银杏内酯注射液静滴辅助阿替普酶静脉溶栓对急性脑梗死患者血清细胞因子水平及神经功能的影响

Effects of alteplase intravenous thrombolysis assisted by ginkgolide injection on serum cytokine levels and neurological function in patients with acute cerebral infarction

目的研究银杏内酯注射液静滴辅助阿替普酶静脉溶栓治疗对急性脑梗死患者血清细胞因子水平及神经功能的影响。方法选取2020年9月至2022年12月于平顶山市第一人民医院就诊的118例急性脑梗死患者为研究对象,按随机数表法分为研究组和对照组各59例。对照组患者采用阿替普酶静脉溶栓治疗,研究组患者采用银杏内酯注射液静滴辅助阿替普酶静脉溶栓治疗,均治疗14 d。比较两组患者的临床疗效,治疗前及治疗1个月后的日常生活活动能力(ADL)评分,治疗前及治疗14 d后的美国国立卫生研究院卒中量表(NIHSS)评分、脑血流动力学指标[阻力指数(RI)、收缩期峰值血流速度(Vs)、平均血流速度(Vm)、舒张期血流速度(Vd)]、血管内皮功能指标[一氧化氮(NO)、血管内皮生长因子(VEGF)、血管性血友病因子(vWF)、内皮素-1(ET-1)]和血清细胞因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、淋巴细胞过氧化小体增殖剂激活型受体γ(PPARγ)、可溶性骨髓细胞样转录因子-1(sTLT-1)]水平,同时比较两组患者治疗期间的不良反应发生情况。结果研究组患者的临床治疗总有效率为94.92%,明显高于对照组的83.05%,差异有统计学意义(P<0.05);治疗14 d后,研究组患者的NIHSS评分为(3.58±1.14)分,明显低于对照组的(5.72±1.69)分,治疗1个月后,研究组患者的ADL评分为(76.24±6.38)分,明显高于对照组的(69.05±5.73)分,差异均有统计学意义(P<0.05);治疗14 d后,研究组患者的Vm、Vs、Vd值分别为(129.58±13.46)cm/s、(153.49±14.28)cm/s、(133.46±12.78)cm/s,明显高于对照组的(113.07±11.54)cm/s、(134.22±15.17)cm/s、(120.08±14.62)cm/s,RI值为0.12±0.03,明显低于对照组的0.17±0.02,差异均有统计学意义(P<0.05);治疗14 d后,研究组患者血清VEGF、NO水平分别为(402.59±31.81)ng/L、(78.62±6.35)μmol/L,明显高于对照组的(372.15±32.49)ng/L、(69.51±5.43)μmol/L,vWF、ET-1水平分别为(153.49±14.28)ng/L、(38.69±5.43)μg/L,明显低于对照组的(134.22±15.17)ng/L、(51.77±6.48)μg/L,差异均有统计学意义(P<0.05);治疗14 d后,研究组患者的血清hs-CRP、IL-6、s TLT-1水平分别为(9.51±2.24)mg/L、(18.75±3.64)mg/L、(51.49±4.38)ng/L,明显低于对照组的(14.79±3.74)mg/L、(25.63±4.92)mg/L、(59.74±5.13)ng/L,PPARγ水平为(463.28±39.65)ng/L,明显高于对照组的(421.57±36.48)ng/L,差异均有统计学意义(P<0.05);研究组患者的不良反应总发生率为6.78%,略高于对照组的3.39%,但差异无统计学意义(P>0.05)。结论银杏内酯注射液静滴与阿替普酶静脉溶栓联合治疗急性脑梗死可显著提高临床疗效,改善患者的脑血流动力学、血管内皮功能,减轻炎症反应,降低神经功能缺损程度,进而提高生活质量。

Objective To investigate the effects of alteplase intravenous thrombolysis assisted by ginkgolide injection on serum cytokine levels and neurological function in patients with acute cerebral infarction.Methods A total of 118 patients with acute cerebral infarction who visited the First People's Hospital of Pingdingshan City from September 2020 to December 2022 were selected and divided into the study group(59 patients)and the control group(59 patients)according to the random number table method.The patients in the control group were treated with intravenous thrombolysis with alteplase,and those in the study group were treated with ginkgolide injection as an adjunct to intravenous thrombolysis with alteplase for 14 d.The clinical efficacy,activity of daily living(ADL)scores before and after 1 month of treatment,National Institutes of Health Stroke Scale(NIHSS)scores before and after 14 d of treatment,cerebral haemodynamic index[resistance index(RI)],and cerebral blood flow were compared between the two groups,as well as Kinetic parameters[resistance index(RI),peak systolic velocity(Vs),mean velocity(Vm),diastolic velocity(Vd)],endothelial function parameters[nitric oxide(NO),vascular endothelial growth factor(VEGF),vascular haemophilia factor(vWF),endothelin-1(ET-1)],and serum cytokines[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),lymphocyte peroxisome proliferator-activated receptor gamma(PPARγ),soluble myeloid-like transcription factor-1(sTLT-1)],and serum cytokine[super-sensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),lymphocyte peroxisome proliferator-activated receptor gamma(PPARγ),soluble myeloid transcription factor-1(sTLT-1)]levels.Results The total effective rate of clinical treatment in the study group was 94.92%,significantly higher than 83.05% in the control group(P<0.05).After 14 days of treatment,the NIHSS score of the study group was(3.58±1.14)points,significantly lower than(5.72±1.69)points in the control group(P<0.05).After 1 month of treatment,the ADL score of the study group was(76.24±6.38)points,significantly higher than(69.05±5.73)points of the control group(P<0.05).After 14 d of treatment,the Vm,Vs,and Vd values of the study group were(129.58±13.46)cm/s,(153.49±14.28)cm/s,and(133.46±12.78)cm/s,respectively,significantly higher than(113.07±11.54)cm/s,(134.22±15.17)cm/s,(120.08±14.62)cm/s of the control group;the RI value was 0.12±0.03,significantly lower than 0.17±0.02 of the control group;the differences were statistically significant(P<0.05).After 14 d of treatment,the serum VEGF and NO levels in the study group were(402.59±31.81)ng/L and(78.62±6.35)μmol/L in the study group,significantly higher than(372.15±32.49)ng/L and(69.51±5.43)μmol/L in the control group;the levels of vWF and ET-1 were(153.49±14.28)ng/L and(38.69±5.43)μg/L,significantly lower than(134.22±15.17)ng/L and(51.77±6.48)μg/L of the control group;the differences were statistically significant(P<0.05).After 14 d of treatment,serum hs-CRP,IL-6,and sTLT-1 levels in the study group were(9.51±2.24)mg/L,(18.75±3.64)mg/L,(51.49±4.38)ng/L,significantly lower than(14.79±3.74)mg/L,(25.63±4.92)mg/L,(59.74±5.13)ng/L in the control group;PPARγ level was(463.28±39.65)ng/L,significantly higher than(421.57±36.48)ng/L of the control group;the differences were statistically significant(P<0.05).The total incidence of adverse reactions was 6.78% in the study group and 3.39% in the control group,with no statistically significant differences between the groups(P>0.05).Conclusion The combination of ginkgolide injection and intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction significantly improves clinical outcomes,cerebral haemodynamics,and endothelial function,reduces the inflammatory response,decreases the degree of neurological deficits,and thus improves the quality of life.