Therapeutic effect,bleeding events and endothelial function of ultra-early application of recombinant tissue plasminogen activator thrombolysis combined with butylphthalide in patients with cardioembolic stroke
Objective To explore the therapeutic effect,bleeding events and endothelial function of ultra-early application of recombinant tissue plasminogen activator(rt-PA)thrombolysis combined with butylphthalide in patients with cardioembolic stroke.Methods One hundred and sixty-eight patients with ultra-early cardiogenic stroke attending the Baoji Central Hospital from January 2022 to August 2023 were enrolled,and randomly assigned into two groups by lottery method,with 84 cases in each group.Combination group was given rt-PA thrombolysis combined with butylphthalide,while control group received intravenous rt-PA thrombolytic therapy.Treatment in both groups lasted for 14 days.Then the clinical efficacy,the incidence of hemorrhagic transformation(HT)within 14 days,serum levels of neuron-specific enolase(NSE),matrix metalloproteinase(MMP-9),cellular fibronectin(c-FN)and vascular endothelial growth factor(VEGF)were detected and compared between two groups.Results There was no significant difference in NIHSS scores between the combined medication group and the control group before treatment(t=0.723,P>0.05).The NIHSS scores of both groups of patients were significantly reduced after 14 days of treatment,and the NIHSS score of the combination group(15.69±3.32)points was lower than that of the control group(8.61±1.87)points(t=8.286,P<0.05).The overall success rate of therapy in the combined drug group(91.67%)showed a noteworthy increase compared to the control group(79.76%)(χ2=4.861,P<0.05).The frequency of HT in the combined group(9.52%)significantly decreased in contrast to the control group(24.43%)(χ2=4.550,P<0.05),with no notable variance in side effects between the two groups(χ2=0.083,P>0.05).Before treatment,the differences in NSE,MMP-9,c-FN,and VEGF between the combination group and the control group were not significant and comparable(t=1.085,1.243,0.142,all P>0.05).The levels of NSE,MMP-9,and c-FN in the two groups of patients after treatment were significantly lower than those before treatment,and the VEGF level in the combination group after treatment was(288.04±79.84)ng·L-1,which significantly higher than(246.82±61.05)ng·L-1 of the control group(t=3.760,P<0.05),the NSE level,MMP-9 level and c-FN level((12.26±2.26)μg·L-1,(100.16±27.42)μg·L-1,(1.50±0.48)mg·L-1)were significantly lower than((13.27±2.5)μg·L-1,(126.34±34.11)μg·L-1,(1.71±0.73)mg·L-1)in the control group(t=5.483,2.203,3.760,all P<0.05).Conclusion Application of ultra-early intravenous rt-PA thrombolytic therapy combined with butylphthalide in the treatment of cardiogenic stroke can effectively reduce the HT rate and improve the vascular endothelial function of patients.
Cardiogenic strokeHemorrhagic transformationRecombinant tissue plasminogen activatorIntravenous thrombolysisButylphthalideVascular endothelial function
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