评价颈动脉粥样斑块稳定性在急性脑梗死静脉溶栓治疗中的意义

Role of stablility of Carotid Atherosclerotic Plaques in the treatment in of rtPA Intravenous Thrombolysis On Acute Cerebral Infarction

目的观察颈动脉粥样硬化斑块在急性脑梗死静脉溶栓治疗前的稳定性，分析评价其在急性脑梗死静脉溶栓治疗中的应用价值。方法分析2013年1月-2016年6月在徐州医科大学附属医院行重组人组织型纤溶酶原激活物（Recombinant Tissue Plasminogen Activator，rtPA）静脉溶栓治疗的发病在4．5h的48例急性脑梗死患者，采集所有患者的年龄、性别、溶栓距发病时间、溶栓前血压、溶栓前、溶栓后2h、24h的NIHSS评分，溶栓后3个月mRS等数据，均行急诊颈部血管超声检查、溶栓前抽取静脉血化验脂蛋白相关磷脂酶A2（Lipopmtein—associated phospholipaseA2，Lp-PLA2）和C反应蛋白（C-reactive protein，CRP）。研究对象根据溶栓治疗有效性指标分为缓解组和未缓解组，依据超声检查诊断分为易损斑块组和稳定斑块组。结果rtPA静脉溶栓治疗，48例患者溶栓后2h缓解9例，24h缓解18例，mRS评分0-1的患者26例，与ECASS-3研究结果相似。出血发生率明显低于ECASS-3实验结果（P〈0．05），缓解组患者其超声诊断易损斑块的例数和检出的易损斑块数量均高于稳定斑块组（P〈0．05）；易损斑块组的30例患者，其溶栓后24hNIHSS评分显著低于溶栓前（P〈0．05），mRS评分分0～1的患者，易损斑块组22例，占73.3％，稳定斑块组4例，占22．2％，两组比较差异有统计学意义（P〈0．05）。易损斑块组的Lp—PLA2和CRP值均高于与相应的稳定斑块组（P〈0．05）。结论颈动脉血管动脉粥样硬化斑块稳定性影响急性脑梗死患者rtPA静脉溶栓治疗的效果，不稳定斑块的患者溶栓治疗效果好。颈部动脉血管超声检查结合LV—PLA2、CRP可以快速评价对急性脑梗死患者的动脉粥样硬化斑块的稳定性，指导临床医生选择合理的治疗方案，改善患者预后，具有重要意义。

Objective To assess the character of carotid atherosclerosis in patients with cerebral infarction before the treatmentin of rtPA by intravenous thrombolysis and to verify the effect of it in the treatmentin of rtPA intravenous thrombolysis on acute cerebral infarction. Methods To analyze retrospectively rtPA by intravenous thrombolysis in 48 cases affected by acute cerebral infarction within 4.5h after being attacked. To Collect each patient＇s age, gender, the time of thrombolysis from the attack, blood pressure before thrombolysis, NIHSS scores before thrombolysis and 2 hours, 24 hours after thrombolysis, mRS and other data three month later. Meanwhile, Lp-PLA2, CRP were tested and recorded. The patients were divided into two groups： effective group and ineffective group according to the effectiveness of the thrombolysis. The patients were divided into two groups： Unstable Plaques group and stable Plaques group according to the diagnosis of ultrasound. Results Among 48 cases of patient with acute cerebral infarction accepted rtPA intravenous thrombolysis treatment, 9 cases of which improve 2h after the thrombolysis ,18 cases of which improve 24h after the thrombolysis, 26 cases mRS score 0-1, this result was similar to ECASS-3.The occurrence rate of the cerebral hemorrhage was lower than ECASS-3. In effective group, the number of the patients with unstable plaques and unstable plaques was obviously higher. In Unstable Plaques group, the patients improved on NIHSS and ruRS and the value of Lp-PLA2 and CRP was higher. Conclusion The stability of carotid atherosclerosis affect the results of thrombolysis by rtPA on acute cerebral infarction. The patient with unstable plaque had good curative effect by thrombolytie therapy. The character of carotid atheroselerosis can be quickly assessed by ultrasound , Lp-PLA2 and CRP, guidling the clinician to choose reasonable therapy and improve the prognosis.