2025 年第 7 期 第 20 卷

阿替普酶静脉溶栓联合依达拉奉右莰醇治疗H型高血压首发脑梗死的效果及促炎因子水平变化

The effect of intravenous thrombolysis with alteplase combined with edaravone and dexborneol in the treatment of H-type hypertension with first-episode cerebral infarction and changes of pro-inflammatory cytokine levels

作者：宋玲玲兰晓艳黄戈伦丘宇温德树

英文作者：Song Lingling Lan Xiaoyan Huang Gelun Qiu Yu Wen Deshu

单位：广西壮族自治区南宁市第三人民医院神经内科，南宁530003

英文单位：Department of Neurology the Third People′s Hospital of Nanning Guangxi Zhuang Autonomous Region Nanning 530003 China

关键词：H型高血压；首发脑梗死；静脉溶栓；依达拉奉右莰醇；促炎因子

英文关键词：H-typehypertension;First-episodecerebralinfarction;Intravenousthrombolysis;Edaravoneanddexborneol;Pro-inflammatoryfactors

• 摘要：

• 目的 观察阿替普酶静脉溶栓后早期应用依达拉奉右莰醇治疗H型高血压首发脑梗死的效果及促炎因子水平变化。方法 纳入2020年1月至2023年12月广西壮族自治区南宁市第三人民医院收治的H型高血压首发脑梗死患者140例，所有患者均接受阿替普酶静脉溶栓治疗，溶栓后24 h内给予依达拉奉右莰醇静脉滴注治疗。治疗14 d后评估临床治疗效果，比较不同治疗效果患者血清高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平变化。采用限制性立方样条模型（RCS）分析上述指标与治疗效果的关系。结果 治疗14 d后，140例患者痊愈2例、显效69例、有效44例、无效25例，有效组115例（82.1%），无效组25例（17.9%）。无效组梗死面积、治疗14 d后美国国立卫生研究院卒中量表评分大于/高于有效组（均P＜0.05）。用药12、24、72 h时，无效组hs-CRP、IL-6、TNF-α、同型半胱氨酸水平均高于有效组（均P＜0.05）。RCS分析显示，hs-CRP、IL-6、TNF-α水平与静脉溶栓联合依达拉奉右莰醇治疗无效的关联呈非线性曲线型剂量-反应关系。高hs-CRP、IL-6、TNF-α水平患者的90 d预后不良发生率高于低hs-CRP、IL-6、TNF-α水平患者（均P＜0.05）。结论 H型高血压首发脑梗死患者静脉溶栓后早期应用依达拉奉右莰醇可起到脑保护作用，hs-CRP、IL-6、TNF-α水平与治疗效果呈非线性曲线型剂量-反应关系。

• Objective  To observe the effect of early application of edaravone and dexborneol in the treatment of H-type hypertension with first stroke after intravenous thrombolysis with alteplase and changes of pro-inflammatory cytokine levels. Methods A total of 140 patients with H-type hypertension and first-episode cerebral infarction admitted to the Third People′s Hospital of Nanning, Guangxi Zhuang Autonomous Region from January 2020 to December 2023 were enrolled. All patients received intravenous thrombolysis with alteplase, as well as edaravone and dexborneol was given intravenous infusion within 24 h after thrombolysis. The clinical efficacy was evaluated after 14 d of treatment, and the levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients with different treatment effects were compared. Restricted cubic spline model (RCS) was used to analyze the relationship between the above indicators and the treatment effect. Results After 14 d of treatment, 2 cases were cured, 69 cases were markedly effective, 44 cases were effective, and 25 cases were ineffective. There were 115 cases (82.1%) in the effective group and 25 cases (17.9%) in the ineffective group. The infarct size and the National Institutes of Health Stroke Scale score after 14 d of treatment in the ineffective group were greater/higher than those in the effective group (all P<0.05). At 12, 24 and 72 h after treatment, the levels of hs-CRP, IL-6, TNF-α and homocysteine in the ineffective group were higher than those in the effective group (all P<0.05). RCS analysis showed that the levels of hs-CRP, IL-6 and TNF-α had a non-linear dose-response relationship with the response to intravenous thrombolysis combined with edaravone and desborneol. The incidence of poor 90-day prognosis in patients with high hs-CRP, IL-6 and TNF-α levels was higher than that in patients with low hs-CRP, IL-6 and TNF-α levels (all P<0.05). Conclusion Early administration of edaravone and dexborneol after intravenous thrombolysis in patients with H-type hypertension and cerebral infarction could provide cerebral protection. The levels of hs-CRP, IL-6 and TNF-α showed non-linear dose-response relationship with the therapeutic effect.