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。
Objective To study the effect of panax notoginseng saponins （PNS） on the efficacy and hemorrhagic transformation （HT） of recombinant tissue- type plasminogen activator （rt- PA） intravenous thrombolysis in patients with acute ischemic stroke. Methods A total of 200 patients with early acute ischemic stroke （the length of time between attack and hospital admission 〈 4.50 h） were divided into 2 groups according to random number table method： treatment group （N = 100） and control group （N = 100）. The control group was treated with routine rt-PA intravenous thrombolysis treatment, and the treatment group was treated with rt-PA intravenous thrombolysis plus PNS injection. The ischemia-reperfusion injury index [malondialdehyde （MDA） and superoxide dismutase （SOD）], hemorrhagic transformation prediction index [matrix metalloproteinase- 9 （MMP- 9） and fibronectin （FN）] and nerve function index [National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI）] were measured and compared before treatment, 24 h after thrombolysis and 14 d after thrombolysis. Adverse drug reactions and hemorrhagic transformation rate were observed 14 d after thrombolysis, and the prognosis （mortality and BI） was evaluated 12 months after thrombolysis. Results Compared with control group, serum SOD （P = 0.000） and BI （P = 0.000） in treatment group were significantly higher, while serum MDA （P= 0.001）, MMP-9 （P= 0.001）, plasma FN （P = 0.000） and NIHSS score （P = 0.006） were significantly lower. In treatment group, 24 h after rt-PA intravenous thrombolysis plus PNS injection, serum MDA （P = 0.000）, MMP-9 （P = 0.000） and BI （P = 0.000） were significantly increased, while NIHSS score （P = 0.000） was significantly decreased; 14 d after treatment, serum MDA （P = 0.000） and MMP-9 （P = 0.000） were decreased, serum SOD （P = 0.000） and BI （P = 0.000） were continuously increased, plasma FN （P = 0.000） and NIHSS score （P = 0.000�
出处
《中国现代神经疾病杂志》
CAS
2016年第11期784-790,共7页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
卒中
脑缺血
三七皂甙
组织型纤溶酶原激活物
脑出血
Stroke
Brain ischemia
Sanehinoside
Tissue plasminogen activator
Cerebral hemorrhage
