标题：脑梗塞再灌注患者血清NSE及S-100β蛋白变化及丁苯酞的干预作用

      作者：程奎山 1，戴益斌 1，谢军朋 1，吴国荣 1，何丛馨 1，李桂峰 1，李宝峰 2，陈波 2，张亦维 3
    (1.东莞市同济医学院附属东莞医院内二科，广东 东莞 523416；
2.东莞市同济医学院附属东莞医院检验科，广东 东莞 523416；
3.重庆两江新区第一人民医院儿科，重庆 401121)

      卷次： 2016年27卷19期

      【摘要】 目的 探讨脑梗塞再灌注患者血清神经元特异性烯醇化酶(NSE)及 S-100β蛋白变化及丁苯酞治
疗脑梗塞再灌注的干预作用。方法 选取 2013年 10月至 2016年 3月期间同济医学院附属东莞医院内二科收
治的超早期脑梗塞患者 100例，以尿激酶作为再灌注手段。根据随机数表法分为观察组 49例和对照组 51例。
所有患者均给予尿激酶 100万~150万U静脉溶栓，对照组患者接受包括溶栓在内的常规治疗，而观察组联合静
脉溶栓治疗和丁苯肽注射液100 mL静脉滴注，2次/d，7 d为一个疗程，比较两组患者治疗期间的血清NSE及S-100
β蛋白变化和神经功能缺损情况。结果 观察组患者溶栓前、溶栓后 1 d和 7 d的NSE分别为(21.7±6.8) U/mL、
(24.6±11.5) U/mL、(12.3±7.6) U/mL，对照组分别为(22.0±6.7) U/mL、(27.9±12.1) U/mL、(16.2±8.8) U/mL，观察组患者
溶栓前、溶栓后1 d和7 d的S-100β分别为(1.2±0.5) μg/L、(1.3±0.4) μg/L、(0.6±0.3) μg/L，对照组分别为(1.1±0.5) μg/L、
(1.4±0.6) μg/L、(0.9±0.3) μg/L，组内比较差异均有显著统计学意义(P<0.01)，组间比较溶栓前差异无统计学意
义 (P>0.05)，溶栓后差异均有统计学意义 (P<0.05)；观察组的再灌注损伤率明显低于对照组 [4.1% (2/49) vs
17.6% (9/51)]，再通率明显高于对照组[40.1% (20/49) vs 29.4% (15/51)]，差异均有统计学意义(P<0.05)；观察组患者
溶栓7 d后神经功能缺损评分为(4.5±1.6)分，明显低于对照组的(9.3±1.7)分，差异有统计学意义(P<0.05)。结论 丁
苯酞可显著改善超早期脑梗塞再灌注患者血清NSE及S-100β蛋白水平，降低再灌注损伤发生率，对降低神经功能
缺损评分有积极意义，可有效预防急性脑梗塞溶栓后再灌注损伤。

      【关键词】 脑梗塞再灌注；神经元特异性烯醇化酶；S-100β蛋白；丁苯酞；干预作用

      【中图分类号】 R743.33 【文献标识码】 A 【文章编号】 1003—6350（2016）19—3102—03


Effect of butylphthalide pretreatment on serum NSE and S-100β levels and brain injury in patients after cerebral
ischemia/reperfusion.
CHENG Kui-shan 1, DAI Yi-bin 1, XIE Jun-peng 1, WU Guo-rong 1, HE Cong-xin 1, LI Gui-feng 1,
LI Bao-feng 2, CHEN Bo 2, ZHANG Yi-wei 3. 1. Department of Internal Medicine NO.2, Dongguan Hospital Affiliated to
Tongji Medical College of Huazhong University of Science and Technology, Dongguan 523416, Guangdong, CHINA; 2.
Department of Clinical Laboratory, Dongguan Hospital Affiliated to Tongji Medical College of Huazhong University of
Science and Technology, Dongguan 523416, Guangdong, CHINA; 3. Department of Pediatrics, the First People's Hospital of
Liangjiang New District of Chongqing, Chongqing 401121, CHINA

【Abstract】 Objective To investigate the changes of serum NSE and S-100β levels in patients after cerebral isch-
emia/reperfusion and verify whether butylphthalide protects against brain ischemia-reperfusion injury. Methods A total of
100 patients with acute cerebral infarction at ultra-early or acute stage, who adminted to our hospital from October 2013 to
March 2016, were selected and randomly divided into the butylphthalide group (49 cases) and the control group (51 cases).
Patients in the control group received standard intravenous thrombolytic therapy with 1 000 000~1 500 000 U urokinase,
while patients in the butylphthalide group were additionally treated with butylphthalide injection at the dosage of 100 mL
twice a day, wth 7 days as one therapeutic course. The serum NSE and S-100β levels as well as neurological functional im-
pairment of the two groups were compared. Results The NSE levels in the butylphthalide group were (21.7±6.8) U/mL,
(24.6±11.5) U/mL, (12.3±7.6) U/mL on day 0, 1 and 7 after thrombolytic therapy, whereas the NSE levels in the control
group were (22.0±6.7) U/mL, (27.9±12.1) U/mL, (16.2±8.8) U/mL. The S-100β levels were (1.2±0.5) μg/L, (1.3±0.4) μg/L,
(0.6±0.3) μg/L in the butylphthalide group and (1.1±0.5) μg/L, (1.4±0.6) μg/L, (0.9±0.3) μg/L in the control group after
thrombolytic therapy on day 0, 1, 7. There were significant differences in NSE and S-100β levels either in the same
group at all time points (P<0.01). There were significant differences between butylphthalide group and control group on
day 1 and day 7 after thrombolytic therapy in NSE and S-100β levels (P<0.05), but not on day 0 (P>0.05). The inci-
dence of ischemia/reperfusion injury was markedly reduced from 17.6 % (9/51) in the control group to 4.1% (2/49) in
the butylphthalide group, accompanied with increased recanalization rate (29.4% (15/51) vs 40.1% (20/49), P<0.05) and
decreased Rankin scale score ((9.3±1.7) vs (4.5±1.6), P<0.05). Conclusion Our study demonstrated that butylphthalide
combined wi