丁苯酞注射液联合双重抗血小板对急性进展性脑梗死的疗效及其机制探讨

Influence of Butylphthalide combined with dual antiplatelet therapy on patients with acute cerebral infarction

摘要:

目的 探讨丁苯酞联合双重抗血小板治疗急性进展性脑梗死（APCI）的疗效及对外周血6-酮-前列腺素F1α（6-keto-PGF1α）、正血小板α-颗粒膜糖蛋白（CD62P）、血栓素B2（TXB2）、同型半胱氨酸（Hcy）、单核细胞趋化蛋白-1（MCP-1）、血管内皮细胞钙黏蛋白（VE-cadherin）表达的影响。方法 选取2018年1月—2019年10月台州市第一人民医院收治的APCI患者204例，随机分为对照组和观察组，每组102例。对照组采用规范化治疗和双重抗血小板治疗，观察组在对照组基础上加用丁苯酞氯化钠注射液治疗。治疗前、治疗后2周及治疗后30 d，进行美国国立卫生研究院卒中量表（NIHSS）、简易精神状态检查量表（MMSE）、蒙特利尔认知功能评估量表（MoCA）、Barthel指数（BI）评分，采用改良Rankin量表（mRS）评价临床预后。治疗前后，检测外周血6-keto-PGF1α、CD62P、TXB2、Hcy、MCP-1、VE-cadherin水平并比较其变化。结果 治疗后，观察组的NIHSS评分均较治疗前及对照组逐步降低，BI、MMSE、MoCA评分均较治疗前及对照组逐步升高（P <0.05）。两组治疗前后6-keto-PGF1α、CD62P、TXB2、Hcy、MCP-1、VE-cadherin差值比较，差异有统计学意义（P <0.05）。随访90 d，观察组的预后良好率高于对照组（78.57% VS 63.54%，P <0.05）。结论 丁苯酞联合双重抗血小板治疗APCI能够下调患者外周血6-keto-PGF1α、CD62P、TXB2、Hcy、MCP-1、VE-cadherin水平，改善患者的神经功能并保护认知功能，提高生活活动能力及临床预后。

Abstract:

Objective To investigate the efficacy of Butylphthalide combined with dual antiplatelet therapy for acute progressive cerebral infarction (APCI) and its influence on peripheral blood 6-keto-prostaglandin F1α (6k-PGF1α), positive platelet α-granular membrane glycoprotein (CD62P), Thromboxane B2 (TXB2), homocysteine (Hcy), monocyte chemotactic protein 1 (MCP-1), and vascular endothelial cell cadherin (VE-cadherin).Methods From January 2018 to October 2019, 204 cases of APCI patients admitted to our hospital were randomly divided into two groups: the control group (n = 102) received standardized treatment and dual antiplatelet therapy, and the observation group (n = 102) received Butylphthalide treatment on the basis of control group. The National Institutes of Health Stroke Scale (NIHSS) score, Mini Mental State Examination Scale (MMSE) score, Montreal Cognitive Assessment Scale (MoCA) score, Barthel Index (BI) were evaluated before treatment, 2 weeks and 30 days after treatment. The levels of 6k-PGF1α, CD62P, TXB2, Hcy, MCP-1, and VE-cadherin in peripheral blood were measured before and after treatment.Results After treatment, the NIHSS scores of patients in the observation group were downtrend compared with before treatment and control group, and the BI, MMSE, MoCA scores showed climbed trend (all P < 0.05). Compared with control group, the differences after and before treatment of 6k-PGF1α, CD62P, TXB2, Hcy, MCP-1, VE-cadherin in observation group were higher (all P < 0.05). During the 90-day follow-up, the prognosis good rate (78.57% VS 63.54%) in the observation group was higher than the control group (P < 0.05).Conclusions Butylphthalide combined with dual antiplatelet therapy can down-regulate the peripheral blood 6k-PGF1α, CD62P, TXB2, Hcy, MCP-1, VE-cadherin of patients with APCI, improve the nerve function and protect cognitive function, and improve life activities and clinical prognosis.