急性缺血性脑卒中伴脑微出血早期降纤治疗的临床观察

Clinical observation of early defibrinogen therapy in patients with acute ischemic stroke complicating cerebral microbleeds

目的探讨早期降纤治疗急性缺血性脑卒中(AIS)伴脑微出血(CMBs)的临床疗效和安全性。方法 136例急性脑梗死患者均分为降纤治疗(A)组和对照(C)组。C组采用血栓通注射液和阿司匹林治疗;A组加用东菱迪芙治疗。治疗前后进行神经功能缺损程度评分,并测定纤维蛋白原(Fib)、D-二聚体(D-D)等指标。应用核磁共振磁敏感加权成像(SWI)对治疗前后CMBs数目进行观察及分级。结果与C组比较,A组神经功能缺损评分和临床疗效的改善明显(P<0.05),总有效率明显高于C组(83.82%vs.69.12%)(P<0.05),治疗后Fib降低,D-D升高(P<0.05)。SWI显示,两组治疗后CMBs的数目大多都呈上升趋势;但A组出现3例出血转化。结论应用降纤药早期治疗AIS伴CMBs的临床疗效显著,但存在CMBs的出血转化风险。

Objective To investigate the efficacy and safety of early defibrinogen therapy in the patients with acute ischemic stroke （AIS） complicating cerebral microbleeds （CMBs）. Methods A total of 136 patients with AIS complicating CMBs was equally randomized into two groups of C （treated with Xueshuantong injection and aspirin） and A（treated with additional DF-521）. A modified Edinburgh-Scandinavian stroke scale （MESSS） was used to evaluate neural function. Plasma fibrinogen and D-dimer were detected before and after therapy. The number of CMBs was examined by MR susceptibility weighted imaging（SWI） as well. Results Compared to group C, the improvement of neural function evaluated by MESSS after treatment was more in group A （ P〈0. 05 ）. The total effectiveness rate was higher in group A than that in group C（83.82% vs. 69.12%） （P〈0. 05）. Compared to group C, plasma fibrinogen was lower and D-dimer was higher in group A（P〈0. 05）. SWI showed that the number of CMBs had a tendency of increasing in both groups after treatment. There were three cases turning to cerebral hemorrhage in group A. Conclusion The efficacy of early defibrinogen therapy is significant in AIS patients with CMBs. But the risk of turning to cerebral hemorrhage still exists.