银杏内酯注射液对脑梗死患者再灌注后血脑屏障的影响

Effect of Ginkgolide Injection on Blood-Brain Barrier after Reperfusion in Patients with Cerebral Infarction

目的探讨银杏内酯注射液对脑梗死患者再灌注后血脑屏障通透性和神经细胞凋亡分子表达水平的影响。方法选取2017年5月—2019年5月期间收治的脑梗死(cerebral infarction,CI)患者90例为研究对象,随机分为对照组和观察组,每组45例。对照组接受常规静脉溶栓治疗并口服尼莫地平片,观察组在常规静脉溶栓治疗的基础上接受银杏内酯注射液治疗。对比两组治疗效果,治疗前后血脑屏障功能(血清白蛋白、脑脊液白蛋白、血脑屏障指数),神经细胞凋亡分子[半胱氨酸蛋白酶-3(Caspasc-3)、B淋巴细胞瘤-2(Bcl-2)、Bcl-2关联X的蛋白质(Bax)]表达水平,缺血半暗带区脑灌注成像参数[脑血流量(rCBF)、脑血容量(rCBV)、脑血流达峰值时间(rTTP)]变化以及不良反应发生情况。结果观察组患者的总有效率86.67%(39/45)显著高于对照组66.67%(30/45)(P<0.05);治疗后观察组的脑脊液白蛋白水平、血脑屏障指数、Caspasc-3、Bax水平、rTTP显著低于对照组(P<0.05);治疗后观察组的Bcl-2水平、rCBF、rCBV显著高于对照组(P<0.05);治疗期间观察组患者的不良反应发生率13.33%(6/45)显著低于对照组的31.11%(14/45)(P<0.05)。结论银杏内酯注射液可以改善脑梗死患者再灌注后血脑屏障功能,减轻缺血再灌注过程中细胞凋亡引起的损伤且更安全。

Objective To explore the effects of Ginkgolide Injection on permeability of blood-brain barrier(BBB)and expression levels of neurons apoptosis molecules in cerebral infarction(CI)patients after reperfusion.Methods Ninety CI patients who were admitted from May 2017 to May 2019 were enrolled as the research objects.They were randomly divided into control group and observation group,45 cases in each group.The control group was treated with routine intravenous thrombolysis and oral nimodipine tablets,while the observation group was treated with Ginkgolide Injection after routine intravenous thrombolysis.The curative effect,changes in BBB function[serum albumin,albumin in cerebrospinal fluid(CSF),BBB index],expression levels of neurons apoptosis molecules[cysteine protease-3(Caspasc-3),B-cell lymphoma-2(Bcl-2),Bcl-2 associated protein(Bax)]and cerebral perfusion imaging parameters in ischemic penumbra[relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative time to peak(rTTP)]before and after treatment,and the occurrence of adverse reactions were compared between the two groups.Results The total response rate of the observation group was significantly higher than that of the control group[86.67%(39/45)vs 66.67%(30/45)](P<0.05).After treatment,levels of CSF albumin,BBB index,Caspase-3,Bax and rTTP in the observation group were significantly lower than those in the control group(P<0.05),while levels of Bcl-2,rCBF and rCBV were significantly higher than those in the control group(P<0.05).The incidence of adverse reactions during treatment in the observation group was significantly lower than that in the control group[13.33%(6/45)vs 31.11%(14/45)](P<0.05).Conclusion Ginkgolide Injection can improve BBB function after reperfusion in CI patients and reduce damage caused by cell apoptosis during ischemia-reperfusion and it is safe.