机械介入取栓术联合rt-PA溶栓治疗对急性脑梗死患者血清PON-1、hs-CRP、Lp-PLA2、NSE水平及神经功能评分的影响

Effects of mechanical intervention with thrombolysis combined with rt-PA thrombolysis on serum PON-1,hs-CRP,Lp-PLA2,NSE and neurological function scores in patients with acute cerebral infarction

目的探讨机械介入取栓术联合重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗对急性脑梗死患者血清对氧磷酶(PON)-1、超敏C反应蛋白(hs-CRP)、脂蛋白相关磷酯酶(Lp-PL)A2、神经元特异性烯醇化酶(NSE)水平及神经功能评分的影响。方法急性脑梗死患者82例按照随机数字法分为观察组和对照组,每组41例。对照组给予rt-PA静脉溶栓治疗,观察组在对照组的基础上联合机械取栓治疗。疗程结束后,比较两组治疗总有效率,血清PON-1、hs-CRP、Lp-PLA2、NSE水平,改良RANKIN量表(mRS)评分、Barthel指数(BI)评分、美国国立卫生研究院脑卒中量表(NIHSS)评分及两组不良反应发生率。结果观察组治疗总有效率(97.56%)明显高于对照组(80.49%;χ~2=6.12,P=0.01)。治疗后,观察组血清PON-1明显高于对照组,hs-CRP、Lp-PLA2、NSE水平明显低于对照组(P<0.05);观察组mRS评分、NIHSS评分明显低于对照组,BI评分明显高于对照组(P<0.05);观察组总不良反应发生率(7.32%)明显低于对照组(24.39%;χ~2=4.48,P=0.03)。结论机械介入取栓术联合rt-PA溶栓治疗急性脑梗死患者的临床疗效显著,且能有效改善血清PON-1、hs-CRP、Lp-PLA2、NSE水平及神经功能。

Objective To investigate the effects of mechanical intervention thrombectomy combined with rt-PA thrombolysis on ser- um PON-1, hs-CRP, Lp-PLA2, NSE and neurological function scores in patients with acute cerebral infarction. Methods 82 subjects were divided into observation and control groups with 41 cases in each group. All patients were admitted to hospital after oxygen and ECG monito- ring closely observed vital signs, improved blood routine, blood glucose and other laboratory tests, while given decreasing blood pressure, re- leasing brain edema and aspirin antiplatelet support symptomatic treatment. On the basis of this, patients in control group received rt-PA in- travenous thrombolytic therapy, and were combined with mechanical thrombectomy in observation group on the basis of the control group. The levels of serum PON-1, hs-CRP, Lp-PLA2, NSE, mRS score, BI index, NIHSS score and adverse effect of two groups were compared. Re- suits The total effective rate （97.56%） was significantly higher in observation group than in control group （80.49% ,X2 = 6.12, P = 0.01 ）. After treatment with different regimens, the serum PON-1 in observation group was significantly higher than that in control group. The levels of hs-CRP, Lp-PLA2 and NSE were significantly lower than those in control group （P〈0.05）. The scores of mRS and NIHSS were significantly lower than those of control group, and the score of BI index was significantly higher than that of control group （P〈0.05）. The incidence of total adverse effect in observation group was significantly lower than that in control group （24.39% ,X^2 =4.48 ,P=0.03 ）. Conclusions The clinical effect of mechanical intervention with thrombectomy combined with rt-PA thrombolysis in the treatment of acute cerebral infarction is significant, and which could effectively improve the serum levels of PON-1, hs-CRP, Lp-PLA2, NSE and neurological function in patients with clinical application.