摘要
目的观察吡拉西坦联合阿替普酶(rt-PA)溶栓治疗急性脑梗死(AIS)的疗效,探讨其对患者认知功能、血清同型半胱氨酸(Hcy)、单核细胞趋化蛋白1 (MCP-1)水平的影响。方法选取2017年10月至2019年12月西安市第九医院收治的AIS患者106例,按随机数表法分为观察组和对照组各53例。在常规治疗基础上,对照组给予rt-PA溶栓,观察组给予吡拉西坦联合rt-PA静脉溶栓,均治疗14 d。治疗后比较两组患者的疗效、不良反应,以及治疗前后的神经功能缺损程度评分(NIHSS)、认知功能评分(MMSE)、脑血流动力学指标[平均血流速度(Vmean)、平均血流量(Qmean)、脑血管外周阻力(R)、特征性阻抗(ZCV)]、血清炎性细胞因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)、超敏C反应蛋白(hs-CRP)]和Hcy、MCP-1水平。结果观察组患者的治疗总有效率为94.34%,明显高于对照组的79.25%,差异有统计学意义(P<0.05);观察组患者治疗后的NIHSS评分为(8.15±1.62)分,明显低于对照组的(9.86±2.13)分,MMSE评分为(25.60±4.12)分,明显高于对照组的(21.45±3.68)分,差异均有统计学意义(P<0.05);观察组患者治疗后的Vmean和Qmean分别为(18.06±3.92) cm/s、(9.62±2.13) mL/s,明显高于对照组的(15.13±3.46) cm/s、(7.38±1.79) m L/s,R和ZCV分别为(76.18±9.53)(kPa·s)/m、(13.29±2.46)(kPa·s)/m,明显低于对照组的(95.27±11.60)(kPa·s)/m、(17.06±2.87)(kPa·s)/m,差异均有统计学意义(P<0.05);观察组和对照组患者治疗后的血清TNF-α[(10.76±2.42) pg/mL vs (13.19±2.80) pg/mL]、IL-6 [(11.52±2.29) pg/mL vs (15.80±3.05) pg/mL]、hs-CRP[(6.02±1.87) mg/L vs (8.74±2.23) mg/L]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组治疗后的血清Hcy和MCP-1分别为(16.42±2.17)μmol/L、(92.58±8.29) pg/mL,明显低于对照组的(20.85±3.06)μmol/L、(116.97±12.41) pg/mL,差异均有统计学意义(P<0.05);观察组和对照组患者的不良反应发生率分别为13.21%、16.98%,差异无统计学意义(P>0.05)。结论吡拉西坦联合rt-PA静脉溶栓治疗AIS疗效确切,其可有效抑制炎性因子水平,降低血清Hcy、MCP-1水平,进一步减轻认知功能障碍,促进神经功能恢复。
Objective To observe the efficacy of piracetam combined with alteplase(recombinant tissue plasminogen activator,rt-PA)in the treatment of acute ischemic stroke(AIS),and to explore its effect on patients'cognitive function,serum homocysteine(Hcy),and monocyte chemotaxis protein 1(MCP-1)levels.Methods From October 2017 to December 2019,106 AIS patients admitted to Xi'an Ninth Hospital were selected and divided into study group and control group with 53 cases each,according to the random number table method.On the basis of conventional treatment,the control group was given rt-PA thrombolysis,and the study group was given piracetam combined with rt-PA intravenous thrombolysis,all treated for 14 days.After treatment,the curative effect,adverse reactions,neurological deficit score(NIHSS),cognitive function score(MMSE),and cerebral hemodynamic indexes(mean blood flow velocity[Vmean],average blood flow[Qmean],cerebrovascular peripheral resistance[R],characteristic Impedance[ZCV]),serum inflammatory cytokine indicators(tumor necrosis factor-α[TNF-α],interleukin-6[IL-6],high-sensitivity C-reactive protein[hs-CRP]),and Hcy and MCP-1 levels before and after treatment of the two groups were compared.Results The total effective rate of treatment in the observation group was 94.34%,which was significantly higher than 79.25%of the control group(P<0.05).The NIHSS score of the observation group after treatment was(8.15±1.62)points,which was significantly lower than(9.86±2.13)points of the control group.The MMSE score was(25.60±4.12)points,which was significantly higher than(21.45±3.68)points of the control group(P<0.05).The Vmean and Qmean of the observation group after treatment were(18.06±3.92)cm/s and(9.62±2.13)mL/s,which were significantly higher than(15.13±3.46)cm/s and(7.38±1.79)mL/s of the control group.R and ZCV were(76.18±9.53)(kPa·s)/m and(13.29±2.46)(kPa·s)/m,respectively,which were significantly lower than(95.27±11.60)(kPa·s)/m and(17.06±2.87)(kPa·s)/m of the control group(P<0.05).Serum TNF-α,IL-6,and hs-CRP of the observation group were significantly lower than those in the control group(P<0.05):TNF-α,(10.76±2.42)pg/mL vs(13.19±2.80)pg/mL;IL-6,(11.52±2.29)pg/mL vs(15.80±3.05)pg/mL;hs-CRP,(6.02±1.87)mg/L vs(8.74±2.23)mg/L.Serum Hcy and MCP-1 of the observation group after treatment were(16.42±2.17)μmol/L and(92.58±8.29)pg/mL,which were significantly lower than(20.85±3.06)μmol/L and(116.97±12.41)pg/mL of the control group(P<0.05).The incidence of adverse reactions in the observation group and the control group were 13.21%and 16.98%,respectively,and the difference was not statistically significant(P>0.05).Conclusion Piracetam combined with rt-PA intravenous thrombolysis has a definite effect in the treatment of AIS.It can effectively inhibit inflammatory factor levels,reduce serum Hcy and MCP-1 levels,further reduce cognitive dysfunction,and promote neurological function recovery.
作者
袁博博
舒庆
马冉冉
李燕青
李建瑞
YUAN Bo-bo;SHU Qing;MA Ran-ran;LI Yan-qing;LI Jian-rui(Department of Neurology,Xi'an No.9 Hospital,Xi'an 710054,Shaanxi,CHINA;Transformation Medical Center,Xi'an No.9 Hospital,Xi'an 710054,Shaanxi,CHINA;Second Department of Neurology,521 Hospital of Ordnance Industry,Xi'an 710065,Shaanxi,CHINA)
出处
《海南医学》
CAS
2020年第23期3008-3012,共5页
Hainan Medical Journal
