[1]李军涛 郭林霞 李国山 张然 杜立铭.依达拉奉对急性脑梗死患者rt-PA静脉溶栓后出血性转化的影响[J].卒中与神经疾病杂志,2019,26(01):47-50,59.[doi:10.3969/j.issn.1007-0478.2019.01.011]
　Li Juntao,Guo Linxia,Li Guoshan,et al.The effects of edaravone on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction[J].Stroke and Nervous Diseases,2019,26(01):47-50,59.[doi:10.3969/j.issn.1007-0478.2019.01.011]
点击复制

依达拉奉对急性脑梗死患者rt-PA静脉溶栓后出血性转化的影响()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第26卷
期数:
2019年01期
页码:
47-50,59
栏目:
论 著
出版日期:
2019-02-26

文章信息/Info

Title:
The effects of edaravone on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction
文章编号:
1007-0478(2019)01-0047-05
作者:
李军涛 郭林霞 李国山 张然 杜立铭
452371 河南省新密市郑州煤炭工业(集团)有限责任公司总医院内一科(神经内科)
Author(s):
Li Juntao;  Guo Linxia;  Li Guoshan;  et al
Department 1(Neurology Department),General Hospital of Zhengzhou Coal Industry(Group)Limited Liability Company, Xinmi 452371
关键词:
依达拉奉 重组组织型纤维蛋白酶原激活剂 静脉溶栓 急性脑梗死 出血性转化 基质金属蛋白酶-9 细胞纤维连接蛋白 胶质纤维酸性蛋白
Keywords:
Edaravone Rt-PA Intravenous thrombolysis Acute cerebral infarction Hemorrhagic transformation Matrix metalloproteinase-9 Cellular fibronectin Glial fibrillary acidic protein
分类号:
R743.32
DOI:
10.3969/j.issn.1007-0478.2019.01.011
文献标志码:
A
摘要:
目的 探讨依达拉奉对急性脑梗死(ACI)患者重组组织型纤维蛋白溶酶原激活剂(rt-PA)静脉溶栓后出血性转化(HT)的干预效果。方法 将入选的200例(发病至入院时间<4.5 h)ACI的患者按照分层区组随机化原则分为对照组和观察组各100例,对照组给予常规治疗和rt-PA 溶栓治疗,观察组在对照组治疗的基础上加用依达拉奉注射液30 mg/次,2次/d,静脉点滴,连用14 d; 于各时间点(治疗前、治疗后第24 h、3 、7 、14 d)监测2组患者治疗前后的基质金属蛋白酶-9(MMP-9)、细胞纤维连接蛋白(c-Fn)、胶质纤维酸性蛋白(GFAP)水平及美国国立卫生研究院卒中量表(NIHSS)评分,并复查颅脑CT或者MRI观察有无HT。结果 治疗后第3、7、14 d重复测量数据比较,观察组患者的MMP-9、c-Fn、GFAP水平、NIHSS评分均低于对照组(P均<0.049)。静脉溶栓后14 d内观察组患者出血性转化发生率低于对照组(P=0.041); 随访3个月观察组病死率1.0%(1/100),对照组病死率3.0%(3/100),2组患者病死率比较无明显差异(经Fisher精确检验,P=0.621); 依达拉奉未发生严重不良反应。结论 依达拉奉能减少rt-PA溶栓后HT的发生,下调MMP-9、c-Fn、GFAP水平和NIHSS评分。
Abstract:
ObjectiveTo study the effects of edaravone on hemorrhagic transformation after recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis in patients with acute cerebral infarction(ACI).Methods 200 patients with early acute cerebral infarction(the length of time between attack and reciption<4.5 h)were divided into two group according to randomized complete blocks designs: control group(n=100)and observation group(n=100).The control group received routine treatment and rt-PA thrombolytic therapy, the observation group was treated with edaravone on the basis of the treatment of the control group, 30 mg once, twice a day, continuous infusion for 14 days. At all time points(before treatment,24 h,3 d,7 d,14 d after treatment)matrix metalloproteinase-9(MMP-9), cell fibrinogen(c-fn), glial fibrillary acidic protein(GFAP)levels and stroke scale at the national institutes of health(NIHSS)were monitored before and after treatment in both groups, and the brain CT or MRI were rechecked to see if there was HT.Results Compared with repeated measurements at various time points(3 d,7 d,14 d after treatment)the levels of MMP-9、c-Fn、GFAP and NIHSS in the observation group were lower than those in the control group(all P<0.049).The incidence of hemorrhagic transformation in the observation group was lower than that in the control group within 14 days after intravenous thrombolysis(P=0.041). Follow-up for 3 months the mortality rate of the observation group was 1.0%(1/100), and that of the control group was 3.0%(3/100).The mortality rate of patients in the two groups was compared(P=0.621, accurately tested by Fisher), and the difference was not statistically significant. There was no serious adverse reaction in idaravone.Conclusion Edaravone could reduce the occurrence of rt-PA thrombolytic HT, the levels of mmp-9, c-fn, GFAP and NIHSS were lower.

参考文献/References:


[1] Simão F,Ustunkaya T,Clermont AC,et al.Plasma kallikrein mediates brain hemorrhage and edema caused by tissue plasminogen activator therapy in mice after stroke[J].Blood,2017,129(16):2280-2290.
[2] Okazaki S,Yamagami H,Yoshimoto T,et al.Cerebral hyperperfusion on arterial spin labeling MRI after reperfusion therapy is related to hemorrhagic transformation[J].J Cereb Blood Flow Metab,2017,37(9):3087-3090.
[3] Okamura K,Tsubokawa T,Johshita H,et al.Edaravone, a free radical scavenger, attenuates cerebral infarction and hemorrhagic infarction in rats with hyperglycemia[J].Neurol Res,2014,36(1):65-69.
[4] 张鹏.依达拉奉预处理提高急性脑梗死rt-PA静脉溶栓疗效及安全性的临床与基础研究[D].南京:南京医科大学,2015:1-84.
[5] 邓婷.依达拉奉对大鼠脑出血后神经细胞凋亡及Caspase-3,PARP-1表达影响的实验研究[D].出版地:成都.四川医科大学,2015:1-69.
[6] 张岩.立体定向注射依达拉奉对脑出血大鼠免疫炎症反应和凋亡的调节作用[D].重庆:第三军医大学,2016:1-127.
[7] 中华医学会神经病学分会.中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[8] 薛静,王昊,高培毅,等.脑微出血与急性缺血性卒中溶栓后出血转化的相关性研究[J].中国卒中杂志,2017,12(6):477-483.
[9] 孙瑞,朱武生.缺血性卒中溶栓后出血转化发生机制的研究进展[J].中国脑血管病杂志,2018,15(1):52-56.
[10] Sifat AE,Vaidya B,Abbruscato TJ.Blood-Brain barrier protection as a therapeutic strategy for acute ischemic stroke[J].AAPS J,2017,19(4):957-972.
[11] Wang L,Wei C,Deng L,et al.The accuracy of serum matrix metalloproteinase-9 for after acute ischemic stroke: a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2018,27(6):1653-1665.
[12] Dang B,Duan X,Wang Z,et al.A therapeutic target of cerebral hemorrhagic stroke: matrix metalloproteinase-9[J].Curr Drug Targets,2017,18(12):1358-1366.
[13] Kuroki T,Tanaka R,Shimada Y,et al.Exendin-4 inhibits matrix metalloproteinase-9 activation and reduces infarct growth after focal cerebral ischemia in hyperglycemic mice[J].Stroke,2016,47(5):1328-1335.
[14] 何金邦,赵晓萍,赵秀欣,等.老年脑出血患者血清cFN水平变化及其临床意义[J].脑与神经疾病杂志,2017,25(2):67-70.
[15] 陈瑶枝.脑出血早期血肿扩大的影像学和生物学预测指标研究[D].北京:首都医科大学,2016:1-55.
[16] Yang Z,Wang KK.Glial fibrillary acidic protein: from intermediate filament assembly and gliosis to neurobiomarker[J].Trends Neurosci,2015,38(6):364-374.
[17] 刘娜,徐树军,王淑荣,等.MMP-9、GFAP和FN浓度与脑梗死后出血转化的预测作用[J].中国现代医学杂志,2014,24(16):41-45.
[18] 杨雪,王丽华.依达拉奉联合rt-PA超时间窗治疗脑梗死的研究进展[J].卒中与神经疾病,2016,23(2):145-146.
[19] 张莉峰,肖悠美,王爱丽.依达拉奉对急性脑梗死患者rt-PA静脉溶栓后MMP-9表达及出血性转化的影响[J].中国急救医学,2016,36(10):913-917.
[20] 杜敢琴,杨晓莉,邓旻南.依达拉奉联合重组组织型纤溶酶原激活剂治疗急性缺血性卒中的汇总分析[J].国际脑血管病杂志,2016,24(9):794-800.

备注/Memo

备注/Memo:
作者单位:452371 河南省新密市郑州煤炭工业(集团)有限责任公司总医院内一科(神经内科)
更新日期/Last Update: 2019-02-20