不同时间窗替奈普酶静脉溶栓治疗对急性脑梗死患者近期疗效及对血清应激因子水平的影响OA
Short-term curative effect of intravenous Tenecteplase thrombolysis at different time windows and its impacts on the levels of serum stress factors in patients with acute cerebral infarction
目的 探讨不同时间窗替奈普酶静脉溶栓治疗对急性脑梗死(ACI)患者近期效果及对血清应激因子水平的影响.方法 回顾性分析2024年1-12月保定市第一中心医院急诊行替奈普酶静脉溶栓治疗的ACI患者150例,入院至溶栓时间≤4.5 h,根据不同溶栓时间窗分为短时组(＜3 h,68例)和长时组(3～4.5 h,82例).观察两组患者溶栓前后病情转归相关指标[美国国立卫生研究院卒中量表评分(NIHSS)、改良Rankin量表评分(mRS)]、生活自理能力[改良Barthel指数(MBI)]、血清氧化应激指标[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、血清炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、基质金属蛋白酶-9(MMP-9)]水平及不良事件(溶栓14 d内出血转化、心血管事件、死亡发生率).结果 两组溶栓后7 d的NIHSS评分和溶栓后90 d的mRS评分较溶栓前降低,且短时组低于长时组(P＜0.05,P＜0.01).两组溶栓后7 d的MBI较溶栓前升高,且短时组高于长时组(P＜0.01).两组溶栓后7 d血清SOD、GSH-Px水平较溶栓前升高,MDA水平较溶栓前降低(P＜0.05);与长时组比较,短时组溶栓后7 d SOD、GSH-Px水平均更高,MDA水平更低(P＜0.01).两组溶栓后7 d血清炎症因子(hs-CRP、IL-1β、MMP-9)水平较溶栓前降低,且短时组低于长时组(P＜0.05,P＜0.01).短时组治疗前后以上指标差值绝对值均大于长时组(P＜0.05).两组患者溶栓后14 d不良事件发生率比较差异均无统计学意义(P＞0.05).结论 替奈普酶静脉溶栓治疗ACI可显著改善患者近期神经功能与日常生活能力,且能有效调控氧化应激反应、下调炎症因子以改善预后,且发病＜3 h溶栓治疗的临床效果及血清应激因子的调控作用更优.
Objective To investigate short-term curative effect of intravenous Tenecteplase thrombolysis at different time windows and its impacts on levels of serum stress factors in patients with acute cerebral infarction(ACI).Methods A retrospective analysis was conducted on 150 ACI patients who received emergency intravenous thrombolysis with Tenecteplase(interval from admission to thrombolysis ≤4.5 h)at the First Central Hospital of Baoding city between January and December 2024.According to different thrombolytic time windows,they were divided into short-time group(＜3 h,n=68)and long-time group(3-4.5 h,n=82).The related indexes of disease outcomes[National Institutes of Health Stroke Scale(NIHSS),Modified Rankin Scale(mRS)],self-care ability[Modified Barthel Index(MBI)],serum oxidative stress markers[superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),malondialdehyde(MDA)],serum inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-1β(IL-1β),matrix metalloproteinase-9(MMP-9)]and adverse events(incidence of hemorrhagic transformation,cardiovascular events and death within 14 d after thrombolysis)in the two groups were observed before and after thrombolysis.Results NIHSS score at 7 d after thrombolysis and mRS score at 90 d after thrombolysis were decreased in both groups,which were lower in short-time group(P＜0.05,P＜0.01).At 7 d after thrombolysis,MBI was increased in both groups,which was higher in short-time group(P＜0.01).At 7 d after thrombolysis,the levels of serum SOD and GSH-Px were increased,while MDA was decreased in both groups(P＜0.05);the former were higher in short-time group,and the latter was lower in short-time group(P＜0.01).At 7 d after thrombolysis,the levels of serum inflammatory factors(hs-CRP,IL-1β,MMP-9)were decreased in both groups(P＜0.05),which were lower in short-time group than in long-time group(P＜0.01).The absolute values of the differences in the above indexes before and after treatment in the short-time group were greater than those in the long-time group(P＜0.05).At 14 d after thrombolysis,there was no significant difference in the incidence of adverse events between the two groups(P＞0.05).Conclusion Intravenous Tenecteplase thrombolysis can significantly improve short-term nerve function and activities of daily living,effectively regulate oxidative stress response,and down-regulate inflammatory factors to improve prognosis of ACI patients.Intravenous thrombolysis with Tenecteplase within 3 h after onset has better clinical effect and regulation effect on serum stress factors.
崔妍莉;李静;张静;钱倩;白艳梅
保定市第一中心医院神经内五科,河北保定 071000保定市第一中心医院神经内五科,河北保定 071000保定市第一中心医院神经内五科,河北保定 071000保定市第一中心医院神经内五科,河北保定 071000保定市第一中心医院神经内五科,河北保定 071000
急性脑梗死溶栓时间窗替奈普酶美国国立卫生研究院卒中量表评分改良Rankin量表评分超氧化物歧化酶超敏C反应蛋白
acute cerebral infarctionthrombolytic time windowTenecteplaseNational Institutes of Health Stroke Scale scoreModified Rankin Scale scoresuperoxide dismutasehigh-sensitivity C-reactive protein
《临床误诊误治》 2026 (12)
65-71,7
保定市科技计划项目(2441ZF075)
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