阿加曲班联合乌司他丁对急性缺血性脑卒中病人血清Lp-PLA2和ADAMTS-1水平的影响

Effect of argatroban combined with ulinastatin on serum levels of Lipoprotein-associated phospholipase A2 and a distintegrin and metalloprotease with thrombospondin type 1 motifs in patients with acute ischemic stroke

目的探讨阿加曲班联合乌司他丁治疗急性缺血性脑卒中病人的疗效及对血清脂蛋白相关磷脂酶A2(Lp-PLA2)和金属肽酶含血小板反应蛋白元-1(ADAMTS-1)水平的影响。方法选取2016年6月至2018年1月在本院就诊的急性缺血性脑卒中病人90例,按随机数字表法分为观察组和对照组,每组各45例,对照组给予阿加曲班治疗,观察组在对照组的基础上联合乌司他丁治疗。治疗7 d后,观察并比较2组病人的疗效、炎性因子以及Lp-PLA2、ADAMTS-1水平,并观察不良反应发生情况。结果治疗前,2组病人的NIHSS、日常生活活动能力(ADL)评分,IL-6、IL-8、TNF-α、hs-CRP、人基质金属蛋白酶-9(MMP-9)、Lp-PLA2、ADAMTS-1水平差异均无统计学意义(P> 0. 05)。治疗后,2组病人的NIHSS评分均显著下降,且观察组下降更显著;ADL评分均显著升高,且观察组升高更显著,差异均有统计学意义(P <0. 05或P <0. 01)。治疗后,2组病人的IL-6、IL-8、hs-CRP、TNF-α和MMP-9、Lp-PLA2、ADAMTS-1水平均显著下降,且观察组下降更加显著,差异均有统计学意义(P <0. 05或P <0. 01)。2组病人均未发生严重的不良反应。结论阿加曲班联合乌司他丁治疗急性缺血性脑卒中病人的疗效较好,可调节体内的炎性反应,降低Lp-PLA2、ADAMTS-1水平,改善预后,在临床上可广泛使用。

Objective To investigate the effect of argatroban combined with ulinastatin on the serum levels of lipoprotein-associated phospholipase A2(Lp-PLA2) and a distintegrin and metalloprotease with thrombospondin type 1 motifs(ADAMTS-1) in the patients with acute ischemic stroke.Methods A total of 90 patients with acute ischemic stroke were selected from June 2016 to January2018.They were divided into observation group and control group according to random number table,with 45 cases in each group.The control group was treated with argatroban,and the observation group was treated with ulinastatin on the basis of the control group.After 7 days of treatment,the efficacy and the levels of inflammatory factors,Lp-PLA2 and ADAMTS-1 were compared and the adverse reactions were observed in both groups.Results There was no significant difference in the scores of National Institute of Health stroke scale(NIHSS) and activties of daily living(ADL),as well as in the levels of interleukin-6(IL-6),IL-8,tumor necrosis factor(TNF)-α,high sensitive C reaction protein(hs-CRP),matrix metallo proteinases 9(MMP-9),Lp-PLA2 and ADAMTS-1 between the two groups before treatment(P> 0.05).After treatment,NIHSS scores of the two groups were significantly decreased,ADL scores were significantly increased,especially in the observation group(P <0.05 or P <0.01).After treatment,the levels of IL-6,IL-8,hs-CRP,TNF-α,MMP-9,Lp-PLA2 and ADAMTS-1 in both groups were significantly decreased,especially in the observation group(P <0.05 or P <0.01).There were no serious adverse reactions occurring in both groups.Conclusions Argatroban combined with ulinastatin is effective in the treatment of acute ischemic stroke,which can regulate the inflammatory reaction in vivo,reduce the levels of Lp-PLA2 and ADAMTS-1,and improve the prognosis.