阿替普酶溶栓对急性缺血性脑卒中患者炎性因子及同型半胱氨酸水平的影响

Effect of thrombolytic therapy with ateplase on inflammatory cytokines and Hcy levels in patients with acute cerebral ischemic stroke

目的观察阿替普酶溶栓治疗急性缺血性脑卒中（ACIS）的临床疗效及其对患者血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、同型半胱氨酸（Hcy）水平的影响。方法选取接受救治的ACIS患者84例为观察对象。采用随机数字表法分为对照组和观察组各42例。对照组给予ACIS常规治疗，观察组在对照组的基础上联用阿替普酶溶栓治疗。比较两组的临床疗效，观察两组治疗前、治疗后24h、治疗后14d美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数变化，以及治疗前、治疗后14d血清IL-6、TNF-α、Hey水平。结果观察组总有效率为95．24％，明显高于对照组的78．57％（χ^2=5．126，P〈0．05）。观察组治疗后24h、治疗后14d的NIHSS评分分别为（7．41±1．52）分、（5．48±0．93）分，均显著低于对照组的（9．69±2．08）分、（8．07±1．35）分（t=5．736、10．239，均P〈0．05）。观察组治疗后24h、治疗后14d的Barthel指数评分分别为（79．48±5．83）分、（86．21±4．33）分，均显著高于对照组的（54．87±5．51）分、（67．22±4．27）分（t=19．882、20．237，均P〈0．05）。治疗后14d，观察组的IL-6、TNF-α、Hcy水平分别为（7．61±1．39）ng／L、（5．05±0．66）ng／L、（11．19±2．81）μmol／L，均显著低于对照组的（9．29±1．57）ng／L、（8．79±0．93）ng／L、（15．67±2．32）μmol／L（t=5．192、21．254、7．968，均P〈0．05）。结论阿替普酶溶栓治疗ACIS患者疗效显著，能有效改善患者神经缺损以及提高患者生活能力，降低血清IL-6、TNF-α及Hey水平，值得临床推广。

Objective To study the clinical curative effect of thrombolytic therapy with ateplase on acute cerebral ischemic stroke （ACIS） and its effect on serum interleukin - 6 （ IL - 6 ）, tumor necrosis factor - α （ TNF - α） and homocysteine（Hcy） levels. Methods 84 patients with ACIS were selected as observation subjects,and they were divided into observation group and control group according to the random table method,42 cases in each group. The control group was given conventional treatment of ACIS, and the observation group was given thrombolytic therapy with ateplase on the basis of conventional treatment. The clinical efficacy of the two groups was compared, the National Institutes of Health Stroke Scale （NIHSS） scores, Barthel index changes before treatment and 24h, 14d after treat- ment,the IL- 6,TNF-α and Hcy levels before treatment and 14d after treatment of the two groups were observed and compared. Results The total effective rate of the observation group was 95.24%, which was significandy higher than 78.57% of the control group（ χ^2 = 5. 126,P 〈 0.05 ）. The NIHSS scores of the observation group 24h and 14d after treatment were （7.41 ± 1.52） points and （5.48 ± 0.93 ） points, respectively, which were significantly lower than （9.69±2.08）points and （8.07± 1.35） points of the control group（t =5. 736,10. 239,all P 〈0.05）. The Barthel index scores of observation group 24h and 14d after treatment were （79. 48 ± 5. 83 ） points and （86. 21 ± 4.33 ） points, respectively, which were significantly higher than （ 54.87 ± 5.51 ） points and （ 67.22± 4.27 ） points of the control group（ t = 19. 882,20.237, all P 〈 0. 05 ）. 14d after treatment, the levels of IL - 6, TNF - α and Hey in the observation group were （ 7.61 ± 1.39 ） ng/L, （5.05 ± 0.66 ） ng/L, （ 11.19 ± 2.81 ） μmol/L, respectively, which were significantly lower than （9.29 ± 1.57 ） ng/L, （ 8.79±0.93 ） ng/L, （ 15.67 ± 2.32 ） μmol/L in the control group （ t = 5. 192,21. 254,7. 968, all P 〈 0. 05）. Conclusion The effect of thrombolytic therapy with ateplase for ACIS patients is Significant, which can effectively improve the NIHSS and Barthel index scores, and reduce the serum levels of IL - 6, TNF -α and Hey. It is worthy of clinical promotion.