DTI NSE评估达比群酯治疗房颤并脑栓塞患者运动康复的临床研究

Clinical study of dabigatran etexilateon rehabilitation in patients with atrial fibrillation combined with cerebral embolism by DTI and NSE

目的应用头颅磁共振弥散张量成像(DTI)、血清神经元特异性烯醇化酶(NSE)评估达比加群酯在房颤并发脑栓塞患者运动康复中的作用。方法选取2017年12月-2018年12月在郑州大学第二附属医院神经康复科、心内科、神经内科、神经外科、老干科、ICU收治的30例房颤并脑栓塞患者进行临床观察,分为达比加群酯组(观察组)和华法林组(对照组)。治疗观察3个月,对治疗前NSE、及治疗前后DTI感兴趣区(ROI)的FA、rFA、FAasy及运动功能损害程度FMA评分来评测疗效,分析两组患者运动功能康复的情况。结果观察组、对照组治疗前的一般资料、各项评分、NSE差异均无统计学意义。观察组治疗3个月后DTI感兴趣区(ROI)的FA、rFA、FAasy及FMA评分与治疗前比较,差异具有统计学意义(P<0.05)。对照组治疗3个月后DTI感兴趣区(ROI)的FA、rFA、FAasy及FMA评分与治疗前比较,差异具有统计学意义(P<0.05)。两组患者治疗后反应神经功能预后的Rankin量表(mRS)评分差异具有统计学意义(P<0.05)。观察组和对照组治疗后FMA评分变化值其差异具有统计学意义(P<0.05)。结论应用达比加群酯治疗房颤合并脑栓塞可以明显改善患者的运动功能康复。

Objective To evaluate the effect of dabigatran etexilate on motor rehabilitation in patients with atrial fibrillation complication with cerebral embolism by DTI and NSE.Methods Totally 30 patients with atrial fibrillation complication with cerebral embolism admitted to the department of neurological rehabilitation, department of cardiology, department of neurosurgery,department of aging and ICU of the Second Affiliated hospital of Zhengzhou university from December 2017 to December 2018 were selected for clinical observation,and were divided into dabigatran etexilate(observation group) and warfarin group(control group).Three months after treatment,the efficacy was evaluated by NSE before the treatment and by FA、rFA、FAasy and FMA scores of the area of interest(ROI)of DTI before and after treatment,and the motor function rehabilitation of the patients in the two groups was analyzed.Results There were no significant differences in general data,scores and NSE between the observation group and the control group before treatment. FA,rFA,FAasy and FMA scores of the DTI region of interest(ROI)in the observation group after 3 months of treatment were significantly different from those before treatment(P<0.05).The FA,rFA,FAasy and FMA scores of the DTI region of interest(ROI)in the control group after 3 months of treatment were significantly different from those before treatment(P<0.05).The Rankin scale(mRS)score of the patients in the two groups had statistical significance(P<0.05).The difference of the change of FMA score between the observation group and the control group after treatment was statistical significance(P<0.05).Conclusion The treatment of atrial fibrillation with cerebral embolism with dabigatran etexilate can significantly improve the motor function rehabilitation of patients.