急性缺血性脑卒中患者阿替普酶静脉溶栓前后VEGF动态监测分析

Dynamic changes of VEGF monitoring before and after intravenous thrombolytic treatment with alteplase in acute ischemic stroke

目的通过对急性缺血性卒中阿替普酶静脉溶栓前后血管内皮生长因子(VEGF)的动态监测,分析VEGF水平在急性缺血性卒中阿替普酶静脉溶栓效果评价方面的价值,探索急性脑梗死静脉溶栓治疗的有效评价系统。方法采用双抗体夹心ELISA法检测急性脑梗死超窗患者,阿替普酶静脉溶栓患者入院当时、住院1、3、7、14 d血清VEGF动态水平及健康成人血清VEGF水平(3组各41例),采用NIHSS评分系统对溶栓组和非溶栓组患者入院当时及住院1、3、7、14 d分别进行神经功能缺损水平评估,分析梗死部位、面积、阿替普酶静脉溶栓与VEGF水平的关系。结果溶栓组、非溶栓组各个时期血清VEGF水平明显高于正常对照组。溶栓组患者溶栓前,溶栓后1、3、7、14 d血清VEGF水平明显高于非溶栓组,发病第7 d达高峰,14 d时较低。治疗14 d后,溶栓组患者NIHSS评分显著低于非溶栓组。溶栓组及非溶栓组患者随着梗死面积增大,血清VEGF水平明显增高。结论VEGF水平监测可以作为阿替普酶静脉溶栓效果的生物学评价指标,为脑梗死患者预后提供参考。

Objective To analyze the value of vascular endothelial growth factor(VEGF)levels in the evaluation of the effect of intravenous thrombolysis with alteplase in acute ischemic stroke and to explore a valid evaluation system for intravenous thrombolysis in acute cerebral infarction.Methods Serum VEGF dynamic levels were measured by ELISA in patients with acute cerebral infarction over time window,the patients with intravenous thrombolysis with alteplase at the time of admission and on the first day,third day,7 d and 14 d of hospitalization,and healthy adults(41 cases in each group).The NIHSS scores was used to assess the level of neurological deficits at the time of admission,the first day,third day,7 d and 14 d of hospitalization in the thrombolysis and non-thrombolysis groups,respectively.The area of cerebral infarction in the thrombolysis group and non-thrombolysis group was measured and counted using cranial MRI and divided into three groups of large,medium and small area(infarct foci≥4 cm in diameter,1.5 cm<diameter<4 cm and≤1.5 cm in diameter,respectively),and the patients were divided into frontal lobe infarction,temporal lobe infarction,parietal lobe infarction,occipital lobe infarction,basal ganglia infarction,brain stem infarction and cerebellar infarcts.The relationship between infarct site,area,alteplase intravenous thrombolysis and VEGF levels were analyzed.Results Serum VEGF levels were significantly higher in the thrombolytic and non-thrombolytic groups than that in the normal control group at all times.The serum VEGF levels were significantly higher in the thrombolysis group before thrombolysis,on the first day,third day,7 d and 14 d after thrombolysis than in the non-thrombolysis group,with a peak on 7 d and a decrease on 14 d.After 14 d of treatment,the NIHSS scores of patients in the thrombolysis group were significantly lower than those in the non-thrombolysis group.The serum VEGF level increased significantly in the thrombolytic and non-thrombolytic groups as the infarct size increased.Conclusion The monitoring of VEGF level can be used as a biological evaluation index of intravenous thrombolytic effect of alteplase and it can provide reference value for the prognosis of patients with cerebral infarction.