依达拉奉治疗短暂性脑缺血发作疗效及作用机制分析

Curative effect of edaravone in the treatment of patients with transient cerebral ischemia and its mechanism

目的：研究依达拉奉治疗短暂性脑缺血发作（TIA）患者的疗效及作用机制。方法选择2015年1～12月在阳泉市第一人民医院治疗的 TIA 患者92例，按照随机数字表法将患者分成观察组与对照组，各46例。两组均给予常规治疗，观察组在此基础上静脉滴注依达拉奉注射液，两组均治疗2周，比较两组疗效及治疗期间的不良反应，采用酶联免疫吸附试验法（ELISA）检测两组治疗前、治疗后第1天、第4天、第7天、第14天血清肿瘤坏死因子-α（TNF-α），转化生长因子-β1（TGF-β1）及基质金属蛋白酶-9（MMP-9）含量水平，比较治疗前及治疗第14天两组高／低切黏度（HSV ／LSV）、血浆黏度（PV）及纤维蛋白原（Fib）的含量水平。结果观察组总有效率是89．13％，明显高于对照组的71．74％（χ2＝4．420，P ＜0．05）。治疗第14天两组的HSV、LSV、PV 以及 Fib 的水平均明显低于治疗前，且观察组均明显低于对照组，差异均有统计学意义（均 P ＜0．05）。观察组治疗第7天和第14天时的血清 TNF-α[（5．99±2．36）pg／mL、（5．82±2．34）pg／mL]和 TGF-β1[（13．94±3．18）pg／L、（12．33±3．57）pg／L]及 MMP-9水平[（42．94±11．65）ng／mL、（38．26±17．58）ng／mL]均明显低于治疗前，差异有统计学意义（t ＝4．703、6．031、5．667、5．074、7．623、6．150，均 P ＜0．05），且观察组低于同期对照组水平，差异有统计学意义（t ＝2．025、5．344、5．894、2．616、6．120、2．228，均 P ＜0．05）。对照组治疗第14天时上述指标水平均明显低于治疗前，差异有统计学意义（P ＜0．05）。两组治疗期间均未出现严重的药物不良反应。结论依达拉奉治疗 TIA 患者疗效显著，其主要是通过调节患者血流动力学及 TNF-α、TGF-β1及 MMP-9的水平而发挥作用，安全性好，值得推广。

Objective To study the curative effect of edaravone in the treatment of patients with transient cerebral ischemia and its mechanism.Methods 92 patients with TIA treated in our hospital from January 2015 to December 2015 were selected,they were randomly divided into observation group and control group,with 46 cases in each group.Both two groups were given conventional treatment,while the observation group added intravenous infusion of edaravone injection,two groups were treated for 2 weeks.Then,the efficacy and adverse reactions during treatment in two groups were compared.The levels of serum tumor necrosis factor alpha（TNF -α）,transforming growth factor beta 1（TGF -β1）and matrix metalloproteinase -9（MMP -9）were detected by enzyme -linked immunosorbent assay（ELISA）in two groups before treatment and 1d,4d,7d,14d after treatment.The levels of high/low shear viscos-ity（HSV /LSV）,plasma viscosity（PV）,as well as fibrinogen（Fib）were also compared before treatment and 14d after treatment.Results The total effective rate of the observation group was 89.13%,which was significantly higher than 71.74% in the control group（χ2 =4.420,P 〈0.05）.The levels of HSV,LSV,PV and Fib in two groups 14d after treatment were significantly lower than before treatment,which of the observation group were significantly lower than the control group,the differences were statistically significant（P 〈0.05）.The serum levels of TNF -α[（5.99 ± 2.36）pg/mL,（5.82 ±2.34）pg/mL],TGF -β1 [（13.94 ±3.18）pg/L,（12.33 ±3.57）pg/L]and MMP -9 [（42.94 ±11.65）ng/mL,（38.26 ±17.58）ng/mL]in the observation group at 7d and 14d after treatment were sig-nificantly lower than before treatment,the differences were statistically significant （t =4.703,6.031,5.667;5.074, 7.623,6.150;all P 〈0.05）,and which in the observation group were lower than the control group in the same peri-od,the differences were statistically significant（t =2.025,5.344,5.894;2.616,6.120,2.228;all P 〈0.05）.The levels of above indicators 14d after treatment in the control group were significantly lower than before treatment,the differences were statistically significant（P 〈0.05）.There were no serious adverse reactions in the two groups during the treatment.Conclusion Edaravone has obvious curative effect in the treatment of patients with TIA,which works by regulating the hemodynamic and the levels of TNF -α,TGF -β1 and MMP -9,it is safe and worthy of promotion.