前列地尔对多发性腔隙性脑梗死患者的血液流变学指标的影响

Effect of alprostadil on hemorrheologlcal indicators of patients with multiple lacunar infarcts

目的 观察前列地尔对多发性腔隙性脑梗死患者的血液流变学指标的影响.方法 146例多发性腔隙性脑梗死患者采用随机数字表法分为观察组76例和对照组70例,两组均被给予常规治疗,观察组加用前列地尔.采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能缺损程度,采用简易精神状态检查表（MMSE）评价认知功能,监测血液流变学指标和甲襞微循环积分,观察两组出现的药物不良反应.结果 两组治疗后的MMSE评分[（24.09±3.88）分、（22.41±4.06）分]比治疗前明显升高,NIHSS评分[（3.67±1.39）分、（4.35±1.62）分]比治疗前明显下降（=7.241、21.095、6.017、14.179,均P＜0.05）;观察组治疗后MMSE评分高于对照组、NIHSS评分低于对照组（t=2.556、2.728,均P＜0.05）.治疗后,两组的全血低切黏度、全血高切黏度、血浆黏度、红细胞沉降率、红细胞聚集指数、红细胞刚性指数、血小板聚集率、纤维蛋白原[（11.80±3.65） mPa/s、（10.90±2.05） mPa/s、（1.90±0.48） mPa/s、（12.64±3.53） mm/h、（5.05±1.28）、（5.74±1.20）、（56.92±13.49）％、（2.97±0.55） g/L、（17.37±3.87）mPa/s、（12.86±2.64） mPa/s、（2.16±0.58）mPa/s、（19.70±4.26）mm/h、（6.48±1.79）、（6.80±1.73）、（62.88±13.74）％、（3.52±0.64） g/L]均比治疗前下降,红细胞变形指数[（0.78±0.15）、（0.68±0.12）]上升（=24.497、15.398、16.814、24.146、14.709、8.558、10.940、46.550、11.591、10.895、13.755、13.791、6.971、5.140、4.782、4.592、9.357,均P＜0.05）;治疗后观察组的各项血液流变学指标比对照组改善程度更大（t=8.949、5.032、2.960、10.936、5.585、4.424、4.330、2.643、5.582,均P＜0.05）.治疗后两组的管袢形态、管袢流态、袢周状态评分[（1.14±0.35）分、（1.64±0.45）分、（2.07±0.29）分、（1.30±0.37）分、（1.85±0.60）分、（2.66±0.38）分]比治疗前明显下降（t=5.818、14.220、30.083、3.580、7.715、9.933,均P＜0.05）;观察组治疗后的管袢形态、管袢流态、袢周状态评分均低于对照组（t =2.685、2.404、10.595,均P＜0.05）.观察组不良反应发生率7.89％ （6/76）,对照组不良反应发生率7.14％ （5/70）;两组差异无统计学意义（x^2=0.030,P＞0.05）.结论 加用前列地尔治疗多发性腔隙性脑梗死,可有效改善血液流变学和微循环指标,从而改善患者的神经缺损与认知功能,药物不良反应发生率较低,具有较高的临床应用价值.

Objective To observe the effect of alprostadil on hemorrheological indicators of patients with multiple lacunar infarcts.Methods 146 cases with multiple lacunar infarcts were randomly divided into observation group（76 cases） and control group（70 cases） by using the method of random number table.The two groups were given conventional treatment.In addition to this,the observation group was treated with alprostadil.NIHSS was used to evaluate neurological deficits,MMSE was used to evaluate cognitive function.The indicators of hemorheology and nailfold microcirculation integral were detected,adverse drug reactions of the two groups were observed.Results After treatment,the MMSE scores of the two groups [（24.09 ±3.88）points,（22.41 ±4.06）points] were significantly higher than before treatment,the NIHSS scores [（3.67 ± 1.39） points,（4.35 ± 1.62） points] decreased significantly （t =7.241,21.095,6.017,14.179,all P 〈 0.05）.After treatment,the MMSE score of the observation group was higher than that of the control group（t =2.556,P 〈0.05）,the NIHSS score of the observation group was lower than that of the control group （t =2.728,P 〈 0.05）.After treatment,the low blood viscosity,whole blood viscosity,plasma viscosity,erythrocyte sedimentation rate,erythrocyte aggregation index,erythrocyte rigidity index,platelet aggregation rate,fibrinogen of the two groups [（11.80 ± 3.65） mPa/s,（10.90 ± 2.05） mPa/s,（1.90 ± 0.48） mPa/s,（12.64 ± 3.53） mm/h,（5.05 ± 1.28）,（5.74 ± 1.20）,（56.92 ± 13.49） %,（2.97 ± 0.55） g/L,（17.37 ± 3.87） mPa/s,（12.86 ±2.64） mPa/s,（2.16 ±0.58） mPa/s,（19.70 ±4.26） mm/h,（6.48 ± 1.79）,（6.80 ± 1.73）,（62.88 ± 13.74）%,（3.52 ± 0.64）g/L] decreased than before treatment,and erythrocyte deformation index [（0.78 ± 0.15）,（0.68 ±0.12）] increased （t =24.497,15.398,16.814,24.146,14.709,8.558,10.940,46.550.11.591,10.895,13.755,13.791,6.971,5.140,4.782,4.592,9.357,all P 〈 0.05）.After treatment,the blood rheology indicators of the observation group improved more significantly than those of the control group （t =8.949,5.032,2.960,10.936,5.585,4.424,4.330,2.643,5.582,all P 〈 0.05）.After treatment,the loop shape,loop pattern,periloop state scores of the two groups [（1.14 ± 0.35） points,（1.64 ± 0.45） points,（2.07 ± 0.29） points,（1.30 ± 0.37） points,（1.85 ± 0.60） points,（2.66 ±0.38） points] decreased significantly than those before treatment （t =5.818,14.220,30.083,3.580,7.715,9.933,all P 〈 0.05）.After treatment,the loop shape,loop pattern,periloop state scores of the observation group were lower than those of the control group （t =2.685,2.404,10.595,all P 〈 0.05）.The incidence rate of adverse reaction of the observation group was 7.89% （6/76）,which of the control group was 7.14% （5/70）,the difference was not statistically significant between the two groups（x^2 =0.030,P 〉 0.05）.Conclusion In the treatment of multiple lacunar infarcts,alprostadil can effectively improve hemorrheological and nailfold microcirculation integral indicators,improve the nerve defect and cognitive function of patients,the incidence rate of adverse reaction is low,it has high value in clinical application.