摘要
目的分析急性脑梗死(ACI)患者阿替普酶(rt-PA)静脉溶栓前后氧化应激表达与功能结局的相互关系,为早期干预、改善ACI患者功能结局提供理论依据。方法前瞻性纳入2016年1月至2019年12月天津医科大学总医院接受rt-PA静脉溶栓治疗的80例ACI患者,溶栓后3个月采用日常生活能力(ADL)量表评估功能结局,并分为功能结局不良组与功能结局良好组;调查患者相关基线资料,于溶栓前、溶栓后3个月测定氧化应激指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醇(MDA)],分析溶栓前氧化应激指标表达与溶栓后3个月功能结局的关系。结果80例ACI患者rt-PA静脉溶栓后3个月SOD、GSH-Px水平高于溶栓前,MDA水平、美国国立卫生研究院卒中量表(NIHSS)评分低于溶栓前(P<0.05)。NIHSS评分与SOD水平(rs=—0.666)、GSH-Px水平(rs=—0.639)呈负相关,与MDA水平(rs=0.663)呈正相关(P<0.05)。80例ACI患者rt-PA静脉溶栓后3个月经ADL量表评估,结果显示33例(41.25%)功能结局不良,ADL量表评分为54(49,58)分;47例(58.75%)功能结局良好,ADL量表评分为67(61,76)分。功能结局不良组溶栓前、溶栓后3个月MDA水平高于功能结局良好组,SOD、GSH-Px水平低于功能结局良好组(P<0.05)。logistic回归分析结果显示,溶栓前后SOD、GSH-Px、MDA异常表达可能与ACI患者rt-PA静脉溶栓功能结局不良有关(OR=2.056、1.497、1.773、1.109、3.450、1.185)。受试者工作特征(ROC)曲线显示溶栓前SOD、GSH-Px、MDA单一及联合预测ACI患者rt-PA静脉溶栓功能结局不良风险价值的曲线下面积(AUC)>0.80,当三者最佳截断值分别取25.055 U/L、110.880 U/L、23.180 nmol/L时,预测价值最佳。结论ACI患者rt-PA静脉溶栓功能结局不良可能与氧化应激有关。
Objective To analyze the relationship between the expression of oxidative stress and functional outcome in patients with acute cerebral infarction(ACI)before and after intravenous thrombolysis with alteplase(rt-PA),and to provide theoretical basis for early intervention and improvement of functional outcome of ACI patients in the future.Methods A total of 80 ACI patients who received rt-PA intravenous thrombolysis in the hospital from January 2016 to December 2019 were prospectively included.The daily living scale(ADL)was used to evaluate the prognosis of the patients three months after thrombolysis,dividing the patients into the poor prognosis group and the good prognosis group.The related baseline data of the patients were investigated,the oxidative stress indexes[superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),propylene glycol(MDA)]were measured three months before and after thrombolysis.The relationship between the expression of oxidative stress before thrombolysis and the functional outcome at three months after thrombolysis was mainly analyzed.Results The levels of SOD and GSH-Px in 80 patients with ACI at three months after rt-PA intravenous thrombolysis were higher than those before thrombolysis,while the levels of MDA and national institute of health stroke scale(NIHSS)scores were lower than those before thrombolysis(P<0.05).NIHSS scores were negatively correlated with the SOD(rs=-0.666)and GSH-PX(rs=-0.639)levels before and after thrombolysis(P<0.05),and positively correlated with the MDA levels(rs=0.663,P<0.05).A total of 80 patients with ACI were evaluated by ADL scale at three months after intravenous thrombolysis in rt-PA.The results showed that 33 patients had poor functional outcome,accounting for 41.25%,the average ADL score was 54(49,58)points;47 cases had good functional outcome,accounting for 58.75%,the average ADL score was 67(61,76)points.The levels of MDA at three months after thrombolysis in the poor functional outcome group were higher than those in the good functional outcome gr
作者
杨春
徐玲玲
万春晓
YANG Chun;XU Lingling;WAN Chunxiao(Department of Rehabilitation Medicine,General Hospital of Tianjin Medical University,Tianjin 300052,China;Department of Neurology,Affiliated Hospital of Nankai University/Tianjin Fourth Hospital,Tianjin 300000,China)
出处
《重庆医学》
CAS
2022年第6期910-915,共6页
Chongqing medicine
基金
国家重点研发计划课题(2017YFC1104004)
天津市自然科学基金重点项目(18JCZDJC98900)。
关键词
急性脑梗死
阿替普酶
溶栓
氧化应激
结局
相关性
acute cerebral infarction
alteplase
thrombolysis
oxidative stress
outcome
correlation
