介入治疗血管内溶栓联合机械取栓在急性缺血性脑卒中的疗效及对免疫细胞水平的影响研究

Interventional treatment of endovascular thrombolysis combined with mechanical thrombectomy in patients with acute ischemic stroke clinical effect and the impact of immune cells

目的探讨介入治疗血管内溶栓联合机械取栓在急性缺血性脑卒中的疗效及对免疫细胞水平的影响。方法收集2017年1月至2017年12月入院治疗的84例急性缺血性脑卒中患者为研究对象,根据治疗方法不同分为对照组42例和观察组42例。对照组采用介入治疗血管内溶栓治疗,观察组介入治疗血管内溶联合机械取栓治疗,两组患者均连续进行3个月随访,并对患者治疗效果进行评估。采用美国国立卫生院神经功能缺损量表(NIHSS)对两组神经功能缺损情况进行评估;采用FACSCalbur型流式细胞仪测定两组治疗前、治疗后3 d CD3^+、CD4^+、CD8^+、CD4^+/CD8+免疫细胞水平;记录并统计两组治疗后TIMI血流≥2级、病变残余狭窄率、24 h症状性颅内出血、血管急性再闭塞及3个月后病死率,比较两组临床疗效及对免疫细胞水平。结果观察组采用介入治疗血管内溶栓联合机械取栓3个月有效率为92.86%,高于对照组73.18%(P<0.05)。观察组治疗后1个月NIHSS量表评分低于对照组(6.24±1.21 vs. 8.41±1.36,P<0.05)。观察组治疗后3个月CD3^+、CD4^+、CD4^+/CD8^+水平(64.63±4.69、46.86±4.06、2.26±0.42)均高于对照组(55.62±3.81、36.74±3.57、1.49±0.29)(P<0.05);观察组治疗后3个月CD8^+水平低于对照组(20.77±3.12 vs. 24.61±3.43)(P<0.05)。观察组治疗后3个月TIMI血流≥2级率(59.52% vs. 95.24%)、血管急性再闭塞率(7.14% vs. 16.67%)均低于对照组(P<0.05)。结论将介入治疗血管内溶栓联合机械取栓用于急性缺血性脑卒中患者有助于提高临床疗效,减轻神经功能缺损,提高机体免疫细胞水平,能改善患者预后,值得推广应用。

Objective To investigate the clinical effect of interventional treatment of intravascular thrombolysis combined with mechanical thrombectomy in patients with acute ischemic stroke and its effect on immune cells. Methods Eighty-four cases of acute ischemic stroke patients who were hospitalized in December-2017 January 2017 were prospectively studied. According to different treatment methods, 42 cases were divided into control group and 42 cases in observation group. The control group was treated with interventional intravascular thrombolysis, the observation group combined with mechanical thrombectomy, both groups were followed up for 3 months continuously, and the treatment effect was evaluated. The neurological deficits of both groups were evaluated by National Institute of Health Neurological Deficiency Inventory ( NIHSS). The levels of CD3^+, CD4^+, CD8^+ and CD4^+/CD8^+ immune cells in the two groups before and after treatment were measured by FACSCalbur flow cytometry. The levels of TIMI blood flow ≥2, the residual stenosis rate, 24 h symptomatic intracranial hemorrhage, acute reocclusion and mortality after 3 months were recorded and statistically analyzed. The clinical curative effect and immune cell level influences. Results The intervention group treated with endovascular thrombolysis combined with mechanical thrombectomy 3 months, the effective rate was 92. 86%, higher than the control group 73. 18%( P < 0. 05 ). The scores of NIHSS in observation group were lower than those of control group Group ( 6. 24 ± 1. 21 vs. 8. 41 ± 1. 36, P < 0. 05). The levels of CD3^+, CD4^+ and CD4^+/CD8^+ in the observation group at 3 months after treatment were higher(64. 63 ±4.69, 46. 86 ± 4. 06 , 2. 26 ±0. 42) than those in the control group(55. 62 ±3.81, 36.74 ±3.57, 1.49 ±0.29)(P <0. 05). The levels of CD8^+ in the observation group at 3 months after treatment were lower than those in the control group (20.77 ±3. 12 vs. 24. 61 ± 3. 43 ,P V0. 05 ). The TIMI blood flow(59. 52% vs. 95. 24%) level and acute reocclusion of blood(16. 67% vs. 7. 14%) in the observation group at 3 months after treatment were lower than the control group ( P < 0. 05 ). Conclusion The interventional treatment of intravascular thrombolysis combined with mechanical embolectomy in patients with acute ischemic stroke help to improve clinical efficacy, reduce neurological deficits, improve immune cell level. It improves the prognosis of patients, it is of great worth to promote the application.