丁苯酞治疗急性缺血性脑卒中患者血管再通后灌注损伤效果

Effect of Butylphthalide on Perfusion Injury after Vascular Recanalization in Patients with Acute Ischemic Stroke

目的:探究丁苯酞通过降低NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体介导的炎症反应减少血管内介入疗法治疗急性缺血性脑卒中患者血管再通后灌注损伤作用。方法:回顾性分析2021年6月至2022年6月安阳市人民医院经治的急性脑卒中血管介入治疗者140例,根据术后是否口服丁苯酞胶囊分为观察组(77例)与对照组(63例),比较两组患者于治疗前、治疗后1周的美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥预后(GOS)及血管再通评分,同时比较两组患者治疗前后外周血清NLRP3、白细胞介素–18(IL–18)及IL–1β水平变化,最后统计两组患者治疗相关不良反应。结果:治疗1周后两组患者NIHSS评分均有不同程度下降、GOS评分均有不同程度上升,且治疗1周后观察组患者NIHSS评分高于对照组,GOS评分低于对照组,差异具有统计学意义(P <0.05)。治疗1周后观察组患者的血管再通评分为(1.89±0.25)分,高于对照组的(1.43±0.31)分,差异具有统计学意义(P <0.05)。治疗1周后两组患者外周血NLRP3、IL–18及IL–1β均有不同程度下降,且治疗1周后观察组患者外周血NLRP3、IL–18及IL–1β均低于对照组,差异具有统计学意义(P <0.05)。两组患者不良反应发生情况比较,差异无统计学意义(P> 0.05)。结论:丁苯酞可减少急性缺血性脑卒中患者血管介入治疗再通后灌注损伤,可能与其通过降低NLRP3炎症小体介导的炎症反应相关,同时不增加治疗不良反应。

Objective To explore the effect of butylphthalide on intravascular interventional therapy for perfusion injury after vascular recanalization in patients with acute ischemic stroke by reducing the NOD-like receptor heat protein domain related protein 3(NLRP3)-mediated inflammatory response. Methods A retrospective analysis was performed on 140 patients with acute stroke treated by vascular interventional therapy in Anyang People’s Hospital from June 2021 to June 2022, and they were divided into an observation group with 77 cases and a control group with 63 cases according to whether they took butylphthalide capsules orally after surgery. The National Institutes of Health stroke scale(NIHSS), Glasgow prognostic score(GOS) and vascular recanalization score were compared between the two groups before and 1 week after treatment, and the changes of peripheral blood NLRP3, interleukin-18(IL-18) and IL-1β levels were compared between the two groups before and after treatment. Finally,treatment-related adverse reactions were analyzed in the two groups. Results After 1 week of treatment, NIHSS score decreased to varying degrees and GOS increased to varying degrees in the two groups. After 1 week of treatment, the NIHSS score of the observation group was higher than that of the control group, while the GOS was lower than that of the control group, the differences were statistically significant(P < 0.05). After 1 week of treatment, the vascular recanalization score of the observation group was(1.89 ± 0.25) points, higher than(1.43 ± 0.31) of the control group points, and the difference was statistically significant(P < 0.05).After 1 week of treatment, peripheral blood NLRP3, IL-18 and IL-1β were decreased in the two groups, and after 1 week of treatment,peripheral blood NLRP3, IL-18 and IL-1β in the observation group were lower than those in the control group, the differences were statistically significant(P < 0.05). There was no statistical significance in the occurrence of adverse reactions between the two groups(P > 0.05). Conclusion Butylphthalein can reduce perfusion injury after vascular interventional recanalization in patients with acute stroke, which may be related to reducing the inflammatory response mediated by NLRP3 inflammasome without increasing the therapeutic adverse reactions.