超声波对急性脑梗死患者血浆t-PA、PAI-1和D-dimer含量和预后的影响及卫生经济学评价

An evaluation of ultrasonic wave on the content of the t-PA/PAI-1 and D-dimer in stroke patients and health economic parameters

目的探讨超声波对急性脑梗死患者的纤溶系统指标t-PA(组织纤溶酶原激活物)、PAI-1(血浆纤溶酶原激活物抑制物-1)、D-dimer(D-二聚体)及患者预后的影响,并进行卫生经济学评价,为制定出经济有效的、符合我国国情的康复治疗方法提供临床依据。方法共选取发病72h内入院的急性脑梗死患者120例,随机分为超声波治疗组(治疗组)及常规治疗组(对照组),各60例;另外同期选取88例正常健康者纳入健康人组。两组患者均接受神经内科常规药物治疗,治疗组同时给予超声波治疗。所有患者在入院时及治疗3周后进行血浆t-PA、PAI-1、D-dimer的检测及美国国立卫生院卒中量表(NIHSS)评分。随访1年,将死亡及再发缺血性血管病记录为终点事件,对两组患者进行生存分析。采用成本-效果分析进行卫生经济学评价。结果经3周治疗后,发现治疗组疗效明显优于对照组(P<0.05);比较两组患者生存曲线发现,治疗组终点事件发生率(11.7%)明显低于对照组(31.7%),差异具有显著性(P<0.05)。两组患者入院时t-PA水平低于健康人组(P<0.05),PAI-1、D-dimer水平高于健康人组(P<0.05),3周后两组t-PA水平较入院时升高(P<0.05);PAI-1、D-dimer较入院时降低(P<0.05),且治疗组变化幅度较对照组显著(P<0.05)。治疗组患者NIHSS评分每减少1分,需花费人民币1013.5元;而对照组花费1712.2元。结论超声波治疗能上调t-PA及下调PAI-1、D-dimer,对脑梗死患者的疗效及预后具有显著改善作用,而且更为经济。

Objective To elucidate whether the ultrasonic wave can affect the content of the t-PA/PAI-1 and D-dimer and improve the prognosis with regard to health economic evaluation in the patients with acute cerebral infarction.Methods All 120 patients with cerebral infarction within the first 72 hours from stroke onset were randomly divided into the control group and therapy group（60 patients respectively）.All patients received routine treatment,while patients in the therapy group were given additional cerebral ultrasonic wave. In both groups,the blood t-PA/PAI-1 and D-dimer were measured by double antibodies sandwich enzyme linked immunosorbent assay（ELISA） at the time of admission and 3 weeks later.According to National Institute of Health Stroke Scale （NIHSS）,the prognosis was evaluated at the time of admission and 3 weeks later.88 healthy persons were acted as the negative control.The prognosis was evaluated at the time of 1 year later,and the Kappa-Meier technique in survival analysis were used to evaluate the associations between the two groups. The health economic evaluation was determined by using the cost-effectiveness analysis.Results The National Institute of Health Stroke Scale （NIHSS） were significantly lower after therapy than before therapy in each group （ P 〈0.05）,and lower in the therapy group than in the control group （ P 〈0.05）.Survival analysis found the patients in the therapy group had a better prognosis（log-rank test, P 〈0.05）.The cost in therapy group was 1013.5 RMB for one point increment of NIHSS,however,those in control group was 1712.2 RMB.Conclusion Ultrasonic wave could improve the prognosis of patients with acute cerebral infarction through affecting the content of t-PA and PAI-1, and be more economic.