作者：段凯强，吴艳峰，薛嘉海，李娟，李春玲，王巍

单位：

1.075000河北省张家口市第一医院急诊科　2.075000河北省张家口市第一医院放射医学科　3.075000河北省张家口市 第一医院老年病二科　4.075000河北省张家口市第一医院神内三科

Units：

1.Emergency Department, Zhangjiakou First Hospital, Zhangjiakou 075000, China 2.Department of Radiology, Zhangjiakou First Hospital, Zhangjiakou 075000, China 3.Department of Geriatrics Ⅱ, Zhangjiakou First Hospital, Zhangjiakou 075000, China 4.Department of Neurology Ⅲ, Zhangjiakou First Hospital, Zhangjiakou 075000, China

关键词：

缺血性卒中；丁苯酞；阿替普酶；治疗结果

Keywords：

Ischemic stroke; Butylphthalide; Alteplase; Treatment outcome

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.270

Funds：

河北省2022年度医学科学研究课题计划（20221896）

摘要：

目的　探讨丁苯酞联合阿替普酶静脉溶栓治疗急性缺血性卒中的临床疗效。方法　选取2021年1月至 2022年4月张家口市第一医院收治的急性缺血性卒中患者 164例，将接受丁苯酞联合阿替普酶静脉溶栓治疗的患者作为 观察组（ n=86），将仅接受阿替普酶静脉溶栓治疗的患者作为对照组（ n=78）。比较两组患者基线资料，入院时、 出院时神经递质〔中枢神经特异性蛋白β（S100β）、神经元特异性烯醇化酶（NSE）〕、病灶体积，入院时、溶栓 后1 h、溶栓后24 h、出院时美国国立卫生研究院卒中量表（NIHSS）评分，弥散张量成像（DTI）参数〔入院时、出 院时患侧表观弥散系数（ADC）、患侧部分各向异性系数（FA），健侧ADC、健侧FA，入院时、出院时相对ADC、 相对FA〕及不良反应发生率。采用Pearson相关分析探讨急性缺血性卒中患者NIHSS评分与DTI参数的相关性。结果　 两组出院时S100β、NSE分别低于本组入院时，病灶体积分别小于本组入院时，且观察组出院时S100β、NSE低于对 照组，病灶体积小于对照组（P＜0.05）。时间与治疗方法在NIHSS评分上存在交互作用（P＜0.05）；时间、治疗方 法在NIHSS评分上主效应显著（P＜0.05）。两组溶栓后1 h、溶栓后24 h、出院时NIHSS评分分别低于本组入院时，溶 栓后24 h、出院时NIHSS评分分别低于本组溶栓后1 h，出院时NIHSS评分分别低于本组溶栓后24 h，且观察组溶栓后 24 h、出院时NIHSS评分低于对照组（P＜0.05）。两组出院时患侧ADC、患侧FA、相对ADC、相对FA分别高于本组入 院时，且观察组出院时患侧ADC、患侧FA、相对ADC、相对FA高于对照组（P＜0.05）。Pearson相关分析结果显示， 急性缺血性卒中患者出院时NIHSS评分与出院时相对ADC呈负相关（r=-0.179，P=0.022），与出院时相对FA呈负相关 （r=-0.241，P=0.002）。观察组肝功能受损、肾功能受损发生率低于对照组（P＜0.05）。结论　丁苯酞联合阿替普酶 静脉溶栓可降低急性缺血性卒中患者S100β、NSE，缩小病灶体积，减轻神经功能损伤及脑组织损伤。

Abstract：

　Objective To investigate the clinical efficacy of butylphthalein combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. Methods A total of 164 patients with acute ischemic stroke admitted to Zhangjiakou First Hospital from January 2021 to April 2022 were selected. Patients receiving butylphthalein combined with alteplase intravenous thrombolysis therapy were selected as the observation group (n=86) , and those receiving alteplase intravenous thrombolysis therapy were selected as the control group (n=78) . Baseline data, neurotransmitter [central nervous system specific protein β (S100β) , neuron specific enolase (NSE) ] and lesion volume at admission and discharge, National Institutes of Health Stroke Scale (NIHSS) score at admission, 1 h after thrombolysis, 24 h after thrombolysis and at discharge, diffusion tensor imaging (DTI) parameters [apparent diffusion coefficient (ADC) and fraction anisotropy (FA) on the affected side at admission and discharge, ADC and FA on the healthy side, relative ADC and relative FA at admission and discharge] and the rate of adverse reactions were compared between the two groups. Pearson correlation was used to analyze the correlation between NIHSS score and DTI parameters in acute ischemic stroke patients. Results The S100β and NSE at discharge of the two groups were lower than those at admission respectively, the lesion volume was smaller than that at admission respectively, the S100βand NSE at discharge of the observation group were lower than those of the control group, the lesion volume was smaller than that of the control group (P < 0.05) . There was an interaction between treatment method and time on NIHSS score (P < 0.05) . The main effect of time and treatment method on NIHSS score was significant (P < 0.05) . In the two groups, the NIHSS score at 1 h after thrombolysis, 24 h after thrombolysis and at discharge was lower than that at admission respectively, the NIHSS score at 24 h after thrombolysis and at discharge was lower than that at 1 h after thrombolysis respectively, and the NIHSS score at discharge was lower than that at 24 h after thrombolysis respectively, and the NIHSS score at 24 h after thrombolysis and at discharge of the observation group was lower than that of the control group (P < 0.05) . ADC and FA on the affected side, relative ADC and relative FA at discharge were higher than those at admission in the two groups, respectively, and ADC and FA on the affected side, relative ADC and relative FA at discharge in the observation group were higher than those in the control group (P < 0.05) . Pearson correlation analysis showed that NIHSS score at discharge was negatively correlated with relative ADC (r=-0.179, P=0.022) and relative FA (r=-0.241, P=0.002) in patients with acute ischemic stroke. The incidence of liver function impairment and kidney function impairment in the observation group was lower than that in the control group (P < 0.05) . Conclusion Butylphthalein combined with alteplase intravenous thrombolysis can reduce S100β, NSE, lesion volume, neurological impairment and brain tissue injury in patients with acute ischemic stroke.

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