三七总皂苷对急性缺血性卒中患者重组组织型纤溶酶原激活物静脉溶栓疗效及出血性转化的影响

发布时间：2018-03-04 19:10

本文选题：卒中　切入点：脑缺血　出处：《中国现代神经疾病杂志》2016年11期 　论文类型：期刊论文

【摘要】：目的探讨三七总皂苷对急性缺血性卒中患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓疗效和出血性转化的影响。方法共200例急性(发病至入院时间4.50 h)缺血性卒中患者采用随机数字表法随机分为常规rt-PA静脉溶栓组(对照组,100例)和rt-PA静脉溶栓联合三七总皂苷治疗组(治疗组,100例),分别于治疗前、静脉溶栓后24 h和14 d检测缺血-再灌注损伤指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]、出血性转化指标[基质金属蛋白酶-9(MMP-9)、纤维连接蛋白(FN)]和神经功能指标[美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)],观察静脉溶栓后14 d药物不良反应和出血性转化发生率,评价静脉溶栓后12个月预后(病死率和BI评分)。结果治疗组患者血清SOD(P=0.000)和BI评分(P=0.000)高于,血清MDA(P=0.001)和MMP-9(P=0.001)、血浆FN(P=0.000)和NIHSS评分(P=0.006)低于对照组。rt-PA静脉溶栓联合三七总皂苷治疗后24 h,血清MDA(P=0.000)和MMP-9(P=0.000)、BI评分(P=0.000)升高,NIHSS评分降低(P=0.000);治疗后14 d,血清MDA(P=0.000)和MMP-9(P=0.000)反而降低,血清SOD(P=0.000)和BI评分(P=0.000)持续升高,血浆FN(P=0.000)和NIHSS评分(P=0.000)持续降低。静脉溶栓后14 d,治疗组患者出血性转化发生率低于对照组[9例(9%)对19例(19%);χ2=4.153,P=0.042)],药物不良反应发生率组间差异无统计学意义[14例(14%)对11例(11%);χ2=0.411,P=0.521]。静脉溶栓后12个月,两组病死率差异无统计学意义[5例(5%)对1例(1%);χ2=1.546,P=0.241],而治疗组生存患者BI评分高于对照组(88.51±11.49对84.47±9.83;t=2.451,P=0.015)。结论三七总皂苷可以减轻急性缺血性卒中患者rt-PA静脉溶栓后缺血-再灌注损伤,降低出血性转化发生率,改善患者预后,且安全性良好。
[Abstract]:Objective to investigate the effects of panax notoginseng saponins on intravenous thrombolysis and hemorrhagic transformation of recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke. The patients were randomly divided into routine rt-PA intravenous thrombolytic group (control group, n = 100) and rt-PA intravenous thrombolytic therapy combined with panax notoginseng saponins group (treatment group, n = 100). The indexes of ischemia-reperfusion injury [malondialdehyde (MDA), superoxide dismutase (SOD)], hemorrhagic transformation index [matrix metalloproteinase-9 (MMP-9), fibronectin (FN)] and neurological function were detected 24 h and 14 d after intravenous thrombolysis. NIHSS and Barthel Index (BI) were used to observe the adverse drug reactions and the incidence of hemorrhagic transformation 14 days after intravenous thrombolysis. Results the prognosis (mortality and BI score) of 12 months after intravenous thrombolysis were higher in the treatment group than in the treatment group. Serum MDA-P0. 001) and MMP-9 P0. 001) and NIHSS score (P 0. 006) were lower than those in control group 24 h after intravenous thrombolytic thrombolysis combined with total saponins of Panax notoginseng (0. 000) and MMP-9 P0. 000BI score P0. 000) increased and decreased significantly (P 0. 000), and serum MDA-P0. 000) and MMP-9 P0. 000) decreased at 14 days after treatment. Serum SODX (0.000) and BI score (P = 0.000) continued to increase. The incidence of hemorrhagic transformation in the treatment group was significantly lower than that in the control group [9 cases, 9 cases) and 19 cases, respectively; 蠂 2 + 4.153% P + 0. 042]. There was no significant difference in the incidence of adverse drug reactions between the two groups [14 cases (14 cases) and 11 cases (14 cases, 14 cases), respectively], and there was no significant difference in the incidence of adverse drug reactions between the two groups [14 cases, 14 cases, 14 cases], 11 cases, respectively, but no significant difference in the incidence of adverse drug reactions between the two groups (14 cases, 14 cases). 11%. 12 months after intravenous thrombolysis, 蠂 2 0. 411 P 0. 521. There was no significant difference in fatality rate between the two groups [5 cases with 5 cases) and 1 case with acute ischemic stroke. The BI score of survival patients in the treatment group was higher than that in the control group (88.51 卤11.49 vs 84.47 卤9.83). Conclusion Panax saponins can reduce the ischemia-reperfusion injury after intravenous thrombolytic therapy in patients with acute ischemic stroke, but the BI score in the treatment group is higher than that in the control group (88.51 卤11.49 vs 84.47 卤9.83). Reduce the incidence of hemorrhagic transformation, improve the prognosis of patients, and the safety is good.
【作者单位】：河南省信阳市中心医院神经内科;
【分类号】：R743.3

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