急性脑卒中患者血小板活化程度以及元活苏的脑保护作用

背景:反映血小板活化程度的特异性分子血小板颗粒膜糖蛋白和肿瘤坏死因子α在正常全血中含量很少,在脑梗死患者血浆中含量增高,元活苏对脑缺血的保护作用是否与此有关?目的:通过测定急性脑卒中患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α的含量及元活苏对缺血性脑卒中患者的脑保护作用,并与复方丹参的治疗效果比较.设计:病例分析.单位:平顶山煤业集团公司总医院内科和郑州大学第二附属医院神经内科.对象:选择2001-01/2003-10平顶山煤业集团公司总医院内科住院的高血压合并急性脑卒中患者144例.随机分为2组:观察组72例,男47例,女25例;年龄90～42岁,平均(69±11)岁.对照组72例,男49例,女23例;年龄85～37岁,平均(68±10)岁.方法:两组患者均进行常规吸氧、降压、脱水、抗凝等方法治疗,对照组给予复方丹参注射液500 mL,1次/d,用药14 d.治疗组给予复方丹参注射液500 mL,1次/d,共14 d和元活苏20mL+生理盐水250 mL,1次/d,共14 d.①入院时和治疗3周后采用欧洲卒中量表(总分最低为0分,最高为100分,分值越高,说明神经功能恢复程度越好)评估两组患者神经功能恢复情况.②入院时(时间窗24～72 h)以及治疗后3周分别抽肘静脉血5mL,采用放免法分析血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量,分析两者水平及元活苏干预后神经功能变化.主要观察指标:治疗前和治疗3周后,①两组患者神经功能恢复情况.②两组患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量.结果:144例患者全部进入结果分析.①欧洲卒中量表评分结果:两组患者治疗后明显高于治疗前[观察组:(79.95±18.64)分,(59.65±19.87)分;对照组:(74.66±15.88)分,(61.25±18.68)分,(t=2.678～4.351,P＜0.01)];治疗后观察组高于对照组(t=2.016～2.158,P＜0.05).②血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量:两组患者治疗后明显低于治疗前[观察组:(22.12±9.52)μg/L,(50.41±22.35)μg/L;(1.05±0.24)μg/L,(1.62±0.50)μg/L;对照组:(26.66±8.22)μg/L,(48.63±21.54)μg/L;(1.35±0.44)μg/L,(1.66±0.48)μg/L,(t=2.678～4.351,P＜0.001)],治疗后观察组低于对照组(t=2.016～2.158,P＜0.05).结论:元活苏能显著能降低急性脑卒中患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量,提高神经功能评分,显著改善神经功能缺损症状.

Platelet activation and brain protection of protein hydrolysate injection for patients with acute stroke

BACKGROUND: The blood levels of specific markers of platelet activation, such as platelet granule membrane protein (GMP-140) and tumor necrosis factor alpha (TNF-α) are very low in healthy individuals, while the plasma levels of them in patients with cerebral infarction increase. Is the protection of brain hydrolysate injection correlated with the phenomenon?OBJECTIVE: In this study, the plasma levels of GMP-140 and TNF-α in patients with acute stroke were measured, the brain protection of brain protein hydrolysate injection on patients with ischemic stroke were investigated, and were compared with the therapeutic effect of compound danshen injection.DESIGN: It was designed for case study.SETTING: This study was conducted at the Medical Department of the General Hospital of Pingdingshan Coal Co. Ltd and the Neurology Department of the Second Hospital Affiliated to Zhengzhou University.PARTICIPANTS: From January 2001 to October 2003, 144 inpatients with hypertension and acute stroke in the Medicine Department of the General Hospital of Pingdingshan Coal Co. Ltd were selected and divided into 2 groups, as experiment group containing 72 cases, 47 males and 25females, with an age from 42 to 90 and in average of (69±11) years old and control group containing 72 cases, 49 males and 23 females, with an age from 37 to 85 and in average of (68±10) years old.METHODS: All the patients in these two groups underwent oxygen inhalation therapy, antihypeetensive therapy, dehydration therapy and anticoagulation therapy. Patients in control group were coadministered 500 mL compound salvia miltiorrhiza injection QD once a day, with a 14-day course of therapy. Patients in experiment group were treated with 500 mL compound salvia miltiorrhiza injection QD and 20 mL protein hydrolysate European stroke scale (ESS), from 0 (worst possible health status) to 100(best possible health status), were used to evaluate the recovery status of (from 24 hours to 72 hours) and 3 weeks post-treatment, 5 mL blood samples were obtained from antecubital veins, then plasma levels of GMP-140and TNF-α were quantified using an RIA (radioimmunoassay) and the changes in neural function before and after brain protein hydrolysate injection were evaluated.MAIN OUTCOME MEASURES: Before treatment and at 3 weeks postwere quantified using an RIA.RESULTS: All the 144 patients entered the statistical analysis procedure.ESS were significantly higher than the pre-treatment scores [Experiment groups: 79.95±18.64 and 59.65±19.87; Control group: (74.66±15.88) and (61.25±18.68), (t=2.678-4.351, P ＜ 0.01). The post-treatment scores of ESS in experiment group were higher than those in control group (t=2.016-2.158,groups, the post-treatment outcomes were significantly lower than the pre-treatment outcomes [Experiment group: (22.12±9.52) μg/L and (50.41±22.35) μg/L, (1.05±0.24) μg/L and (1.62±0.50) μg/L; Control group: (26.66±8.22) μg/L and (48.63±21.54) μg/L, (1.35±0.44) μg/L and (1.66±0.48) μg/L; (t=2.678-4.351, P ＜ 0.001)]. And the post-treatment levels of the two markers were lower in experiment group than those in control group (t=2.016-2.158, P ＜ 0.05).CONCLUSION: Brain protein hydrolysate injection can significantly decrease the plasma levels of GMP-140 and TNF-α in patients with acute stroke, and it is capable of increasing the ESS scores and improving the impaired neural functions greatly.