阿加曲班对急性缺血性脑卒中患者侧支血流、炎症因子及血管内皮功能的影响

Effect of argatroban on collateral blood flow and inflammatory factors and endothelial function in patients with acute cerebral infarction

目的 探究阿加曲班对急性缺血性脑卒中患者脑侧支血流、炎症因子及血管内皮功能以及预后的影响。方法 回顾性选取2018年2月—2020年3月徐州市肿瘤医院收治的96例急性缺血性脑卒中患者为研究对象,根据治疗方法不同将患者分为对照组和试验组,每组各48例,对照组采用常规治疗方法治疗,试验组患者在常规治疗的基础上加用阿加曲班注射液,第1~2天,阿加曲班注射液60 mg加入500 mL 0.9%氯化钠注射液中,24 h由输注泵持续泵入;第3~5天,10 mg阿加曲班注射液加入100 mL 0.9%氯化钠注射液中,输注泵3 h内输注完毕,每天2次,第6~10天改为每天1次;10 d后予以常规治疗,两组患者均共治疗30 d。分别于治疗前及治疗后检测血管内皮功能的指标内皮素-1(ET-1)、一氧化氮(NO)及炎症因子白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)水平。分别于治疗前和治疗后采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评估,按照美国介入和治疗神经放射学学会/介入放射学学会(ASITN/SIR)制定的侧支血流分级标准评估患者治疗后侧支血流状况。结果 治疗前,两组患者的炎症因子(hs-CRP、IL-6)及血管内皮功能指标(NO、ET-1)指标比较,差异无统计学意义(P>0.05)。治疗后,两组NO水平均显著升高(P<0.05),ET-1水平均显著降低(P<0.05),对照组炎症因子hs-CRP、IL-6水平较治疗前无明显改善(P>0.05),试验组炎症因子hs-CRP、IL-6水平均较治疗前显著降低(P<0.05);治疗后试验组患者的炎症因子(hs-CRP、IL-6)及血管内皮功能指标(NO、ET-1)指标水平较对照组明显改善(P<0.05);治疗前两组NIHSS评分比较,差异无统计学意义(P>0.05),经过30 d的治疗,试验组和对照组的NIHSS评分均显著低于治疗前(P<0.05),且试验组患者的NIHSS评分较对照组显著降低(P<0.05)。治疗30 d后,试验组患者侧支血流代偿情况较对照组改善明显(P<0.05);治疗过程中未发现阿加曲班的不良反应。结论 急性缺血性脑卒中患者应用阿加曲班治疗后,炎症反应程度降低,血管内皮功能的损伤减轻,阿加曲班在一定程度上可改善患者侧支血流代偿情况,进一步改善神经功能恢复,从而提升治疗效果。

Objective To investigate the effects of argatroban on cerebral collateral blood flow, inflammatory factors, vascular endothelial function and prognosis in patients with acute ischemic stroke. Methods A total of 96 patients with acute ischemic stroke treated in Xuzhou Cancer Hospital from February 2018 to March 2020 were selected retrospectively. According to different treatment methods, the patients were divided into control group and experimental group, with 48 cases in each group. Patients in the control group were treated with routine treatment. The patients in the experimental group were treated with Argatroban Injection on the basis of routine treatment. On the first to second days, Argatroban Injection 60 mg + 0.9% Sodium Chloride Injection 500 mL,which was continuously pumped by the infusion pump for 24 h, On the 3rd to 5th days, 10 mg of Argatroban Injection was added to100 mL of 0.9% Sodium Chloride Injection. The infusion pump completed the infusion within three hours, twice a day, and changed to once a day on the 6th to 10th days. Routine treatment was given after 10 days. Both groups were treated for 30 days. Endothelin-1(ET-1), nitric oxide(NO), inflammatory factor interleukin-6(IL-6) and high-sensitivity C-reactive protein(hs-CRP) were measured before and after treatment. The neurological deficit was assessed with the National Institutes of Health Stroke Scale(NIHSS) before and after treatment, and the blood flow of the treated posterior branch was evaluated according to the collateral blood flow classification standard formulated by the American Society of interventional and Therapeutic Neuroradiology/Society of interventional radiology(ASITN/SIR). Results Before treatment, there was no significant difference in inflammatory factors(hsCRP, IL-6) and vascular endothelial function(NO, ET-1) between the two groups(P > 0.05). After treatment, the levels of inflammatory factors(hs-CRP, IL-6) and vascular endothelial function(NO, ET-1) in the experimental group were significantly improved compared with those in the control group(P < 0.05). After 30 d of treatment, the collateral blood flow compensation in the experimental group was better than that in the control group(P < 0.05), and the NIHSS score was significantly higher than that in the control group(P < 0.05). No adverse reactions of argatroban were found during the treatment. Conclusion After the treatment of acute ischemic stroke patients with argatroban, the degree of inflammatory reaction is reduced and the damage of vascular endothelial function is reduced. Argatroban can improve the collateral blood flow compensation of patients to a certain extent,further improve the recovery of neurological function, and improve the treatment effect.