2024 年第 4 期 第 19 卷

注射用阿替普酶对不同血清非对称性二甲基精氨酸水平急性脑梗死患者的治疗效果

Therapeutic effect of alteplase for injection on acute cerebral infarction patients with different serum asymmetric dimethylarginine levels

作者：孙炎王刚刘宏娜梁盼盼

英文作者：Sun Yan Wang Gang Liu Hongna Liang Panpan

单位：河北北方学院附属第一医院神经内科，张家口075000

英文单位：Department of Neurology the First Affiliated Hospital of Hebei North University Zhangjiakou 075000 China

关键词：急性脑梗死；注射用阿替普酶；血管内皮功能；治疗效果

英文关键词：Acutecerebralinfarction;Alteplaseforinjection;Vascularendothelialfunction;Therapeuticeffect

• 摘要：

• 目的 分析注射用阿替普酶对不同血清非对称性二甲基精氨酸(ADMA)水平的急性脑梗死患者治疗效果。方法 选取2021年5月至2023年5月河北北方学院附属第一医院收治的106例急性脑梗死患者，以ADMA水平0.883 μmol/L为临界值，将ADMA>0.883 μmol/L的52例患者作为高表达组，ADMA≤0.883 μmol/L的54例患者作为低表达组。2组患者均给予降低颅内压、保护神经、改善循环和调节血压等基础治疗，同时给予注射用阿替普酶0.9 mg/kg，2组患者均在治疗2周后进行效果评价。检测和比较2组患者神经因子、炎症因子、纤溶功能、血管内皮功能指标、血液流变学指标、改良Rankin量表、美国国立卫生研究院卒中量表评分和临床疗效。结果 治疗后2组患者髓鞘碱性蛋白、中枢神经特异蛋白、神经元特异性烯醇化酶、高敏C反应蛋白、白细胞介素1β、肿瘤坏死因子α、Ⅰ型纤溶酶原激活抑制物、P-选择素、血管性血友病因子、内皮素1、低切全血黏度、高切全血黏度、血浆黏度水平和改良Rankin量表、美国国立卫生研究院卒中量表评分均低于治疗前，但高表达组均高于低表达组，差异均有统计学意义（均P＜0.05）。治疗后2组患者组织型纤溶酶原激活物和一氧化氮水平均高于治疗前，但高表达组均低于低表达组，差异均有统计学意义（均P＜0.05）。高表达组总有效率低于低表达组［78.8%（41/52）比92.6%（50/54）］，差异有统计学意义（χ2=4.121，P=0.042）。多因素Logistic回归分析结果表明髓鞘碱性蛋白、中枢神经特异蛋白、神经元特异性烯醇化酶、Ⅰ型纤溶酶原激活抑制物、P-选择素、血管性血友病因子、低切全血黏度、高切全血黏度、血浆黏度、一氧化氮和内皮素1均是不同ADMA水平的急性脑梗死患者治疗效果的主要危险因素（均P=0.001）。结论 急性脑梗死患者采用注射用阿替普酶治疗后均取得较好效果，且ADMA低表达水平急性脑梗死患者治疗后神经功能、纤溶功能和血液流变学改善更为明显，炎症反应和血管内皮损伤较轻。

• Objective To analyze the therapeutic effect of alteplase for injection on acute cerebral infarction patients with different serum asymmetric dimethylarginine (ADMA) levels. Methods A total of 106 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Hebei North University from May 2021 to May 2023 were selected. With the ADMA level of 0.883 μmol/L as the critical value, and 52 patients with ADMA>0.883 μmol/L were selected as the high expression group, and 54 patients with ADMA≤0.883 μmol/L were selected as the low expression group. Both groups were given basic treatment such as reducing intracranial pressure, protecting nerves, improving circulation and regulating pressure, and at the same time, 0.9 mg/kg alteplase for injection was given. The therapeutic effect was evaluated after 2 weeks of treatment in both groups. The neurological factors, inflammatory factors, fibrinolysis function, vascular endothelial function index, hemorheology index, modified Rankin scale score, National Institutes of Health Stroke Scale score and clinical efficacy were detected and compared between the two groups. Results After treatment, the levels of myelin basic protein, central nervous system specific protein, neuron-specific enolase, high-sensitivity C-reactive protein, interleukin-1β, tumor necrosis factor-α, type Ⅰ plasmin activation inhibitor, P-selectin, tubulohemophilia factor, endothelin-1, low-cut whole blood viscosity, high-cut whole blood viscosity, plasma viscosity and the scores of modified Rankin scale and National Institutes of Health Stroke Scale score in the two groups were lower than those before treatment, and those in the high expression group were higher than those in the low expression group (all P<0.05). After treatment, the levels of tissue plasminogen activator and nitric oxide in the two groups were higher than those before treatment, and those in the high expression group were lower than those in the low expression group (all P<0.05). The total effective rate of high expression group was lower than that of low expression group ［78.8%（41/52） vs 92.6%（50/54）］, and the difference was statistically significant (χ2=4.121, P=0.042). The results of multivariate Logistic regression analysis showed that myelin basic protein, central nervous system specific protein, neuron-specific enolase, type Ⅰ plasmin activation inhibitor, P-selectin, tubulohemophilia factor, low-cut whole blood viscosity, high-cut whole blood viscosity, plasma viscosity, nitric oxide and endothelin-1 were the main risk factors of treatment effect in patients with acute cerebral infarction with different ADMA levels (all P=0.001). Conclusion The treatment of acute cerebral infarction with alteplase for injection has a good effect, and the improvement of neurological function, fibrinolytic function and hemorheology is more obvious in patients with acute cerebral infarction with low expression of ADMA, and the inflammatory reaction and vascular endothelial damage are less.