依达拉奉右莰醇联合瑞舒伐他汀钙治疗急性后循环脑梗死患者的临床研究

Clinical trial of edaravone and dexborneol combined with rosuvastatin calcium in the treatment of patients with acute posterior circulation cerebral infarction

目的 观察依达拉奉右莰醇注射用浓溶液联合瑞舒伐他汀钙胶囊治疗急性后循环脑梗死患者的临床疗效及安全性。方法 将急性后循环脑梗死患者按队列法分为对照组和试验组。对照组给予瑞舒伐他汀钙5 mg;试验组在对照组治疗的基础上,静脉滴注依达拉奉右莰醇注射用浓溶液15 mL。比较2组患者的临床疗效,神经功能、生化指标、氧化应激反应指标、Toll样受体4/核因子κB(TLR4/NF-κB)信号通路分子水平,预后和药物不良反应发生情况。结果 对照组入组49例,试验组入组51例。治疗后,试验组和对照组的总有效率分别为92.16%(47例/51例)和77.55%(38例/49例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组和对照组的神经元特异性烯醇化酶分别为(11.67±1.35)和(16.77±1.94)μg·L^(-1),中枢神经特异性蛋白β分别为(1.01±0.12)和(1.54±0.16)μg·L^(-1),低密度脂蛋白胆固醇分别为(2.03±0.24)和(3.74±0.38)mmol·L^(-1),三酰甘油分别为(1.28±0.14)和(2.12±0.23)mmol·L^(-1),总胆固醇分别为(3.11±0.32)和(4.15±0.42)mmol·L^(-1),肌酸激酶同工酶分别为(8.76±1.02)和(10.12±1.06)U·L-1,超敏C反应蛋白分别为(11.01±1.25)和(15.32±1.64)mg·L^(-1),血清活性氧簇分别为(387.68±39.24)和(473.11±48.23)μmol·L-1,丙二醛分别为(3.02±0.39)和(4.14±0.45)nmol·mL^(-1),超氧化物歧化酶水平分别为(59.24±6.05)和(41.67±4.97)U·mL^(-1),TLR4 mRNA相对表达量分别为0.26±0.03和0.43±0.04,NF-κB mRNA相对表达量分别为0.17±0.02和0.25±0.03,改良Rankin量表评分分别为2.02±0.29和2.94±0.30,日常生活活动能力评分分别为(56.34±5.74)和(45.64±4.69)分;试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组的总药物不良反应发生率分别为31.37%和26.53%,在统计学上差异无统计学意义(P>0.05)。结论 依达拉奉右莰醇注射用浓溶液联合瑞舒伐他汀钙胶囊治疗急性后循环脑梗死患者的临床疗效明确,其能有效调节患者神经功能、氧化应激反应和血脂及TLR4/NF-κB信号通路分子水平,明显改善患者预后。

Objective To observe the clinical effect and safety of edaravone and dexborneol concentrated solution for injection combined with rosuvastatin calcium capsules in the treatment of patients with acute posterior circulation cerebral infarction.Methods Patients with acute posterior circulation cerebral infarction were divided into control group the treatment group was treated with intravenous drip of edaravone and dexborneol concentrated solution for injection 15 mL on the basis of control group.The clinical effect,neurological function,biochemical indicators,oxidative stress response indicators,the levels of Toll like receptor 4/nuclear factor kB(TLR4/NF-КB)signaling pathway molecules,prognosis,and adverse drug reactions were compared between the two groups.Results There were 49 cases in control group and 51 cases in treatment group.After treatment,the total effective rates in treatment group and control group were 92.16%(47 cases/51 cases)and 77.55%(38 cases/49 cases),with statistically significant difference(P<0.05).After treatment,the levels of neuron specific enolase in treatment group and control grouwpere(11.67±1.35)and(16.77±1.94)μg·L^(-1);the levels of central nervous system-specific protein were(1.01±0.12)and(1.54±0.16)μg·L^(-1);the levels of low density lipoprotein cholesterol were(2.03±0.24)and(3.74±0.38)mmol.L^(-1);the levels of triglyceride were(1.28±0.14)and(2.12±0.23)mmol L^(-1);the levels of total cholesterol were(3.11±0.32)and(4.15±0.42)mmol.L^(-1);the levels of creatine kinase isozyme were(8.76±1.02)and(10.12±1.06)U.L^(-1);the levels of high-sensitivity C-reactive protein were(11.01±1.25)and(15.32±1.64)mg·L^(-1);the levels of serum reactive oxygen species were(387.68±39.24)and(473.11±48.23)μmol.L^(-1);the levels of malondialdehyde were(3.02±0.39)and(4.14±0.45)nmol·mL^(-1);the levels of superoxide dismutase were(59.24±6.05)and(41.67±4.97)U·mL^(-1);the relative expression levels of TLR4 mRNA were 0.26±0.03 and 0.43±0.04;the relative expression levels of NF-kB mRNA were 0.17±0.02 and 0.25±0.03;the modified Rankin scale scores were 2.02±0.29 and 2.94±0.30;the activity of daily living scores were 56.34±5.74 and 45.64±4.69.The above indexes were significantly different between control group and treatment group(all P<0.05).The total incidence of adverse drug reactions in treatment group and control group were 31.37%and 26.53%,with no statistically significant difference between the two groups(P>0.05).Conclusion Edaravone and dexborneol concentrated solution for injection combined with rosuvastatin calcium capsules is effective in the treatment of patients with acute posterior circulation cerebral infarction,and can effectively regulate the patients'neurological function,oxidative stress response,blood lipid levels and TLR4/NF-kB signaling pathway molecules,and significantly improve the prognosis.