Effects of butylphthalide combined with alteplase on neurological function, fibrinolytic activity and inflammation factors in patients with ischemic cerebral infarction
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摘要:目的 探讨丁苯酞联合阿替普酶对缺血性脑梗死患者神经功能及纤维蛋白溶解活性、炎性因子水平的影响。方法 选取84例缺血性脑梗死患者随机分为2组，对照组应用阿替普酶治疗，研究组在对照组基础上应用丁苯酞治疗。比较2组患者的治疗效果、生活能力、梗死面积、美国国立卫生研究院卒中量表(NIHSS)评分、炎性因子水平、肾功能、不良反应发生率。结果 研究组治疗效果显著优于对照组(P < 0.05); 治疗后，研究组生活能力评分显著高于对照组，梗死面积显著小于对照组, NIHSS评分显著低于对照组(P < 0.05); 治疗后，研究组炎性因子水平显著低于对照组(P < 0.05); 治疗前, 2组肾功能指标水平无显著差异(P>0.05), 治疗后，研究组肌酐清除率显著高于对照组, 24 h尿蛋白定量和血清肌酐(Scr)水平显著低于对照组(P < 0.05); 2组不良反应发生率无显著差异(P>0.05)。结论 丁苯酞联合阿替普酶治疗缺血性脑梗死患者效果显著，可有效改善患者临床症状，降低炎性反应，提高生活能力，缩小梗死面积，降低NIHSS评分，还可降低不良反应发生率，安全性高，能改善患者预后。Abstract:Objective To investigate the effects of butylphthalide combined with alteplase on neurological function, fibrinolytic activity and inflammation factors in patients with ischemic cerebral infarction.Methods A total of 84 patients with ischemic cerebral infarction admitted to our hospital were randomly divided into two groups. The control group was treated with ateplase and the research group was treated with butylphthalide on the basis of the control group. The therapeutic effect, life ability, infarction size, National Institute of Health Stoke Scale(NIHSS) score, inflammatory factor level, renal function and incidence of adverse reactions were compared between the two groups.Results The therapeutic effect of the study group was better than that of the control group (P < 0.05). After treatment, the living ability of the study group was higher, and the infarct size was less and NIHSS score was lower than the control group, the difference was statistically significant (P < 0.05). The inflammatory factor level of the study group was lower than that of the control group (P < 0.05). There was no significant difference in renal function between the two groups before treatment (P>0.05). After treatment, the creatinine clearance rate of the study group was higher than that of the control group, 24 h urine protein quantitation. The serum creatinine(Scr) level was lower than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion For patientswith ischemic cerebral infarction, butylphthalide combined with alteplase is effective, which can effectively improve clinical symptoms, reduce inflammatory response, improve living ability, and reduce infarct size and NIHSS score. In addition, the treatments in combination can reduce the incidence of adverse reactions, and has higher safety, and can improve the prognosis of patients.
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表 1 2组生活能力、梗死面积与NIHSS评分对比(x±s)
组别 n 生活能力/分 脑梗死面积/cm2 NIHSS评分/分 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 42 58.2±14.1 62.3±11.4 16.4±2.7 13.1±1.1 7.4±2.6 6.7±2.4 研究组 42 63.3±13.9 73.9±15.7* 16.5±2.8 11.0±0.9* 7.5±2.5 6.1±2.3* NIHSS: 美国国立卫生研究院卒中量表。与对照组比较, *P < 0.05。 
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表 2 2组炎性因子水平对比(x±s)
组别 n CRP/(mg/L) IL-6/(ng/L) IL-8/(ng/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 42 23.8±1.3 13.8±1.4 59.0±1.3 27.2±1.9 43.3±2.4 30.8±1.5 研究组 42 23.1±1.3 7.4±1.1* 59.1±1.6 12.3±1.2* 43.9±2.6 24.8±0.9* CRP: C反应蛋白; IL-6: 白细胞介素-6; IL-8: 白细胞介素-8。与对照组比较，*P < 0.05。
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表 3 2组肾功能指标比较(x±s)
组别 n 肌酐清除率/(mL/min) 24 h尿蛋白定量/g 血清肌酐/(mg/dL) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 42 74.1±0.4 74.2±0.9 1.2±0.2 1.5±0.1 1.8±0.3 1.5±0.3 研究组 42 74.2±0.4 75.1±0.5* 1.1±0.1 0.7±0.1* 1.8±0.2 1.0±0.3* 与对照组比较, *P < 0.05。
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