远隔缺血后适应联合静脉溶栓治疗急性脑梗死的疗效及对细胞因子的影响

Effect of remote ischemic postcondition combined with intravenous thrombolysis on acute cerebral infarction and cytokines

目的探讨远隔缺血后适应(RIPostC)联合静脉溶栓治疗急性脑梗死的疗效及对血管内皮生长因子(VEGF)、基质金属蛋白酶9(MMP9)的影响。方法选取2020年9月—2022年12月徐州医科大学第二附属医院神经内科收治的急性脑梗死患者169例,随机分为对照组85例和干预组84例。2组患者均接受重组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗及序贯标准药物治疗,干预组给予RIPostC治疗。收集患者人口统计学和基线临床资料。评估患者90 d的改良Rankin量表(mRS)评分,测定2组患者入院时、入院后24 h及入院后7 d VEGF和MMP9水平。转归不良定义为90 d时mRS评分≥2分。采用多因素logistic回归分析评价RIPostC治疗与预后不良的独立相关性。结果干预组患者90 d mRS评分0~1分者占68.2%,对照组为51.2%,2组比较差异有统计学意义(P=0.024)。多因素回归分析显示,RIPostC干预(OR 0.372,95%CI 0.172~0.805,P=0.012)、基线NIHSS评分(OR 1.336,95%CI 1.184~1.508,P<0.001)与90 d预后存在独立相关性。同一组别入院时、入院后24 h、入院后7 d时VEGF和MMP9水平比较,差异有统计学意义(P<0.001),不同组别间上述3个测定时间点VEGF和MMP9水平差异无统计学意义(P>0.05)。结论RIPostC联合静脉溶栓治疗急性脑梗死患者可以促进神经功能恢复,改善预后。

Objective To investigate the effect of remote ischemic postcondition(RIPostC)combined with intravenous thrombolysis on the outcome of patients with acute cerebral infarction and its impact on vascular endothelial growth factor(VEGF)and matrix metalloproteinase 9(MMP9).Methods A total of 169 acute cerebral infarction patients who were admitted to Department of Neurology,the Second Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2022 were enrolled.They were randomly divided into two groups:a control group(n=85)and an intervention group(n=84).All the patients received intravenous thrombolytic therapy with recombinant plasminogen activator(rt-PA)and sequential standard drug treatment,while the intervention group received RIPostC.Their demographics and baseline clinical data were collected.The 90-day modified Rankin scale(mRS)scores were evaluated,and the levels of VEGF and MMP9 at admission,at post-admission 24 h,and at post-admission 7 days were measured.Poor outcome was defined as a mRS score of≥2 at 90 days.Multivariate logistic regression analysis was used to evaluate the independent correlation between RIPostC treatment and poor prognosis.Results The intervention group showed that 68.2%of patients scored 0-1 on the 90-day mRS score,compared with 51.2%in the control group,with statistical difference(P=0.024).Multivariate logistic regression analysis showed that,RIPostC intervention(OR 0.372,95%CI 0.172-0.805,P=0.012),and baseline NIHSS score(OR 1.336,95%CI 1.184-1.508,P<0.001)were independently associated with 90-day prognosis.There was statistical difference in VEGF and MMP9 levels within the same group at admission,at post-admission 24 h,and at post-admission 7 days(P<0.001).There was no statistical difference in VEGF and MMP9 levels between the two groups at the above three measurement time points(P>0.05).Conclusions RIPostC combined with intravenous thrombolysis can promote the recovery of neurological function and improve the prognosis in patients with acute cerebral infarction.