摘要
目的 基于临床评分、血管内皮功能等指标探讨阿加曲班联合阿司匹林在急性脑梗死患者中的治疗作用.方法 前瞻性选取沧州市中心医院2022年6月～2023年11月收治的108例急性脑梗死患者,按随机数表法将患者分为对照组和观察组,各54例,前者给予阿司匹林片单纯治疗,后者给予阿司匹林片联合阿加曲班注射液治疗,疗程均为1周.比较两组患者治疗前和治疗1周临床评分;比较两组患者治疗前和治疗1周血管内皮功能;比较两组患者治疗前和治疗1周脂蛋白相关磷脂A2(Lp-PLA2)、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)等指标水平;比较两组患者治疗期间安全性.结果 治疗1周后,观察组美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)评分低于对照组,改良Barthel指数(MBI)高于对照组[(9.12±3.10)分 vs.(16.30±2.92)分、(2.04±0.10)分 vs.(4.45±0.37)分、(75.14±6.22)分 vs.(60.90±5.77)分],差异均有统计学意义(t=12.389、46.206、12.334,P＜0.05).治疗1周后,观察组内皮素-1较对照组更低,一氧化氮(NO)、血管内皮生长因子(VEGF)、内皮依赖性血管舒张功能(FMD)较对照组更高[(45.25±4.46)ng/L vs.(56.70±5.87)ng/L、(69.01±12.20)μmol/L vs.(54.79±11.59)μmol/L、(392.09±61.88)pg/ml vs.(350.03±52.67)pg/ml、(15.70±2.15)％vs.(10.21±1.16)％],差异均有统计学意义(t=11.413、6.210、3.804、16.544,P＜0.05).治疗 1 周后,观察组 Lp-PLA2、MMP-9、TNF-α 较对照组更低[(4.50±0.22)pg/ml vs.(11.09±1.15)pg/ml、(110.27±10.70)µg/L vs.(169.45±19.10)μg/L、(2.02±0.15)μg/L vs.(4.59±0.30)μg/L],差异均有统计学意义(t=41.360、19.864、56.306,P＜0.05).两组患者治疗期间安全性比较,差异无统计学意义(P＞0.05).结论 急性脑梗死患者应用阿加曲班联合阿司匹林治疗其症状明显改善,且安全性良好,其机制可能与调节血管内皮功能及血清细胞因子水平有关.
Abstract
Objective To investigate the therapeutic role of argatroban combined with aspirin in patients with acute cerebral infarction based on clinical scores,vascular endothelial function and other indicators.Methods Prospectively selected 108 patients with acute cerebral infarction admitted to Cangzhou City Central Hospital from June 2022 to November 2023 as the study subjects,the patients were divided into 54 cases each in the control group and the treatment group according to the method of randomized numerical table,and the former was given aspirin tablets for simple treatment,and the latter was given aspirin tablets combined with argatroban injection for a period of 1 week.Clinical scores,vascular endothelial function,lipoprotein-associated phospholipid A2(Lp-PLA2),matrix metalloproteinase-9(MMP-9),and tumor necrosis factor-α(TNF-α)(before and 1 week of treatment)and safety(during treatment)were compared between the two groups.Results The National Institutes of Health Stroke Scale(NIHSS),modified Rankin Scale(mRS)scores,endothelin-1,Lp-PLA2,MMP-9,and TNF-α in the treatment group were lower than those in the control group after 1 week of treatment[(9.12±3.10)points vs.(16.30±2.92)points,(2.04±0.10)points vs.(4.45±0.37)points,(45.25±4.46)ng/L vs.(56.70±5.87)ng/L,(4.50±0.22)pg/mL vs.(11.09±1.15)pg/mL,(110.27±10.70)μg/L vs.(169.45±19.10)μg/L,(2.02±0.15)µg/L vs.(4.59±0.30)µg/L],with statistically significant differences(t=12.389,46.206,11.413,41.360,19.864,56.306,P＜0.05);modified Barthel index(MBI),nitric oxide(NO),vascular endothelial growth factor(VEGF),endothelial dependent vasodilatory function(FMD)were higher in the control group[(75.14±6.22)points vs.(60.90±5.77)points,(69.01±12.20)μmol/L vs.(54.79±11.59)μmol/L,(392.09±61.88)pg/ml vs.(350.03±52.67)pg/ml,(15.70±2.15)％vs.(10.21±1.16)％],the differences were statistically significant(t=12.334,6.210,3.804,16.544,P＜0.05).There was no difference in the safety comparison between the two groups(P＞0.05).Conclusion Patients with acute cerebral infarction were treated with argatroban in combination with aspirin for significant improvement of their symptoms with a favorable safety profile,the mechanism of which may be related to the regulation of vascular endothelial function and serum cytokine levels.
基金项目
沧州市科技局重点研发计划指导项目(213106011)
维普
万方数据