依达拉奉联合尤瑞克林治疗对急性脑梗死患者脑血管储备能力、血管内皮细胞功能及血清VEGF、MMP-9水平的影响

Effects of edaravone combined with urinary kallikrein on cerebral vascular reserve capacity,vascular endothelial cell function,serum vascular endothelial growth factor and matrix metalloproteinase-9 levels in patients with acute cerebral infarction

目的探究依达拉奉联合尤瑞克林治疗对急性脑梗死(ACI)患者脑血管储备能力、血管内皮细胞功能和血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)水平的影响。方法选取2018年5月至2020年4月间西安高新医院神经内一科收治的162例ACI患者作为研究对象,按随机数表法分为观察组和对照组各81例。对照组患者予以依达拉奉治疗,观察组患者予以依达拉奉联合尤瑞克林治疗,疗程均为14 d。比较两组患者治疗前后的血管内皮细胞功能[内皮素-1(ET-1)、血栓素B2(TXB2)、脂蛋白相关磷脂酶A2(Lp-PLA2)]、血清VEGF、MMP-9水平、脑血管功能[脑血管储备能力(CVR)、平均血流速度(MFV)、搏动指数(PI)、屏气指数(BHI)]、疾病恢复情况[神经功能恢复情况(mRS)、日常生活能力(BI)评分]及治疗期间不良反应发生情况。结果治疗后,观察组患者的ET-1、TXB2、Lp-PLA2分别为(62.41±6.24)pg/mL、(163.22±15.84)pg/mL、(18.06±2.27)mmol/mL,明显低于对照组的(73.33±7.76)pg/m L、(190.27±18.81)pg/mL、(22.57±2.16)mmol/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的VEGF为(268.41±93.47)pg/mL,明显高于对照组的(201.44±57.36)pg/m L,MMP-9为(36.48±5.11)pg/m L,明显低于对照组的(47.29±6.91)pg/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的MFV、BHI、CVR分别为(76.26±7.04)cm/s、0.83±0.02、(26.76±4.11)%,明显高于对照组的(68.42±8.69)cm/s、0.77±0.08、(24.61±4.67)%,PI为0.65±0.09,明显低于对照组的0.71±0.11,差异均有统计学意义(P<0.05);治疗后,观察组患者的mRS评分为(0.82±0.14)分,明显低于对照组的(1.41±0.54)分,BI评分为(83.27±17.46)分,明显高于对照组的(63.28±15.34)分,差异均有统计学意义(P<0.05);治疗期间,观察组患者不良反应总发生率为3.70%,略低于对照组的6.17%,但差异无统计学意义(P>0.05)。结论依达拉奉联合尤瑞克林治疗能显著改善ACI患者的内皮细胞功能,提高脑血管储备能力和血管灌注能力,保护缺血缺氧处神经功能,进而促进患者神经功能和日常生活能力恢复,且安全性较高。

Objective To explore the effects of edaravone combined with urinary kallikrein on cerebral vascular reserve capacity,vascular endothelial cell function,levels of serum vascular endothelial growth factor(VEGF)and matrix metalloproteinase-9(MMP-9)in patients with acute cerebral infarction(ACI).Methods A total of 162 patients with ACI admitted to the First Department of Neurology,Xi'an High-Tech Hospital were enrolled as the research objects between May 2018 and April 2020.According to random number table method,they were divided into an observation group(81 cases)and a control group(81 cases).The patients in the control group were treated with edaravone,while the patients in the observation group were additionally treated with urinary kallikrein,for 14 d.The vascular endothelial cell function[endothelin-1(ET-1),thromboxane B2(TXB2),lipoprotein associated phospholipase A2(Lp-PLA2)],levels of serum VEGF and MMP-9,cerebrovascular function[cerebral vascular reserve(CVR)capacity,mean flow velocity(MFV),pulsation index(PI),breath-holding index(BHI)]and disease recovery[scores of Modified Rankin Scale(mRS)and Barthel Index Assessment Scale(BI)]before and after treatment,and the incidence of adverse reactions during treatment were compared between the two groups.Results After treatment,ET-1,TXB2,and Lp-PLA2 in the observation group were(62.41±6.24)pg/mL,(163.22±15.84)pg/mL,and(18.06±2.27)mmol/mL,which were significantly lower than(73.33±7.76)pg/mL,(190.27±18.81)pg/mL,and(22.57±2.16)mmol/mL in the control group(P<0.05).After treatment,VEGF level in the observation group was(268.41±93.47)pg/mL,which was significantly higher than(201.44±57.36)pg/mL in the control group,while the MMP-9 level was(36.48±5.11)pg/mL,significantly lower than(47.29±6.91)pg/mL in the control group(P<0.05).After treatment,MFV,BHI,and CVR in the observation group were(76.26±7.04)cm/s,0.83±0.02,and(26.76±4.11)%,which were significantly higher than(68.42±8.69)cm/s,0.77±0.08,and(24.61±4.67)%in the control group,while PI was 0.65±0.09,significantly lower than 0.71±0.11 in the control group(P<0.05).After treatment,mRS score in the observation group was(0.82±0.14)points,which was significantly lower than(1.41±0.54)points in the control group,while BI score was(83.27±17.46)points,significantly higher than(63.28±15.34)points in the control group(P<0.05).During treatment,total incidence of adverse reactions in the observation group was 3.70%,which was slightly lower than 6.17%in the control group,but the difference was not statistically significant(P>0.05).Conclusion Edaravone combined with urinary kallikrein can significantly improve endothelial cells function,improve cerebral vascular reserve capacity and vascular perfusion capacity,protect nerve function at ischemia-hypoxia site,and thus promote the recovery of nerve function and activities of daily living in ACI patients,with high safety.