标题：依达拉奉联合尤瑞克林治疗对急性脑梗死患者脑血管储备能力、血管内皮细胞功能及血清VEGF、MMP-9水平的影响

      作者：刘媛媛，张静，贺军    西安高新医院神经内一科，陕西 西安 710082

      卷次： 2023年34卷22期

      【摘要】 目的 探究依达拉奉联合尤瑞克林治疗对急性脑梗死(ACI)患者脑血管储备能力、血管内皮细胞功能和血管内皮生长因子(VEGF)、基质金属蛋白酶-9 (MMP-9)水平的影响。方法 选取2018年5月至2020年4月间西安高新医院神经内一科收治的162例ACI患者作为研究对象，按随机数表法分为观察组和对照组各81例。对照组患者予以依达拉奉治疗，观察组患者予以依达拉奉联合尤瑞克林治疗，疗程均为14 d。比较两组患者治疗前后的血管内皮细胞功能[内皮素-1 (ET-1)、血栓素 B2 (TXB2)、脂蛋白相关磷脂酶A2 (Lp-PLA2)]、血清VEGF、MMP-9水平、脑血管功能[脑血管储备能力(CVR)、平均血流速度(MFV)、搏动指数(PI)、屏气指数(BHI)]、疾病恢复情况[神经功能恢复情况(mRS)、日常生活能力(BI)评分]及治疗期间不良反应发生情况。结果 治疗后，观察组患者的ET-1、TXB2、Lp-PLA2分别为(62.41±6.24) pg/mL、(163.22±15.84) pg/mL、(18.06±2.27) mmol/mL，明显低于对照组的(73.33±7.76) pg/mL、(190.27±18.81) pg/mL、(22.57±2.16) mmol/mL，差异均有统计学意义(P<0.05)；治疗后，观察组患者的VEGF为(268.41±93.47) pg/mL，明显高于对照组的(201.44±57.36) pg/mL，MMP-9为(36.48±5.11) pg/mL，明显低于对照组的(47.29±6.91) pg/mL，差异均有统计学意义(P<0.05)；治疗后，观察组患者的MFV、BHI、CVR分别为(76.26±7.04) cm/s、0.83±0.02、(26.76±4.11)%，明显高于对照组的(68.42±8.69) cm/s、0.77±0.08、(24.61±4.67)%，PI为0.65±0.09，明显低于对照组的 0.71±0.11，差异均有统计学意义(P<0.05)；治疗后，观察组患者的mRS评分为(0.82±0.14)分，明显低于对照组的(1.41±0.54)分，BI评分为(83.27±17.46)分，明显高于对照组的(63.28±15.34)分，差异均有统计学意义(P<0.05)；治疗期间，观察组患者不良反应总发生率为3.70%，略低于对照组的6.17%，但差异无统计学意义(P>0.05)。结论 依达拉奉联合尤瑞克林治疗能显著改善ACI患者的内皮细胞功能，提高脑血管储备能力和血管灌注能力，保护缺血缺氧处神经功能，进而促进患者神经功能和日常生活能力恢复，且安全性较高。
      【关键词】 急性脑梗死；依达拉奉；尤瑞克林；脑血管储备能力；血管内皮细胞功能；血管内皮生长因子；基质金属蛋白酶-9
      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2023）22—3218—05

Effects of edaravone combined with urinary kallikrein on cerebral vascular reserve capacity, vascular endothelialcell function, serum vascular endothelial growth factor and matrix metalloproteinase-9 levels in patients withacute cerebral infarction.
LIU Yuan-yuan, ZHANG Jing, HE Jun. The First Department of Neurology, Xi'an High-TechHospital, Xi'an 710082, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of edaravone combined with urinary kallikrein on cerebral vascu-lar reserve capacity, vascular endothelial cell function, levels of serum vascular endothelial growth factor (VEGF) andmatrix metalloproteinase-9 (MMP-9) in patients with acute cerebral infarction (ACI). Methods A total of 162 patientswith ACI admitted to the First Department of Neurology, Xi'an High-Tech Hospital were enrolled as the research objectsbetween May 2018 and April 2020. According to random number table method, they were divided into an observationgroup (81 cases) and a control group (81 cases). The patients in the control group were treated with edaravone, while thepatients in the observation group were additionally treated with urinary kallikrein, for 14 d. The vascular endothelialcell function [endothelin-1 (ET-1), thromboxane B2 (TXB2), lipoprotein associated phospholipase A2 (Lp-PLA2)],levels of serum VEGF and MMP-9, cerebrovascular function [cerebral vascular reserve (CVR) capacity, mean flow ve-locity (MFV), pulsation index (PI), breath-holding index (BHI)] and disease recovery [scores of Modified RankinScale (mRS) and Barthel Index Assessment Scale (BI)] before and after treatment, and the incidence of adverse reac-tions during treatment were compared between the two groups. Results After treatment, ET-1, TXB2, and Lp-PLA2in the observation group were (62.41±6.24) pg/mL, (163.22±15.84) pg/mL, and (18.06±2.27) mmol/mL, which weresignificantly lower than (73.33±7.76) pg/mL, (190.27±18.81) pg/mL, and (22.57±2.16) mmol/mL in the control group(P<0.05). After treatment, VEGF level in the observation group was (268.41±93.47) pg/mL, which was significantlyhigher than (201.44±57.36) pg/mL in the control group, while the MMP-9 level was (36.48±5.11) pg/mL, significantlylower than (47.29±6.91) pg/mL in the control group (P<0.05). After treatment, MFV, BHI, and CVR in the observationgroup were (76.26±7.04) cm/s, 0.83±0.02, and (26.76±4.11)%, which were significantly higher than (68.42±8.69) cm/s,0.77±0.08, and (24.61±4.67)% in the control group, while PI was 0.65±0.09, significantly lower than 0.71±0.11 in thecontrol group (P<0.05). After treatment, mRS score in the observation group was (0.82±0.14) points, which was signif-icantly lower than (1.41±0.54) points in the control group, while BI score was (83.27±17.46) points, significantly high-er than (63.28±15.34) points in the control group (P<0.05). During treatment, total incidence of adverse reactions inthe observation group was 3.70%, which was slightly lower than 6.17% in the control group, but the difference wasnot statistically significant (P>0.05). Conclusion Edaravone combined with urinary kallikrein can significantly im-prove endothelial cells function, improve cerebral vascular reserve capacity and vascular perfusion capacity, protectnerve function at ischemia-hypoxia site, and thus promote the recovery of nerve function and activities of daily living inACI patients, with high safety.
      【Key words】 Acute cerebral infarction; Edaravone; Urinary kallikrein; Cerebral vascular reserve capacity; Vascu-lar endothelial cell function; Vascular endothelial growth factor; Matrix metalloproteinase-9