vs. (51.94±6.34) μmol/L, and (508.57±36.34) μmol/L vs. (576.34±38.44) μmol/L], with statistical differences (t=5.59, 5.66, 3.63, and 8.00; all P<0.05). After two weeks' treatment, the serum levels of IL-6, TNF-α, and hs-CRP in the observation group were lower than those in the control group [(8.45±3.12) ng/L vs. (13.67±3.96) ng/L, (0.72±0.28) ng/L vs. (1.23±0.34) ng/L, and (9.67±4.28) ng/L vs. (14.78±4.55) ng/L], with statistical differences (t=6.47, 7.23, and 5.11; all P<0.05). Conclusion　Intravenous thrombolysis by rt-PA combined with edaravone dexborneol for patients with IS can significantly improve the treatment efficacy and their neurological function and reduce the levels of oxidative stress and inflammatory factors, and has better therapeutic effects than rt-PA alone.

Key words:

Recombinant tissue plasminogen activator, , Edaravone dexborneol, , Ischemic stroke, Neurological function, Oxidative stress

张小静王晓琴屈源.

重组组织型纤溶酶原激活剂联合依达拉奉右莰醇对缺血性脑卒中患者的临床疗效 [J]. 国际医药卫生导报, 2024, 30(7): 1131-1136.

Zhang Xiaojing, Wang Xiaoqin, Qu Yuan.

Clinical effect of rt-PA combined with edaravone dexborneol for patients with ischemic stroke [J]. International Medicine and Health Guidance News, 2024, 30(7): 1131-1136.

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