丁苯酞联合阿替普酶治疗急性缺血性脑卒中的临床效果及对患者血清炎性因子及神经递质水平的影响

Effect of butylphthalide combined with alteplase on acute ischemic stroke,serum inflammatory factors and neurotransmitters

目的探讨丁苯酞联合阿替普酶治疗急性缺血性脑卒中的临床效果及对患者血清炎性因子及神经递质水平的影响。方法选取2015年5月至2018年3月大连大学附属中山医院收治的急性缺血性脑卒中患者95例为研究对象。采用前瞻性研究的方法,完全随机分为观察组(48例)和对照组(47例)。在常规治疗基础上,对照组给予阿替普酶静脉溶栓治疗,观察组给予丁苯酞静脉滴注联合阿替普酶治疗。治疗2周后,比较2组患者美国国立卫生研究院卒中量表(NIHSS)评分、临床疗效、炎性因子和神经递质水平、不良反应等指标。结果治疗2周后,2组NIHSS评分均低于治疗前,且观察组低于对照组[(6. 2±1. 0)分比(9. 2±1. 2)分],差异均有统计学意义(均P <0. 01)。观察组总有效率明显高于对照组[93. 8%(45/48)比78. 7%(37/47)],差异有统计学意义(P <0. 05)。治疗2周后,观察组患者血清白细胞介素2、白细胞介素6、C反应蛋白、肿瘤坏死因子α水平明显低于对照组(均P <0. 01),血清5-羟色胺、多巴胺含量明显高于对照组(P <0. 05或P <0. 01),谷氨酸、天冬氨酸含量明显低于对照组(P <0. 05或P <0. 01)。结论丁苯酞联合阿替普酶有助于缓解缺血性脑卒中患者神经功能缺损程度,提高临床疗效,可能与抑制炎症反应、调节神经递质水平等因素有关。

Objective To explore the effect of butylphthalide combined with alteplase on acute ischemic stroke,serum inflammatory factors and neurotransmitters.Methods A total of 95 patients with acute ischemic stroke were prospectively enrolled from May 2015 to March 2018 in Affiliated Zhongshan Hospital of Dalin University.They were randomly divided into observation group(n=48)and control group(n=47).On the basis of conventional treatments,the control group had alteplase intravenous thrombolysis;the observation group had intravenous administration of butyphthalide combined with alteplase.After 2 weeks of treatment,National Institutes of Health Stroke Scale(NIHSS)score,clinical efficacy,inflammatory factors,neurotransmitters and adverse reactions were analyzed.Results After treatment,NIHSS score significantly decreased and the score in the observation group was lower than that in the control group[(6.2±1.0)vs(9.2±1.2)](P<0.01).Clinical effective rate in the observation group was significantly higher than that in the control group[93.8%(45/48)vs 78.7%(37/47)](P<0.05).Serum levels of interleukin-2,interleukin-6,C-reactive protein and tumor necrosis factor-αin the observation group were significantly lower than those in the control group(P<0.01).Serum levels of5-hydroxytryptamine and dopamine in the observation group were significantly higher while glutamate and aspartate levels were lower than those in the control group(P<0.05 or P<0.01).Conclusion Butyphthalide combined with alteplase helps to alleviate neurological deficit of ischemic stroke patient and improve the clinical efficacy,which may be related to inhibiting inflammatory response and regulating neurotransmitter level.