标题：尤瑞克林联合瑞替普酶静脉溶栓对急性轻型缺血性卒中患者神经功能及血清Cav-1、PTX3水平的影响

      作者：王平江，白粉娥，巨彦龙，张婧    长庆油田职工医院急诊科，陕西 西安 710201

      卷次： 2020年31卷23期

      【摘要】 目的 探讨尤瑞克林联合瑞替普酶静脉溶栓对急性轻型缺血性卒中神经功能及血清陷窝蛋白1 (Cav-1)、正五聚蛋白3 (PTX3)水平的影响。方法 采用前瞻性随机对照研究方法选取2016年8月至2019年12月长庆油田职工医院收治的急性轻型缺血性卒中患者106例，以随机数表法将患者分为联合组和对照组，每组53例。在常规治疗基础上，对照组采取瑞替普酶静脉溶栓，联合组采取尤瑞克林联合瑞替普酶静脉溶栓，均治疗14 d。比较两组患者的治疗效果、治疗前后的美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、血液流变学指标(血浆黏度、全血低切黏度、全血高切黏度、纤维蛋白原)、脑血管储备功能指标[脑血管储备(CVR)、屏气指数(BHI)、搏动指数(PI)]和血清Cav-1、PTX3水平，并观察两组患者治疗期间的不良反应。结果 联合组患者治疗14 d后的临床疗效优于对照组，差异有统计学意义(P<0.05)；联合组患者治疗 14 d后的NIHSS、mRS评分分别为(0.72±0.15)分、(1.82±0.19)分，明显低于对照组的(1.26±0.22)分、(2.16±0.24)分，差异均有统计学意义(P<0.05)；联合组患者治疗14 d后的血浆黏度、全血低切黏度、全血高切黏度、纤维蛋白原和血清Cav-1、PTX3水平分别为(1.24±0.13) mPs·s、(8.67±0.94) mPs·s、(4.65±0.28) mPs·s、(3.28±0.64) g/L、(10.42±1.57) μg/L、(9.28±1.69) ng/mL，明显低于对照组的(1.56±0.22) mPs·s、(10.85±1.13) mPs·s、(4.97±0.47) mPs·s、(3.95±0.80) g/L、(12.85±1.86) μg/L、(10.97±2.04) ng/mL，差异均有统计学意义(P<0.05)；联合组患者治疗14 d后的CVR、BHI水平分别为(12.86±1.72)%、1.36±0.25，明显高于对照组的(10.19±1.46)%、0.98±0.22，PI水平为0.51±0.12，明显低于对照组的0.62±0.10，差异均有统计学意义(P<0.05)；联合组和对照组患者治疗期间的总不良反应发生率分别为9.43%、15.09%，差异无统计学意义(P>0.05)。结论 急性轻型缺血性卒中应用尤瑞克林联合瑞替普酶静脉溶栓治疗可促进患者神经功能恢复，降低大脑功能障碍程度，改善血液流变学与脑血管储备功能，降低血清Cav-1、PTX3水平，临床治疗效果显著，且治疗过程中安全性高。
      【关键词】 尤瑞克林；瑞替普酶；急性轻型缺血性卒中；神经功能；陷窝蛋白1；正五聚蛋白3；疗效；安全性
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2020）23—3017—05

Effects of urinary kallindinogenase combined with reteplase intravenous thrombolysis on neurological functionand serum Cav-1 and PTX3 levels in patients with acute mild ischemic stroke.
WANG Ping-jiang, BAI Fen-e, JUYan-long, ZHANG Jing. Department of Emergency, Changqing Oilfield Staff Hospital, Xi'an 710201, Shaanxi, CHINA
【Abstract】 Objective To investigate the effect of urinary kallindinogenase combined with reteplase intrave-nous thrombolysis on the neurological function and serum caveolin 1 (Cav-1) and pentraxin 3 (PTX3) levels in acutemild ischemic stroke. Methods From August 2016 to December 2019, a prospective randomized controlled study wasused to select 106 patients with acute mild ischemic stroke admitted to Changqing Oilfield Staff Hospital. The patientswere divided into the combined group and control group by random number table method, with 53 patients in eachgroup. On the basis of conventional treatment, the control group was treated with reteplase for intravenous thrombolysis,and the combined group was given urinary kallindinogenase combined with reteplase for intravenous thrombolysis, andboth for 14 days. The treatment effect, the National Institutes of Health Stroke Scale (NIHSS) scores the modifiedRankin Scale (mRS) scores, hemorheology indexes (plasma viscosity, whole blood low-shear viscosity, whole bloodhigh-shear viscosity, fibrinogen), cerebrovascular reserve function indexes (cerebrovascular reserve [CVR], breathholding index [BHI], pulsatility index [PI]) and serum Cav-1 and PTX3 levels before and after treatment were com-pared between the two groups of patients. And the adverse reactions during the treatment of the two groups were ob-served. Results The clinical efficacy of patients in the combined group was better than that of the control group after14 days of treatment, and the difference was statistically significant (P<0.05). After 14 days of treatment, the NIHSS andmRS scores in the combined group were (0.72±0.15) points and (1.82±0.19) points, respectively, which were significant-ly lower than corresponding (1.26±0.22) points and (2.16±0.24) points of the control group (P<0.05). After 14 days oftreatment, the plasma viscosity, whole blood low shear viscosity, whole blood high shear viscosity, fibrinogen and se-rum Cav-1 and PTX3 levels in the combined group were (1.24±0.13) mPs·s, (8.67±0.94) mPs·s, (4.65±0.28) mPs·s,(3.28±0.64) g/L, (10.42±1.57) μg/L, (9.28±1.69) ng/mL, respectively, which were significantly lower than corresponding(1.56±0.22) mPs·s, (10.85±1.13) mPs·s, (4.97±0.47) mPs·s, (3.95±0.80) g/L, (12.85±1.86) μg/L, (10.97±2.04) ng/mL ofcontrol group (all P<0.05). After 14 days of treatment, the CVR and BHI levels in the combined group were (12.86±