不同时间窗阿替普酶静脉溶栓治疗急性脑梗死的疗效观察

Curative effects of intravenous thrombolysis with alteplase in different time windows on acute cerebral infarction

目的探讨不同时间窗阿替普酶(rt-PA)静脉溶栓治疗急性脑梗死(ACI)的疗效及对超敏C反应蛋白(hs-CRP)、脂联素(APN)、应激因子、神经分子生物学指标水平的影响。方法选取2018年2月至2020年11月收治的ACI患者100例,根据患者接受rt-PA静脉溶栓时间分为两组,观察组为50例发病距离溶栓时间<3 h的患者,对照组为50例发病距离溶栓时间在3~4.5 h的患者,比较两组患者的治疗效果、治疗前后血清超敏C反应蛋白(hs-CRP)、脂联素(APN)、应激因子丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-px)、超氧化物歧化酶(SOD)、神经生长因子(NGF)、髓鞘碱性蛋白(MBP)水平及美国国立卫生研究院卒中量表(NIHSS)评分、脑卒中患者临床神经功能受损度评分(MESSS)评分。结果观察组治疗的总有效率为88.00%,稍高于对照组80.00%,两组比较差异无统计学意义(P>0.05)。治疗后观察组的hs-CRP低于对照组,APN水平高于对照组,差异均有统计学意义(P<0.05)。治疗后观察组的MDA水平低于对照组,SOD、GSH-px水平高于对照组,差异均有统计学意义(P<0.05)。治疗后观察组的血清NGF、MBP水平高于对照组,差异均有统计学意义(P<0.05)。治疗后观察组的NIHSS、MESSS评分低于对照组,差异均有统计学意义(P<0.05)。结论使用rt-PA静脉溶栓治疗ACI患者,治疗时间窗越短,疗效越好,可明显改善血清hs-CRP、APN和应激因子水平,减轻对神经功能的影响。

Objective To explore the curative effects of intravenous thrombolysis with alteplase(rt-PA)in different time windows on the treatment of acute cerebral infarction(ACI),and the influence on levels of high-sensitivity C-reactive protein(hs-CRP),adiponectin(APN),stress factors and neurological molecular biological indicators. Methods A total of 100 ACI patients who were admitted to the hospital from February 2018 to November 2020 were enrolled. According to the different intravenous thrombolysis time with alteplase,they were divided into the observation group(50 cases,interval between onset and thrombolysis shorter than 3 h)and the control group(50 cases,interval between onset and thrombolysis within 3~4.5 h).The curative effect,levels of serum hs-CRP,APN,stress factors malondialdehyde(MDA),Glutathione peroxidase(GSH-px)and superoxide dismutase(SOD),nerve growth factor(NGF),myelin basic protein(MBP),National Institute of Health stroke scale(NIHSS)and Modified Edinburgh Scandinavian stroke scale (MESSS) scores before and after treatment were compared between the two groups. Results The total response rate of treatment in the observation group was slightly higher than that in the control group(88.00% vs 80.00%)(P>0.05). After treatment,hs-CRP in the observation group was significantly lower than that in the control group(P<0.05),while APN level was significantly higher than that in the control group(P<0.05).After treatment,MDA level in the observation group was significantly lower than that in the control group(P<0.05),while levels of SOD and GSH-px were significantly higher than those in the control group(P<0.05).After treatment,serum NGF and MBP levels in the observation group were higher than those in the control group(P<0.05). After treatment,NIHSS and MESSS scores in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Using rt-PA intravenous thrombolysis to treat ACI patients,the shorter the treatment time window,the better the curative effect,which can significantly improve the serum hs-CRP,APN and stress factor levels,and reduce the impact on nerve function.