二甲双胍与重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性脑卒中伴糖尿病患者疗效

Efficacy of Intravenous Thrombolysis with Metformin and Recombinant Tissue Plasminogen Activator in Patients with Acute Ischemic Stroke and Diabetes Mellitus

目的 评估急性缺血性脑卒中伴糖尿病行二甲双胍+重组组织型纤溶酶原激活剂(阿替普酶)静脉溶栓的效果。方法 选取2021年2月—2022年2月菏泽市定陶区人民医院收治的68例急性缺血性脑卒中伴糖尿病患者,随机分为常规组和综合组,各34例。两组均予以阿替普酶溶栓治疗,常规组行阿卡波糖治疗,综合组增加二甲双胍治疗,比较两组患者疗效、血糖水平和预后。结果 综合组有效率(97.06%)比常规组(79.41%)高,差异有统计学意义(χ^(2)=5.100,P=0.024)。用药前,两组空腹血糖及糖化血红蛋白等指标差异无统计学意义(t=0.760、0.765,P=0.450、0.447)。用药后,综合组空腹血糖及糖化血红蛋白等指标比常规组低,差异有统计学意义(t=5.344、5.128,P<0.001)。结论 二甲双胍、阿替普酶有协同机制,能恢复神经功能,稳定血糖,且能提升自理能力,可减少脑卒中伴糖尿病造成的机体损伤。

Objective To evaluate the effect of intravenous thrombolysis with metformin + recombinant tissue plasminogen activator(alteplase) in acute ischemic stroke patients with diabetes.Methods A total of 68 patients with acute ischemic stroke complicated with diabetes who were admitted to Dingtao District People’s Hospital of Heze City from February 2021 to February 2022 were selected and randomly divided into a routine group and a comprehensive group,34 cases in each group.Both groups were treated with alteplase thrombolysis,the routine group was treated with acarbose,and the comprehensive group was additionally treated with metformin.Comparison of curative effect,blood glucose level and prognosis between two groups of patients.Results The effective rate of the comprehensive group(97.06%) was higher than that of the routine group(79.41%),and the difference was statistically significant(χ^(2)=5.100,P=0.024).Before treatment,there was no statistically significant difference in fasting blood glucose and glycosylated hemoglobin between the two groups,the difference was not statistically significant(t=0.760,0.765,P=0.450,0.447).After treatment,the indexes such as fasting blood glucose and glycosylated hemoglobin in the comprehensive group were lower than those in the routine group,and the difference was statistically significant(t=5.344,5.128,P<0.001).Conclusion Metformin and alteplase have a synergistic mechanism,which can restore nerve function,stabilize blood glucose,and improve self-care ability,which can reduce the body damage caused by stroke complicated with diabetes.