依达拉奉右莰醇联合血管介入...SE水平和血小板功能的影响_李世芳.pdf

Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期依达拉奉右莰醇联合血管介入术治疗急性脑梗死的疗效及对患者血清Lp-PLA_(2)、NSE水平和血小板功能的影响李世芳1，肖文1，张会平21.宝鸡市第三医院神经内科，陕西宝鸡721001；2.宝鸡市高新医院神经内科，陕西宝鸡721002【摘要】目的观察依达拉奉右莰醇联合血管介入术治疗急性脑梗死(ACI)的疗效，并探讨其对患者血清脂蛋白相关磷脂酶A2 Lp-PLA_(2)、神经元特异性烯醇化酶(NSE)水平和血小板功能的影响。方法选取2021年1月至2022年2月宝鸡市第三医院与宝鸡市高新医院收治的105例ACI患者作为研究对象，采用分层区组随机化方法，按各医院分层，按照11比例将患者分为对照组52例和观察组53例，两组患者均行常规治疗和血管介入手术治疗，此外，对照组给予依达拉奉注射液，观察组给予依达拉奉右莰醇注射用浓溶液，两组患者均治疗14 d。比较两组患者治疗后的临床疗效，以及治疗前后的血清Lp-PLA_(2)、NSE水平、血小板功能和并发症发生情况。结果观察组患者的治疗总有效率为94.34%，明显高于对照组的80.77%，差异有统计学意义(P0.05)；治疗后，观察组患者的血清Lp-PLA_(2)、NSE分别为(169.4614.68)mg/L、(7.960.82)mg/L，明显低于对照组的(192.3616.04)mg/L、(9.780.58)mg/L，差异均有统计学意义(P0.05)；治疗后，观察组患者的血小板黏附率、血小板聚集率、CD62p和选择素分别为(35.893.56)%、(29.103.46)%、(2.830.50)%、(10.882.17)mg/L，明显低于对照组的(39.683.48)%、(31.573.66)%、(3.170.49)%、(12.032.09)mg/L，差异均有统计学意义(P0.05)。结论依达拉奉右莰醇联合血管介入术治疗急性脑梗死的疗效较好，其可降低患者血清Lp-PLA_(2)、NSE水平，改善血小板功能。【关键词】急性脑梗死；依达拉奉右莰醇；血管介入术；脂蛋白相关磷脂酶A2；神经元特异性烯醇化酶；疗效【中图分类号】R743.3【文献标识码】A【文章编号】10036350（2023）13182504Efficacy of edaravone dexborneol combined with vascular intervention in the treatment of acute cerebralinfarction and the influence on serum Lp-PLA_(2)and NSE levels and platelet function.LI Shi-fang1,XIAO Wen1,ZHANG Hui-ping2.1.Department of Neurology,Baoji Third Hospital,Baoji 721001,Shaanxi,CHINA;2.Department ofNeurology,Baoji High-tech Hospital,Baoji 721002,Shaanxi,CHINA【Abstract】ObjectiveTo observe the efficacy of edaravone dexborneol combined with vascular intervention inthe treatment of acute cerebral infarction(ACI),and investigate the influence on serum lipoprotein-associated phospholi-pase A2 Lp-PLA_(2),neuron-specific enolase(NSE)levels,and platelet function.MethodsA total of 105 patientswith ACI admitted to Baoji Third Hospital and Baoji High-tech Hospital from January 2021 to February 2022 were se-lected as the research subjects.They were divided into the control group(52 cases)and the observation group(53 cases)by stratified blocked randomization method.All patients were given conventional treatment and vascular interventionaloperation.The control group was treated with edaravone injection,while the observation group was treated with edara-vone dexborneol injection.All patients were treated for 14 days.The two groups were compared in terms of clinical effi-cacy after treatment,serum Lp-PLA_(2)and NSE levels before and after treatment,platelet function,and the incidenceof complications.ResultsThe total treatment response rate in the observation group was 94.34%,significantly higherthan 80.77%in the control group,with a statistically significant difference(P0.05).After treatment,serum Lp-PLA_(2)and NSE levels,platelet adhesion rate,platelet aggregation rate,CD62p level,and selectin level in the observation groupwere(169.4614.68)mg/L,(7.960.82)mg/L,(35.893.56)%,(29.103.46)%,(2.830.50)%,and(10.882.17)mg/L,significantly lower than(192.3616.04)mg/L,(9.780.58)mg/L,(39.683.48)%,(31.573.66)%,(3.170.49)%,and(12.032.09)mg/L in the control group,with statistically significant differences(P0.05).ConclusionEdaravone dexborneol combined with vascular intervention is ef-fective in the treatment of ACI,which can lower serum Lp-PLA_(2)and NSE levels,and improve platelet function.【Key words】Acute cerebral infarction;Edaravone dexborneol;Vascular interventional operation;Lipoprotein-as-sociated phospholipaseA2;Neuron-specific enolase;Efficacy 论著 doi:10.3969/j.issn.1003-6350.2023.13.001基金项目：陕西省自然科学发展项目(编号：Xz-2123)。第一作者：李世芳(1984)，女，主治医师，主要研究方向为神经介入、脑血管病、癫痫等。通讯作者：肖文(1969)，男，主任医师，主要研究方向为神经介入、睡眠障碍，E-mail：。1825海南医学2023年7月第34卷第13期Hainan Med J,Jul.2023,Vol.34,No.13急性脑梗死(acute cerebral infarction，ACI)也称急性缺血性脑卒中，其因脑动脉供血不足导致脑组织局部缺氧缺血，从而引发患者神经功能障碍，在所有脑卒中患者中的发病率为60%70%，全球约有1 700万名ACI患者1-2。研究表明，ACI患者发病24 h内进行血管介入手术为临床主要治疗方法，血管介入手术可提高大血管闭塞的再通率，但存在脑出血、脑栓塞等常见并发症3。依达拉奉右莰醇则是一种强效氧自由基清除剂，由依达拉奉与右莰醇组成，可抑制炎性细胞因子，保护脑细胞4。目前采用依达拉奉右莰醇联合血管介入术对 ACI 患者进行治疗的相关研究较少。本研究旨在通过联合两种方法对AIC患者进行治疗并探讨其对患者血清脂蛋白相关磷脂酶A2 lipo-prorein-assoeiated phosphohpase A2，Lp-PLA_(2)、神经元特异性烯醇化酶(neuronspecific enolase，NSE)水平和血小板功能的影响。1资料与方法1.1一般资料选取2021年1月至2022年2月宝鸡市第三医院和宝鸡市高新医院收治的105例ACI患者作为研究对象。纳入标准：(1)经头颅CT和MRI检查，符合 缺血性卒中基层诊疗指南(2021年)急性脑梗死诊断标准5；(2)发病时间0.05)，具有可比性，见表1。本研究经宝鸡市第三医院和宝鸡市高新医院医学伦理委员会审核通过。1.2治疗方法两组患者均给予控血压、吸氧、血脂、血糖、抗血小板抗凝等常规治疗以及血管内介入治疗。具体方法：常规消毒，局麻下使用 Selding-er针，经股动脉穿刺，进入动脉鞘，5F导管行脑血管造影，确定闭塞病变血管位置后，将 420 mm 或 630 mm 的SeldingerTMAB支架经微导管送入，固定支架推丝使缓慢将微导管回撤释放支架，通过Rebar微导管“Y”阀进行负压抽吸，5 min后将直接与微导管同时拉出；检查支架上附着的血栓情况并使用20 mL注射器将导引导管内的血栓吸出直到导引导管内血流通畅。对照组患者血管内介入治疗后CT检查未见出血，24 h内给予依达拉奉注射液(南京先声东元制药有限公司，国药准字H20050280，20 mL30 mg)，加入适量生理盐水稀释后静脉滴注，30 mg/次，两次/d，滴注时间控制在0.5 h内。观察组患者血管内介入治疗后CT检查未见出血，24 h内给予依达拉奉右莰醇注射用浓溶液(南京先声东元制药，国药准字H20200007，5 mL10 mg：2.5 mg6支/盒)静脉滴注，成人1次1支(含依达拉奉 30 mg)，两次/d，滴注时间控制在 0.5 h内。两组疗程共14 d。1.3观察指标(1)疗效6：治疗前与治疗14 d后采用 NIHSS评分评价疗效。痊愈：NIHSS 评分改善90%100%；显效：NIHSS评分改善60%90%；好转：NIHSS评分改善20%59%；无效：未达以上标准。有效率=(痊愈+显效+好转)患者数/总患者数100%。(2)血液指标：于清晨抽取两组患者治疗前后的静脉血5 mL，根据试剂盒说明采用化学发光免疫分析法检测Lp-PLA_(2)水平；按相关测定试剂盒说明采用酶联免疫吸附试验检测NSE水平。(3)血小板功能：分别抽取患者治疗前后静脉血5 mL，DG5033A酶标仪检测选择素OD值，FACS calibur流式细胞仪检测P-选择素(CD62p)，血小板黏附率、血小板聚集率采用血小板分析仪进行检测。(4)并发症：比较两组患者治疗期间出现发热、穿刺皮肤红肿、脑出血等情况。1.4统计学方法应用SPSS22.0统计软件分析数据。计量资料以均值标准差(x-s)表示，组内和组间独立样本分别采用配对样本t检验；计数资料比较采用2检验、Fisher精确概率法。以P0.05表示差异有统计学意义。2结果2.1两组患者的临床疗效比较观察组患者的治疗总有效率为94.34%，明显高于对照组的80.77%，差异有统计学意义(2=4.456，P=0.0350.05)。治疗后，两组患者的Lp-PLA_(2)、NSE均明显下降，且观察组明显低于对照组，差异均有统计学意义(P0.05)；治疗后，两组患者的上述各项指标均下降，且观察组明显低于对照组，差异均有统计学意义(P0.05)，见表4。表2两组患者的临床疗效比较(例)Table 2Comparison of clinical efficacy between the two groups ofpatients(n)组别观察组对照组例数5352痊愈2014显效1514好转1514无效310总有效率(%)94.3480.77表4两组患者治疗前后的血小板功能比较(x-s)Table 4Comparison of platelet function between the two groups of patients before and after treatment(x-s)组别观察组对照组t值P值例数5352治疗前44.953.8745.023.910.0970.923治疗后35.893.56a39.683.48a5.7600.001治疗前36.225.5835.935.030.2840.776治疗后29.103.46a31.573.66a3.9470.001治疗前3.850.613.830.700.1720.864治疗后2.830.50a3.170.49a3.6760.001治疗前17.143.2117.213.500.1160.908治疗后10.882.17a12.032.09a2.8730.005注：与同组治疗前比较，aP0.05。Note:Compared with that in the same group before treatment,aP0.05)，见表5。3讨论ACI是具有高致残率、高死亡率、高并发症发生率的神经系统疾病，近几年在我国呈年轻化且越演越烈的趋势，威胁人类生命健康，给不少家庭经济带来沉重的负担7。随着科学技术、影像技术的进步，血管内介入治疗ACI已成为主流方式，具有良好效果，但是仍有部分患者预后效果欠佳。ACI患者因缺血/再灌注导致氧浓度升高，体内抗氧化物质被过量消耗，氧化应激反应得不到有效控制，大量氧自由基和炎症因子作用于脑血管中内皮细胞，导致趋化因子释放，最终内皮细胞吸附大量白细胞导致颅内的毛细血管被阻塞，于是发生痉挛并导致缺血造成脑细胞受损8。依达拉奉右莰醇是一种强效的氧自由基清除剂，可通过血脑屏障降低脑细胞膜氧化应激损伤、保护神经血管单位、抑制炎症因子和蛋白表达，可避免脑细胞的二次伤害，起到保护脑细胞的作用9。本研究结果显示，治疗后，观察组的疗效好于对照组且差异有统计学意义(P0.05)，治疗后，两组患者的Lp-PLA_(2)、NSE均下降且观察组明显低于对照组，差异均有统计学意义(P0.05)。治疗后两组患者血小板黏附率、血小板聚集率、CD62p和选择素较治疗前明显下降，且观察组下降比对照组明显，差异有统计学意义(P0.05)。王亚博等13的研究发现，急性脑梗死表5两组患者的并发症比较(例)Table 5Comparison of complications between the two groups ofpatients(n)组别观察组对照组例数5352发热12穿刺皮肤红肿11脑出血01总发生率(%)3.777.69表3两组患者治疗前后的血清Lp-PLA_(2)、NSE比较(x-s，mg/L)Table 3Comparison of serum Lp-PLA_(2)and NSE between the twogroups of patients before and after treatment(x-s，mg/L)组别观察组对照组t值P值例数5352治疗前233.9120.03232.4319.110.4010.689治疗后169.4614.68a192.3616.04a8.2700.001治疗前17.081.3317.351.301.0980.274治疗后7.960.82a9.780.58a12.4920.001Lp-PLA_(2)NSE注：与同组治疗前比较，aP0.05。Note:Compared with that in the same group before treatment,aP0.05.1827海南医学2023年7月第34卷第13期Hainan Med J,Jul.2023,Vol.34,No.13通过银杏内酯注射液联合阿替普酶治疗后血清中Lp-PLA-(2)和 NSE 水平下降，且比对照组下降更显著。刘深龙等14研究替罗非班治疗进展性脑梗死的疗效，结果显示，血小板黏附率、血小板聚集率、CD62p和选择素均低于对照组，这与本研究结果相似。究其原因，依达拉奉右莰醇作为神经保护剂，其中的依达拉奉可清除羟基、过氧化物和超氧阴离子，右莰醇可调节脑血屏障通透性以及抑制炎症因子，两种物质相互协调保护脑神经，同时保护氧化应激状态下海马HT 22神经元、星型胶质细胞和血管内皮细胞，其表现出清除自由基、抗炎、保护血脑屏障等多重作用，覆盖了更广泛的缺血后神经损害机制15。综上所述，依达拉奉右莰醇联合血管介入术能有效治疗急性脑梗死，降低ACI患者体内血清Lp-PLA_(2)和NSE水平，改善血小板功能，促进患者神经功能的恢复，提高生活质量，具有临床应用价值。参考文献1 Liu X,Rao S,Wang J.Intravenous thrombolysis in combination withmild hypothermia therapy in the treatment of acute cerebral infarc-tion J.Pak J Med Sci,2019,35(4):1161-1166.2 Zhang R,Tian HL,Wang LT,et al.Domestic research progress of in-travenous thrombolysis and intravascular treatment of 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