消栓肠溶胶囊联合大剂量降纤酶治疗急性脑梗死伴发颈动脉粥样硬化斑块临床研究
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摘要
目的:观察消栓肠溶胶囊联合大剂量降纤酶对急性脑梗死伴发颈动脉粥样硬化斑块患者脑血流指标及血小板表面α-颗粒膜糖蛋白(CD62P)、血小板溶酶体膜糖蛋白(CD63)分子表达的影响。方法:选取84例急性脑梗死伴发颈动脉粥样硬化斑块患者,按照随机数字表法分为观察组和对照组各42例。所有患者均给予基础治疗,在此基础上对照组给予大剂量降纤酶治疗,观察组在对照组基础上联合消栓肠溶胶囊治疗。对比2组中医证候积分及临床疗效,检测患者治疗前后的脑循环动力学参数、血脂指标及CD62P、CD63分子表达水平。结果:治疗后,2组中医证候积分均较治疗前降低(P <0.05),观察组中医证候积分比对照组降低更明显(P <0.05)。总有效率观察组95.24%,高于对照组的76.19%(P <0.05)。治疗后,2组平均血流速、平均血流量均较治疗前增加(P <0.05),外周阻力、脑血管床特性阻抗水平均较治疗前降低(P <0.05);观察组平均血流速、平均血流量均高于对照组(P <0.05),外周阻力、脑血管床特性阻抗水平均低于对照组(P <0.05)。治疗后,2组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平均较治疗前降低(P <0.05),高密度脂蛋白(HDL)水平均较治疗前升高(P <0.05);观察组TC、TG、LDL水平均低于对照组(P <0.05),HDL水平高于对照组(P <0.05)。治疗后,2组CD62P、CD63分子表达水平均较治疗前降低(P <0.05),观察组CD62P、CD63分子表达水平均低于对照组(P <0.05)。结论:消栓肠溶胶囊联合大剂量降纤酶应用于急性脑梗死伴发颈动脉粥样硬化斑块患者有显著的治疗效果,脑循环动力学参数及血脂指标均有较大改善,CD62P、CD63分子表达水平有所降低,值得临床推广。
Objective:To observe the effect of Xiaoshuang Changrong capsules combined with high-dose defibrase on the indexes of cerebral blood flow and the expression of platelet surfaceα-granule membrane glycoprotein(CD62 P) and platelet lysosomal membrane protein(CD63) in patients with acute cerebral infarction complicated with carotid atherosclerotic plaques.Methods:A total of 84 cases of patients with acute cerebral infarction complicated with carotid atherosclerotic plaques were divided into the observation group and the control group according to the random number table method, 42 cases in each group. Both groups were given routine treatment. The control group was additionally treated with high-dose defibrase,and the observation group was additionally treated with Xiaoshuang Changrong capsules based on the treatment of the control group. The Chinese medicine syndrome scores and the clinical effect in the two groups were compared; the cerebral hemodynamic parameters, the indexes of serum lipids and the levels of expression of CD62 P and CD63 before and after treatment were detected. Results: After treatment, the Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P <0.05), and the decrease in the observation group was more obvious than that in the control group(P < 0.05). The total effecti ve rate was 95.24% in the observation group,higher than that of 76.19% in the control group(P < 0.05). After treatment,the mean flow velocity and the mean blood flow in the two groups were increased when compared with those before treatment(P < 0.05),while the levels of peripheral resistance and cerebral vascular characteristic impedance in the two groups were decreased when compared with those before treatment(P< 0.05);the mean flow velocity and the mean blood flow in the observation group were higher than those in the control group(P < 0.05),while the levels of peripheral resistance and cerebral vascular characteristic impedance in the observation group were lower than those in the control group(P < 0.05). After treatment,the levels of total cholesterol(TC),triglyceride(TG)and low density lipoprotein(LDL) in the two groups were decreased when compared with those before treatment(P < 0.05),while the levels of high density lipoprotein(HDL) in the two groups were increased when compared with those before treatment(P < 0.05);the levels of TC,TG and LDL in the observation group were lower than those in the control group(P <0.05),while the level of HDL in the observation group was higher than that in the control group(P < 0.05). After treatment,the levels of expression of CD62 P and CD63 in the two groups were decreased when compared with those before treatment(P < 0.05),and the above levels in the observation group were lower than those in the control group(P < 0.05). Conclusion:The therapy of Xiaoshuang Changrong capsules combined with high-dose defibrase has significant curative effect in treating acute cerebral infarction complicated with carotid atherosclerotic plaques. The cerebral hemodynamic parameters and the indexes of serum lipids were significantly improved, and the levels of expression of CD62 P and CD63 were decreased.Therefore,the therapy is worthy of clinical promotion.
Objective:To observe the effect of Xiaoshuang Changrong capsules combined with high-dose defibrase on the indexes of cerebral blood flow and the expression of platelet surfaceα-granule membrane glycoprotein(CD62 P) and platelet lysosomal membrane protein(CD63) in patients with acute cerebral infarction complicated with carotid atherosclerotic plaques.Methods:A total of 84 cases of patients with acute cerebral infarction complicated with carotid atherosclerotic plaques were divided into the observation group and the control group according to the random number table method, 42 cases in each group. Both groups were given routine treatment. The control group was additionally treated with high-dose defibrase,and the observation group was additionally treated with Xiaoshuang Changrong capsules based on the treatment of the control group. The Chinese medicine syndrome scores and the clinical effect in the two groups were compared; the cerebral hemodynamic parameters, the indexes of serum lipids and the levels of expression of CD62 P and CD63 before and after treatment were detected. Results: After treatment, the Chinese medicine syndrome scores in the two groups were decreased when compared with those before treatment(P <0.05), and the decrease in the observation group was more obvious than that in the control group(P < 0.05). The total effecti ve rate was 95.24% in the observation group,higher than that of 76.19% in the control group(P < 0.05). After treatment,the mean flow velocity and the mean blood flow in the two groups were increased when compared with those before treatment(P < 0.05),while the levels of peripheral resistance and cerebral vascular characteristic impedance in the two groups were decreased when compared with those before treatment(P< 0.05);the mean flow velocity and the mean blood flow in the observation group were higher than those in the control group(P < 0.05),while the levels of peripheral resistance and cerebral vascular characteristic impedance in the observation group were lower than those in the control group(P < 0.05). After treatment,the levels of total cholesterol(TC),triglyceride(TG)and low density lipoprotein(LDL) in the two groups were decreased when compared with those before treatment(P < 0.05),while the levels of high density lipoprotein(HDL) in the two groups were increased when compared with those before treatment(P < 0.05);the levels of TC,TG and LDL in the observation group were lower than those in the control group(P <0.05),while the level of HDL in the observation group was higher than that in the control group(P < 0.05). After treatment,the levels of expression of CD62 P and CD63 in the two groups were decreased when compared with those before treatment(P < 0.05),and the above levels in the observation group were lower than those in the control group(P < 0.05). Conclusion:The therapy of Xiaoshuang Changrong capsules combined with high-dose defibrase has significant curative effect in treating acute cerebral infarction complicated with carotid atherosclerotic plaques. The cerebral hemodynamic parameters and the indexes of serum lipids were significantly improved, and the levels of expression of CD62 P and CD63 were decreased.Therefore,the therapy is worthy of clinical promotion.
引文
[1]蔡楠,何飞,王芳,等.急性脑梗死患者血清神经元特异性烯醇化酶水平与梗死部位、体积及神经功能缺损的相关性[J].山东医药,2018,58(1):73-75.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:101.
[4]中华神经科学会,中华神经外科学会.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[5]胡华,张燕辉,刘杰,等.神经保护剂联合中成药治疗急性脑梗死疗效及安全性评价的研究思路[J].中华中医药杂志,2017,32(12):5453-5458.
[6]黄美媚,钟剑萍,黎宏庄,等.血脂、血清β-AP和尿酸水平与急性脑梗死患者脑内微出血及预后的关系[J].山东医药,2017,57(11):66-69.
[7]赖苹,何彦玲,杨超.急性脑梗死患者颈动脉粥样硬化及血流动力学参数变化[J].海南医学,2018,29(5):669-671.
[8]李广运.培哚普利联合瑞舒伐他汀治疗冠心病的疗效及对血管内皮功能与血小板活化功能的影响[J].中西医结合心脑血管病杂志,2018,16(1):70-73.
[9]邓有琦,左宏,严建东,等.降纤酶治疗急性脑梗塞的疗效及对血浆纤维蛋白原的影响[J].现代生物医学进展,2016,16(5):919-921.
[10]贾宝,韩怀志.降纤酶对急性脑梗死患者血清超敏C反应蛋白、D-二聚体及NIHSS评分和Barthel指数的影响[J].海南医学,2016,27(18):2945-2947,2948.
[11]曹喜贵,何赵娜.消栓肠溶胶囊联合阿替普酶治疗急性脑梗死的临床研究[J].现代药物与临床,2018,33(4):740-744.
[12]吴波.消栓肠溶胶囊加茴拉西坦治疗对脑梗死康复期患者脑血流灌注、神经功能的影响[J].海南医学院学报,2017,23(24):3456-3458,3462.
[2]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[3]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:101.
[4]中华神经科学会,中华神经外科学会.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):381-383.
[5]胡华,张燕辉,刘杰,等.神经保护剂联合中成药治疗急性脑梗死疗效及安全性评价的研究思路[J].中华中医药杂志,2017,32(12):5453-5458.
[6]黄美媚,钟剑萍,黎宏庄,等.血脂、血清β-AP和尿酸水平与急性脑梗死患者脑内微出血及预后的关系[J].山东医药,2017,57(11):66-69.
[7]赖苹,何彦玲,杨超.急性脑梗死患者颈动脉粥样硬化及血流动力学参数变化[J].海南医学,2018,29(5):669-671.
[8]李广运.培哚普利联合瑞舒伐他汀治疗冠心病的疗效及对血管内皮功能与血小板活化功能的影响[J].中西医结合心脑血管病杂志,2018,16(1):70-73.
[9]邓有琦,左宏,严建东,等.降纤酶治疗急性脑梗塞的疗效及对血浆纤维蛋白原的影响[J].现代生物医学进展,2016,16(5):919-921.
[10]贾宝,韩怀志.降纤酶对急性脑梗死患者血清超敏C反应蛋白、D-二聚体及NIHSS评分和Barthel指数的影响[J].海南医学,2016,27(18):2945-2947,2948.
[11]曹喜贵,何赵娜.消栓肠溶胶囊联合阿替普酶治疗急性脑梗死的临床研究[J].现代药物与临床,2018,33(4):740-744.
[12]吴波.消栓肠溶胶囊加茴拉西坦治疗对脑梗死康复期患者脑血流灌注、神经功能的影响[J].海南医学院学报,2017,23(24):3456-3458,3462.