尿激酶在内镜血肿清除治疗幕上高血压脑出血患者中的作用研究

Role of urokinase in endoscopic hematoma clearance for patients with supratentorial hypertensive intracerebral hemorrhage

目的 探讨尿激酶结合内镜血肿清除在幕上高血压脑出血患者中的疗效,并对血清迁移率蛋白B1(HMGB-1)及肿瘤坏死因子相关凋亡诱导配体(TRAIL)表达的影响。方法 选取2018年8月—2020年6月新疆维吾尔自治区喀什地区第二人民医院收治110例的幕上高血压脑出血患,根据治疗方案分为对照组和观察组,每组55例。对照组给予常规治疗+内镜血肿清除,观察组在对照组的基础上给予尿激酶冲洗。比较两组患者治疗前后美国国立卫生院卒中量表(NIHSS)评分、局部脑血流量、血清炎症因子、临床疗效、血清HMGB-1及TRAIL表达情况。结果 治疗后,观察组临床总有效率高于对照组(P<0.05)。观察组周边远区和近区脑血流量均高于对照组(P<0.05)。观察组NIHSS评分低于对照组(P<0.05)。而观察组血清高敏C反应蛋白(hs-CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、HMGB-1及TRAIL浓度均低于对照组(P<0.05)。结论 尿激酶结合内镜血肿清除在幕上高血压脑出血患者中的应用效果好,可抑制HMGB-1及TRAIL表达,能有效改善患者局部脑血流、降低血清炎症因子水平。

Objective To investigate the efficacy of urokinase combined with endoscopic hematoma clearance in patients with supratentorial hypertensive intracerebral hemorrhage and its effect on the expression of serum high-mobility group box-1(HMGB-1) and tumor necrosis factor-related apoptosis-inducing ligand(TRAIL). Methods A total of 110patients with supratentorial hypertensive cerebral hemorrhage who were admitted to our hospital from August 2018 to June 2020 were enrolled, and according to the treatment regimen, they were divided into control group and observation group, with 55 patients in each group. The patients in the control group were given conventional treatment and endoscopic hematoma clearance, and those in the observation group were given urokinase flushing in addition to the treatment in the control group. The two groups were compared in terms of National Institutes of Health Stroke Scale(NIHSS) score, local cerebral blood flow, serum inflammatory factors, clinical outcome, and the expression of serum HMGB-1 and TRAIL before and after treatment. Results After treatment, the observation group had a significantly higher overall response rate than the control group(P <0.05). Compared with the control group, the observation group had a significantly higher cerebral blood flow in the far and near areas(P <0.05). The observation group had a significantly lower NIHSS score than the control group(P <0.05). Compared with the control group, the observation group had significantly lower serum levels of high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α, HMGB-1, and TRAIL(P <0.05). Conclusions Urokinase combined with endoscopic hematoma clearance is effective in patients with supratentorial hypertensive intracerebral hemorrhage and can inhibit the expression of HMGB-1 and TRAIL, effectively improve local cerebral blood flow, and reduce the serum levels of inflammatory factors.