不同剂量羟乙基淀粉40氯化钠在低灌注致短暂性脑缺血发作中的疗效观察

Therapeutic effects of different doses of hydroxyethyl starch 40 sodium chloride on transient ischemic attack caused by hypoperfusion

目的应用不同剂量的羟乙基淀粉40氯化钠治疗因低灌注导致的短暂脑缺血发作,并评价其临床效果及其作用原理。方法2015年1月至2019年1月住院及门诊治疗的脑缺血发作患者78例为研究对象,随机分为高、低剂量治疗组和对照组,每组26例。治疗组分别给予羟乙基淀粉氯化钠注射液(低剂量组给予250 ml,静脉滴注,1次/d;高剂量组给予250 ml,静脉滴注,2次/d)治疗,对照组只给予和治疗组一样的基础治疗(扩血管及抗血小板聚集、抗凝等),分别于7 d、14 d观察3组患者的治疗效果、NIHSS/GCS量表变化、不良事件发生、外周血炎性因子(IL-6、IL-10、TNF-α)、炎性标志物(CRP、MMPs)水平,患者均于3个月、6个月随访,应用ABCD2评估量表评估患者风险。结果2组患者治疗前ABCD2评分差异无统计学意义(P>0.05)。治疗后治疗组疗效明显高于对照组,差异有统计学意义(P<0.05),NIHSS/GCS量表评分较治疗前均改善,且治疗组NIHSS/GCS评分较同期对照组改善明显,差异均有统计学意义(P<0.05),其中高剂量组和低剂量组疗效差异无统计学意义(P>0.05)。3组患者治疗前外周血各炎性因子水平差异无统计学意义(P>0.05),治疗后患者外周血MMPs、CRP、IL-6、TNF-α均低于治疗前,IL-10水平高于治疗前,治疗组指标变化幅度高于对照组,差异有统计学意义(P<0.05),其中IL-6、TNF-α、CRP、MMP-2高剂量组较低剂量组炎性指标变化更为显著,差异有统计学意义(P<0.05)。随访结果显示高剂量组远期卒中风险评估改善明显,差异有统计学意义(P<0.05)。结论羟乙基淀粉40氯化钠在治疗低灌注脑缺血发组有良好的治疗效果,其作用原理可能在于其改善低灌注、降低炎性反应相关,其中高剂量对于改善血清炎性因子效果显著。

Objective To investigate the therapeutic effects of different doses of hydroxyethyl starch 40 sodium chloride on transient ischemic attack caused by hypoperfusion,and to explore its action mechanism.Methods A total of 78 patients with cerebral ischemic attack who were treated in our hospital from January 2015 to January 2019 were enrolled in the study,who were randomly divided into high-dose group,low-dose group and control group,with 26 cases in each group.Before treatment there were no significant differences in the general data among the three groups(P>0.05).The patients in low-dose group and low-dose group,on the basis of basic treatment,were given hydroxyethyl starch 40 sodium chloride by intravenous drip at the dose of 500ml,250ml,respectively,once a day.The patients in control group were treated only by basic treatment(vasodilation,anti platelet aggregation,anticoagulation).The curative effects at7d,14d after treatment,and brain nerve function damage,adverse reactions,peripheral blood inflammatory factors(IL-6,IL-10,TNF-α),inflammatory markers(CRP,MMPs)were observed and compared among the three groups.Moreover all the patients were followed up for 3 months and 6 months,and ABCD2 was used to assess the risk of patients.Results Before treatment there were no significant differences in ABCD2 scores among the three groups(P>0.05).After treatment,the curative effects and NIHSS/GCS scores in high-dose group,low-dose group were superior to those in control group(P<0.05),however,there were no significant differences in curative effects between high-dose group and low-dose group(P<0.05).After treatment,the levels of MMPs,CRP,IL-6 and TNF-αin the three groups were decreased,but,the IL-10 levels were increased,moreover the decrease degree and increase degree in high-dose group and low-dose group were more significant than those in control group(P<0.05).In addition the changes of IL-6,TNF-α,CRP and MMP the high-dose group were more significant than those in lower-dose group(P<0.05).The follow up results showed that the long-term stroke risk assessment in high-dose group was significantly improved(P<0.05).Conclusion Hydroxyethyl starch 40 sodium chloride has better therapeutic effects on transient ischemic attack due to hypoperfusion,and its action mechanism may be related to its improvement effects on hypoperfusion and in relieving inflammatory response,in which,the high dose has significant effects in improving serum inflammatory factors.