尿激酶静脉溶栓与动脉溶栓治疗急性脑梗死的效果及安全性分析
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摘要
目的分析分别应用尿激酶静脉溶栓与动脉溶栓对急性脑梗死患者的治疗效果及安全性。方法回顾性分析2016年1月—2018年1月接受治疗的86例急性脑梗死患者。根据溶栓治疗途径的不同分为对照组和观察组,每组43例。对照组应用尿激酶静脉溶栓,观察组应用尿激酶动脉溶栓。对比2组溶栓前、溶栓1周时血清簇集蛋白(CLU)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平以及血管再通率,并在溶栓30 d后对2组采用改良的Rankin量表(mRS)评分判断疗效,比较致死率与出血事件发生率。结果溶栓1周时,2组的CLU、hs-CRP、TNF-α、IL-6水平均较溶栓前下降,且观察组比对照组下降幅度更大(P<0.05)。观察组血管再通率和总有效率均高于对照组,mRS评分低于对照组(P<0.05)。2组致死率、颅内出血和其他部位出血发生率比较差异均无统计学意义(P>0.05)。结论尿激酶动脉溶栓对急性脑梗死患者疗效更明显,且安全性较高。
Objective To analyze efficacy and safety of intravenous thrombolysis and arterial thrombolysis with Urokinase in treatment of patients with acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted during January 2016 and January 2018 were divided into control group and observation group(n=43 in each group) according to different methods of thrombolytic therapy. Control group was treated with intravenous thrombolysis with Urokinase, while observation group was treated with arterial thrombolysis with Urokinase. Serum levels of cluster protein(CLU), high sensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6) and vascular recanalization rate were compared before and after thrombolysis for 1 week between two groups. Curative effect was evaluated by modified Rankine scale(mRS) at 30 d after thrombolysis, and mortality rate and incidence rate of bleeding events were compared in two groups. Results At the time of thrombolysis for one week, levels of CLU, hs-CRP, TNF-α and IL-6 were significantly lower than those before thrombolysis in two groups, and the decreased values in observation group were greater than those in control group(P<0.05). In observation group, vascular recanalization rate and the total effective rate were significantly higher, while mRS score was significantly lower than those in control group(P<0.05). There were no significant differences in incidence rates of mortality, intracranial hemorrhage and other bleeding between two groups(P>0.05). Conclusion Urokinase arterial thrombolysis may be more effective and safe in treatment of patients with acute cerebral infarction.
Objective To analyze efficacy and safety of intravenous thrombolysis and arterial thrombolysis with Urokinase in treatment of patients with acute cerebral infarction. Methods A total of 86 patients with acute cerebral infarction admitted during January 2016 and January 2018 were divided into control group and observation group(n=43 in each group) according to different methods of thrombolytic therapy. Control group was treated with intravenous thrombolysis with Urokinase, while observation group was treated with arterial thrombolysis with Urokinase. Serum levels of cluster protein(CLU), high sensitive C-reactive protein(hs-CRP), tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6) and vascular recanalization rate were compared before and after thrombolysis for 1 week between two groups. Curative effect was evaluated by modified Rankine scale(mRS) at 30 d after thrombolysis, and mortality rate and incidence rate of bleeding events were compared in two groups. Results At the time of thrombolysis for one week, levels of CLU, hs-CRP, TNF-α and IL-6 were significantly lower than those before thrombolysis in two groups, and the decreased values in observation group were greater than those in control group(P<0.05). In observation group, vascular recanalization rate and the total effective rate were significantly higher, while mRS score was significantly lower than those in control group(P<0.05). There were no significant differences in incidence rates of mortality, intracranial hemorrhage and other bleeding between two groups(P>0.05). Conclusion Urokinase arterial thrombolysis may be more effective and safe in treatment of patients with acute cerebral infarction.
引文
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[20] 朱美娥,龚道恺.血液学指标与急性缺血性脑卒中颈动脉粥样硬化的关系探讨[J].中西医结合心脑血管病杂志,2016,14(22):2701-2703.
[21] 李猛,宣之东,于瑞敏,等.脑梗死患者血清脂联素、瘦素、白细胞介素6与颈动脉内膜中层厚度的相关性研究[J].中国综合临床,2012,28(11):1172-1174.
[22] 郑敏,季雪莲,王慧敏.醒脑静注射液治疗急性脑梗死疗效及对神经功能、生化指标影响的临床研究[J].中华肿瘤防治杂志,2016,23(S2):59-60.
[23] Liu Y Z,Wang C,Wang Q,et al.Role of fractalkine/CX3CR1 signaling pathway in the recovery of neurological function after early ischemic stroke in a rat model[J].Life Sci,2017,184:87-94.
[24] 姜大景,胡婷婷,汪华,等.多模式CT指导下静脉和动脉溶栓治疗急性脑梗死的效果和安全性比较[J].中国CT和MRI杂志,2016,14(3):38-40,54.
[25] Coutinho J M,Liebeskind D S,Slater L A,et al.Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke:a pooled analysis of the SWIFT and STAR studies[J].JAMA Neurol,2017,74(3):268-274.
[26] 马琪林,童绥君,张艺丹,等.CT灌注指导下尿激酶动脉溶栓治疗6～9 h急性脑梗死的疗效及安全性分析[J].中华神经医学杂志,2013,12(11):1101-1105.
[27] 王朝斌,侯立刚.动脉溶栓与动静脉溶栓对急性期缺血性脑卒中病人血管再通率、症状性脑出血发生率及病死率的影响[J].中西医结合心脑血管病杂志,2017,15(19):2480-2482.
[28] Zerna C,Hegedus J,Hill M D.Evolving treatments for acute ischemic stroke[J].Circ Res,2016,118(9):1425-1442.
[29] 刘迪,陈洁,赵宇,等.机械性血管再通治疗超时间窗急性缺血性脑卒中患者11例[J].介入放射学杂志,2016,25(4):287-292.
[2] Gocmen R,Arsava E M,Oguz K K,et al.Atherosclerotic intracranial internal carotid artery calcification and intravenous thrombolytic therapy for acute ischemic stroke[J].Atherosclerosis,2018,270:89-94.
[3] Barreto A D,Ford G A,Shen L,et al.Randomized,multicenter trial of ARTSS-2 (argatroban with recombinant tissue plasminogen activator for acute stroke)[J].Stroke,2017,48(6):1608-1616.
[4] 黄才英,刘本德,刘金平.尿激酶溶栓治疗急性脑梗死后出血的临床效果分析[J].重庆医学,2016,45(32):4502-4504.
[5] 赵建国,高长玉,项宝玉,等.脑梗死和脑出血中西医结合诊断标准(试行)[J].中国中西医结合杂志,2006,26(10):948-949.
[6] 林喜喜,张君,王伟,等.血管内再通术治疗非急性动脉粥样硬化性颈内动脉颅外段闭塞的疗效观察[J].中国卒中杂志,2018,13(4):304-310.
[7] Georgievski-Brkic B,Savic M,Nikolic D,et al.Evaluation of functional outcome measured by modified Rankin scale in rtPA treated patients with acute ischemic stroke[J].Arch Ital Biol,2016,154(4):125-132.
[8] 郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:54.
[9] Dong X L,Xu S J,Zhang L,et al.Serum resistin levels may contribute to an increased risk of acute cerebral infarction[J].Mol Neurobiol,2017,54(3):1919-1926.
[10] 项颖,王宝梅,刘永宏,等.脑梗死急性期血压变化与心脑缺血事件的相关性研究[J].西部医学,2018,30(6):851-855,860.
[11] Tan Q,Chen Q,Niu Y,et al.Urokinase,a promising candidate for fibrinolytic therapy for intracerebral hemorrhage[J].J Neurosurg,2017,126(2):548-557.
[12] Xu X,Li C,Wan T,et al.Risk factors for hemorrhagic transformation following intravenous thrombolysis in acute cerebral infarction:a retrospective single center study[J].World Neurosurg,2017,101:155-160.
[13] 贺大权,秦雪颖,赵丹华,等.阿替普酶动、静脉溶栓治疗急性缺血性脑卒中的比较性研究[J].实用临床医药杂志,2016,20(17):21-24.
[14] 王达.经导管选择性脑动脉内介入溶栓治疗急性脑梗死效果观察[J].临床医学,2018,38(6):3-5.
[15] 徐艳,李辉华.簇集蛋白在急性脑梗死中的表达及其临床意义[J].重庆医学,2016,45(21):2942-2945.
[16] 王京娥,陈燕,高山,等.血清簇集蛋白、和肽素和抵抗素检测在2型糖尿病急性脑梗死治疗中的临床意义[J].现代中西医结合杂志,2017,26(29):3257-3259.
[17] Aragonès G,Auguet T,Guiu-Jurado E,et al.Proteomic profile of unstable atheroma plaque:increased neutrophil defensin 1,clusterin and apolipoprotein E levels in carotid secretome[J].J Proteome Res,2016,15(3):933-944.
[18] 刘玉平.依达拉奉对老年急性脑梗死患者血清炎性因子及其社会功能的影响[J].临床医学,2016,36(11):40-42.
[19] 马丽苹,高义,王晓鹏.瑞舒伐他汀联合普罗布考对老年脑梗死患者颈动脉粥样硬化、血脂及炎性因子的研究[J].中国循证心血管医学杂志,2016,8(3):335-338.
[20] 朱美娥,龚道恺.血液学指标与急性缺血性脑卒中颈动脉粥样硬化的关系探讨[J].中西医结合心脑血管病杂志,2016,14(22):2701-2703.
[21] 李猛,宣之东,于瑞敏,等.脑梗死患者血清脂联素、瘦素、白细胞介素6与颈动脉内膜中层厚度的相关性研究[J].中国综合临床,2012,28(11):1172-1174.
[22] 郑敏,季雪莲,王慧敏.醒脑静注射液治疗急性脑梗死疗效及对神经功能、生化指标影响的临床研究[J].中华肿瘤防治杂志,2016,23(S2):59-60.
[23] Liu Y Z,Wang C,Wang Q,et al.Role of fractalkine/CX3CR1 signaling pathway in the recovery of neurological function after early ischemic stroke in a rat model[J].Life Sci,2017,184:87-94.
[24] 姜大景,胡婷婷,汪华,等.多模式CT指导下静脉和动脉溶栓治疗急性脑梗死的效果和安全性比较[J].中国CT和MRI杂志,2016,14(3):38-40,54.
[25] Coutinho J M,Liebeskind D S,Slater L A,et al.Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke:a pooled analysis of the SWIFT and STAR studies[J].JAMA Neurol,2017,74(3):268-274.
[26] 马琪林,童绥君,张艺丹,等.CT灌注指导下尿激酶动脉溶栓治疗6～9 h急性脑梗死的疗效及安全性分析[J].中华神经医学杂志,2013,12(11):1101-1105.
[27] 王朝斌,侯立刚.动脉溶栓与动静脉溶栓对急性期缺血性脑卒中病人血管再通率、症状性脑出血发生率及病死率的影响[J].中西医结合心脑血管病杂志,2017,15(19):2480-2482.
[28] Zerna C,Hegedus J,Hill M D.Evolving treatments for acute ischemic stroke[J].Circ Res,2016,118(9):1425-1442.
[29] 刘迪,陈洁,赵宇,等.机械性血管再通治疗超时间窗急性缺血性脑卒中患者11例[J].介入放射学杂志,2016,25(4):287-292.