静脉低剂量重组组织型纤溶酶原激活物治疗短暂性脑缺血发作的临床对照研究

目的研究和分析静脉低剂量重组组织型纤溶酶原激活物(rt-PA)治疗短暂性脑缺血发作(TIA)的临床效果。方法选取86例TIA患者作为研究对象,根据治疗方式将其分为观察组41例(应用低剂量rt-PA静脉溶栓治疗联合阿司匹林抗血小板治疗)和对照组45例(应用阿司匹林抗血小板治疗)。比较2组患者入院时、治疗第1、3、7、14天时组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)水平。比较2组患者治疗各时段的TIA控制率,对2组患者进行为期1年的随访,比较患者转为急性脑梗死的比例。结果治疗第1、3天,观察组患者的血浆t-PA水平显著高于对照组(P0.05)。在治疗前、后各时点,2组患者的血浆PAI-1水平的差异均无统计学意义(P0.05)。2组患者各时段TIA控制率的差异无统计学意义(P0.05)。观察组和对照组分别有2例和4例患者于随访期内转为急性脑梗死,2组患者转为急性脑梗死比例的差异无统计学意义(P0.05)。结论在阿司匹林抗血小板治疗的基础上采用静脉滴注低剂量rt-PA进行溶栓治疗,能够提高TIA初期患者的血浆t-PA水平,有助于降低血栓形成风险,但对于患者的血浆PAI-1水平、近期疗效和远期预后的作用并不显著。

Clinical comparative study on intravenous low dose recombinant tissue plasminogen activator in the treatment of transient ischemic attack

Objective To study and analyze the therapeutic effects of intravenous low dose recombinant tissue plasminogen activator (rt-PA) in the treatment of transient ischemic attack (TIA).Methods A total of 86 TIA patients were selected as the research subjects and divided into observation group (intravenous low dose rt-PA thrombolysis treatment combined with aspirin antiplatelet therapy applied,41 cases) and the control group (single aspirin antiplatelet therapy applied,45 cases) according to the treatment methods.The plasma tissue plasminogen activator (t-PA),the plasminogen activator inhibitor-1 (PAI-1) on admission,at 1,3,7,14 d of the treatment were detected and compared.The control rates of TIA of the patients in the two groups were observed and compared.The patients in the two groups were followed up for 1 year,the ratios of transformation to acute cerebral infarction in the two groups were observed and compared.Results At 1,3 d of the treatment,the plasma t-PA levels of the patients in the observation group were significantly higher than that in the control group,and the differences between the two groups were statistically significant (P ＜ 0.05).At every time points before and after the treatment,the differences of the plasma PAI-1 levels between the two groups were not statistically significant (P ＞ 0.05).There were no statistically significant differences in control rates of TIA in each period of time between the patients in the two groups (P ＞ 0.0 5).During the period of following-up,there were 2 cases and 4 cases of patients with transformation to acute cerebral infarction in the observation group and the control group,respectively,and there was no significant differences in the ratios of transformation to acute cerebral infarction between the two groups (P ＞ 0.05).Conclusion The application of intravenous infusion of low dose of rt-PA for thrombolysis on the basis of the antiplatelet therapy of aspirin can increase the plasma t-PA level in early period of patients with TIA,help to reduce the risk of thrombosis,but has no obvious influences on the plasma PAI-1 levels,the clinical efficacy and the long-term prognosis.