慢性脑供血不足的内皮功能变化及药物干预的影响

目的探讨慢性脑供血不足(CCCI)的发病机制和病理过程及药物干预对内皮功能的影响。方法根据日本2000年修订的CCCI诊断标准选择研究对象90例,将其分为基础治疗组(A组)、养血清脑颗粒组(B组)、联合用药组(C组)各30例,同时选正常对照组(D组)27例,用药前后测定血清一氧化氮(NO)、血管内皮素-1(ET-1)水平,检测血管内皮功能,并进行统计学分析。结果A、B、C组治疗前分别与D组比较,NO水平降低,ET-1水平升高,差异有统计学意义(P均<0.01);A组治疗前后比较,血清NO、ET-1水平及内皮依赖性血管舒张功能(EDD)差异均无统计学意义,而B、C 2组治疗后各指标水平均较治疗前有改善(P<0.01),非内皮依赖性血管舒张功能(NEDD)在A、B、C 3组治疗前后无差异;治疗后B、C 2组各指标比较差异均无统计学意义,但分别与A组比较,除NEDD(P>0.05)外其他各指标差异均有统计学意义(P<0.01)。结论CCCI患者存在内皮功能异常,而养血清脑颗粒能够调节血管活性物质水平,改善EDD。     

黛力新与养血清脑颗粒治疗120例慢性脑供血不足疗效观察

目的 通过干预焦虑情绪,观察黛力新合用养血清脑颗粒治疗慢性脑供血不足的疗效.方法 选择2006-2008年神经科门诊的240例慢性脑供血不足患者,随机分成2组,治疗组给予黛力新每日晨服1片,同时服用养血清脑颗粒4g,3次/d.连服4～8周.分别于4周和8周随访1次.结果 治疗8周时总有效率分别为93.33%、78.33%,疗效明显优于治疗4周.对照组单用养血清脑颗粒4g,3次/d,治疗组的疗效优于对照组,且观察期间无不良反应.结论 黛力新通过改善焦虑情绪,提高疗效,两者合用治疗慢性脑供血不足安全有效.     

养血清脑颗粒治疗143例慢性脑供血不足的疗效

目的观察养血清脑颗粒治疗慢性脑供血不足的疗效.方法慢性脑供血不足患者(CCCI)143例,男性76例,女性67例,年龄63±8.9岁,予养血清脑颗粒4g(1袋),po.tid,连服4～8周,分别于4周和8周时随访一次.结果治疗8周时头晕、失眠及头重的总有效率分别为92.3%、88.2%及83.3%.疗效明显优于治疗4周时,观察期间无不良反应.结论养血清脑颗粒治疗CCCI安全有效.     

养血清脑颗粒治疗椎-基底动脉供血不足的疗效观察

目的 评价养血清脑颗粒治疗椎-基底动脉供血不足的临床疗效.方法 治疗组52例采用养血清脑颗粒治疗,对照组47例采用复方丹参片治疗.60d后分别观察两组患者临床疗效和血液流变学改善情况.结果 总有效率养血清脑颗粒治疗组为88.5%(46/52例),复方丹参片对照组为68.1%(32/47例),差异有显著性意义(P＜0.05);治疗组治疗后血液流变学3项指标改善明显优于对照组(P＜0.05).结论 养血清脑颗粒治疗椎基底动脉供血不足的疗效优于复方丹参片,是治疗椎-基底动脉供血不足的理想药物.     

养血清脑颗粒对大鼠慢性脑缺血细胞凋亡及神经细胞突触结构的影响

目的 研究养血清脑颗粒对大鼠慢性脑缺血模型的神经细胞凋亡及突触结构的影响.方法 SD大鼠随机分为假手术对照组、慢性缺血组、慢性缺血+养血清脑颗粒治疗组、慢性缺血+养血清脑颗粒预防组.应用大鼠双侧颈总动脉结扎方法制备慢性脑缺血大鼠模型,应用流式细胞术检测细胞凋亡,透射电镜和图像分析观察并测定大鼠海马及皮质突触的形态参数.结果 流式细胞术显示脑缺血14天后,细胞凋亡明显增多,养血清脑颗粒可明显抑制细胞凋亡;缺血组可导致突触结构参数变化,而慢性缺血+养血清脑颗粒治疗组和慢性缺血+养血清脑颗粒预防组可明显减轻这一变化.结论 养血清脑颗粒对慢性脑缺血细胞凋亡及突触结构改变的抑制作用有可能对慢性脑缺血的病理改变起到预防和治疗的作用.     

养血清脑颗粒治疗慢性脑供血不足疗效观察

本文主要观察在常规治疗的同时对患者应用养血清脑颗粒治疗的疗效,现报告如下。1资料与方法1.1一般资料所有患者均为我院内科2011-06—2011-12收治的慢性脑供血不足患者46例,随机分为实验组23例,男15例,女8例,平均年龄45.6岁,病程4～12个月;合并高     

养血清脑颗粒治疗血管性痴呆的疗效观察

目的观察养血清脑颗粒对血管性痴呆（VD）患者的疗效。方法将VD患者80例随机分2组进行临床对照,治疗组采用养血清脑颗粒,对照组采用尼莫地平片治疗,2组病人在治疗前后进行疗效比较及CBA检查结果比较。结果治疗组患者疗效、CBA较治疗前有明显改善（P〈0．05）。结论养血清脑颗粒对VD患者认知、行为能力有明显的改善作用。     

急性脑血管病患者血浆t-PA、PAI-1水平的临床意义研究

目的 探讨急性脑血管病患者血浆组织型纤溶酶原激活物（tissue-type plasminogen activator,t-PA）及纤溶酶原激活物抑制剂-1（plasminogen activator inhibitor-1,PAI-1）抗原含量的变化规律。方法 运用酶联免疫吸附法（enzyme-linked immunosorbent assay,ELISA）法测定2007年10月至2008年9月78例急性脑出血、脑梗死和短暂性脑缺血发作（transient ischemic attack,TIA）患者血浆t-PA及PAI-1抗原含量水平,并与同期22例健康对照组进行比较。结果 与对照组比较,脑出血组血浆t-PA水平明显升高、PAI-1水平降低（P均<0.001）;脑梗死组血浆t-PA及PAI-1水平均较对照组明显升高（P均<0.001）;TIA组血浆t-PA水平低于对照组（P=0.006）,PAI-1水平升高（P<0.001）。结论 急性脑血管病患者存在纤溶活性的异常。     

血纤溶活性变化对颈动脉粥样硬化和急性脑梗死患者的影响和分析

目的：研究血纤溶活性变化对颈动脉粥样硬化患者和急性脑梗死患者的影响。方法：67例急性脑梗死患者（ACI组）和62名健康体检老年人（对照组），均行彩色多普勒超声诊断仪超声观察颈动脉有无斑块；同时测定血浆组织型纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制物-1（PAI-1）的活性。结果：对照组中有颈动脉斑块者与无颈动脉斑块者相比，血浆t-PA降低，PAI-1升高，P／t值升高（P〈0．05）；观察组颈动脉斑块发生率明显高于对照组（P〈0．05）；观察组患者急性期血浆t-PA、PAI-1升高，P／t值减少（P〈0．05）。结论：颈动脉硬化时，机体纤溶活性处于减低状态；急性脑梗死发生时，纤溶活性处于相对亢进状态。     

多奈哌齐联合养血清脑颗粒改善轻度认知功能障碍的效应

目的评价多奈哌齐联合养血清脑颗粒对轻度认知功能障碍患者的疗效。方法30例轻度认知功能障碍患者随机分为多奈哌齐组14例;多奈哌齐联合养血清脑颗粒16例,共服用16周。分别测定两组治疗前后简易智力状态量表(MMSE)总分及成人韦氏记忆测验记忆商(MQ);经颅多普勒(TCD)检查评估两组治疗前后的脑血流参数改变。结果(1)治疗前多奈哌齐组及多奈哌齐联合养血清脑颗粒治疗组在MMSE的亚项记忆力和回忆力无显著差别(P>0.05);治疗16周后多奈哌齐组及多奈哌齐联合养血清脑颗粒治疗组在MMSE的亚项记忆力和回忆力上较治疗前有显著差别(P<0.05);(2)治疗前多奈哌齐组及多奈哌齐联合养血清脑颗粒治疗组在MQ的亚项图片回忆、再认及背数方面上无显著差别,治疗后多奈哌齐组及多奈哌齐联合养血清脑颗粒治疗组在亚项图片回忆、再认及背数方面较治疗前均有提高;联合治疗组更为显著。(3)治疗前TCD检测两组患者均可显示双侧脑血流不对称、血管阻力指数增高,治疗后自身对照脑血流趋于对称,血管阻力指数降低,多奈哌齐联合养血清脑颗粒组改变明显(P<0.05),多奈哌齐组无显著改善(P>0.05)。结论多奈哌齐联合养血清脑颗粒对改善轻度认知功能障碍患者的记忆力及脑血流改善有明显疗效。     

阿加曲班治疗急性脑梗死对患者血管内皮功能Hcy及炎症状态的影响

目的探讨阿加曲班治疗急性脑梗死对患者血管内皮功能、Hcy及炎症状态的影响。方法选取我院2014-01—2016-06收治的75例急性脑梗死患者,随机分为2组,对照组(n=36)采取常规治疗措施,试验组(n=39)在常规治疗的基础上加用阿加曲班,观察治疗前后患者血管内皮功能(NO、ET-1)、Hcy及炎症状态(hs-CRP)的变化,并对2组上述指标进行对比。结果治疗前,2组NO、ET-1、Hcy、hs-CRP水平比较,差异均无统计学意义(P0.05)。治疗后,2组NO水平均较治疗前升高,ET-1、Hcy、hs-CRP水平均较治疗前降低,差异均有统计学意义(P0.05);试验组NO水平高于对照组,ET-1、Hcy、hs-CRP水平低于对照组,差异均有统计学意义(P0.05)。结论阿加曲班治疗急性脑梗死患者,可减轻血管内皮功能损伤,降低炎症反应程度,从而改善患者的神经功能,提升治疗效果。     

A decrease in plasminogen activator inhibitor-1 activity after successful percutaneous transluminal coronary angioplasty is associated with a significantly reduced risk for coronary restenosis.

To determine a possible relation of changes in plasma levels of plasminogen activator inhibitor 1 (PAI-1) and tissue plasminogen activator (t-PA) to the development of coronary restenosis after successful coronary angioplasty (PTCA), we followed 104 patients with a low grade residual stenosis after PTCA (less than 30%) for a period of 12 months. PAI-1 plasma levels (functional activity) and t-PA antigen were determined 1 day before PTCA and 3 days, 3 months and 6 months thereafter. Thirty-four patients (32.69%) developed angiographically proven coronary restenosis (group A) within a time range of 4-48 weeks (median 12.5 weeks) after PTCA while the remaining patients (group B) had neither clinical signs nor angiographic evidence of restenosis after 6 months. No significant differences could be demonstrated in t-PA antigen or PAI-1 activity (plasma levels between the two groups of patients the day before PTCA). During the whole observation period t-PA plasma levels were not significantly different between the two groups; however, PAI-1 plasma levels were significantly higher at 3 months and 6 months after PTCA in patients of group A (p less than 0.005). When the pattern of PAI-1 plasma levels over time (increase or decrease between two consecutive time points of blood collection) was used to discriminate between the two study groups only 3.5-18% of patients with a decrease in PAI-1 developed coronary restenosis within the following observation period in contrast to 25-58% of patients with an increase in PAI-1 plasma levels (p less than 0.05 to p less than 0.0005).     

血栓通联合阿司匹林对急性脑梗死患者凝血纤溶功能及血清神经递质的影响

目的探讨血栓通联合阿司匹林对急性脑梗死患者凝血纤溶功能及血清神经递质的影响。方法将92例急性脑梗死患者随机分为联合用药组和对照组,每组46例。对照组给予阿司匹林(0.1 g/d)口服治疗,联合用药组给予血栓通(450 mg/d)联合阿司匹林治疗。比较两组患者治疗前后临床疗效、凝血纤溶功能、血清神经递质水平。结果与治疗前比较,联合用药组及对照组治疗后NIHSS评分显著降低(均P<0.01)。联合用药组及对照组治疗前NIHSS评分差异无统计学意义(P>0.05),联合用药组治疗后NIHSS评分显著低于对照组(P<0.05)。两组间预后差异有统计学意义,联合用药组有效率显著高于对照组(P<0.05)。与治疗前比较,联合用药组及对照组治疗后血清纤溶酶原激活物(t-PA)水平显著升高,纤溶酶原激活物抑制剂-1(PAI-1)及血小板α颗粒膜蛋白-140(GMP-140)水平显著降低(均P<0.05)。与对照组比较,联合用药组治疗前t-PA、PAI-1、GMP-140水平差异均无统计学意义(均P>0.05);联合用药组治疗后t-PA水平显著降低,PAI-1及GMP-140水平显著升高(均P<0.05)。与治疗前比较,联合用药组及对照组治疗后5-羟色胺(5-HT)及多巴胺(DA)水平显著升高,血清谷氨酸(Glu)及天冬氨酸(Asp)水平显著降低(均P<0.05)。与对照组比较,联合用药组治疗前5-HT、DA、Glu、Asp水平差异均无统计学意义(均P>0.05)。与对照组比较,联合用药组治疗后5-HT及DA水平显著升高,Glu及Asp水平显著降低(均P<0.05)。结论血栓通联合阿司匹林治疗有助于改善急性脑梗死患者神经功能缺损程度,提高临床疗效,可能与调节患者凝血纤溶功能和血清神经递质等因素有关。     

急性脑梗死患者凝血、抗凝及纤溶功能的临床研究

目的研究急性脑梗死患者凝血、抗凝和纤溶系统功能指标的变化,探讨急性脑梗死的发病机制,为其临床早期诊断和治疗提供依据。方法对比检测了209例急性脑梗死患者与100例健康成人的血浆血管性血友病因子抗原(vW F:A g)、P-选择素(GM P-140)、纤维蛋白原(Fg)的含量,抗凝血酶(AT)、蛋白S(PS)、蛋白C(PC)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PA I-1)的活性,并进行了分析与评价。结果血浆中vW F:A g、GM P-140、Fg的含量、PA I-1活性较对照组均明显升高,而AT、PS、PC、t-PA活性较对照组均明显下降,差异非常显著(P<0.01~0.001)。结论急性脑梗死患者存在着明显的高凝状态和较低的抗凝和纤溶活性,这与其发生及病情进展密切相关。     

Influence of butyphthalide combined with urinary kallikrein in ACI treatment on neuro-cytokines and vascular endothelial function and its clinical effect

Abstract

Objective: To study the influence of butyphthalide combined with urinary kallikrein in acute cerebral infarction (ACI) treatment on neuro-cytokines and indicators of vascular endothelial function, observe the curative effect and adverse effects, and discuss its safety and feasibility.

Method: 110 ACI patients were chosen as the objects, and classified into observation group (55 cases) and control group (55 cases) according to the method of random number table. Butyphthalide injection combined with urinary kallikrein was adopted for the observation group based on conventional treatment, while cinepazide maleate injection combined with alprostadil injection was applied for the control group based on conventional treatment. The following indicators of both groups were compared before and after treatment: neurotrophic factor (NTF), nerve growth factor (NGF), neuron specific enolase (NSE); content of CXC chemotactic factor ligand 16 (CXCL16), soluble CD ligand (CD40L), Fibulin-5 and high mobility group box B1 (HMGB1); the content of indicators of vascular endothelial function including plasma endothelin ?1 (ET-1) and no therapeutic effects and adverse effects were recorded.

Results: NSE of both groups after treatment decreased obviously, and the content of NTF and NGF increased obviously. NSE content of observation group was lower than that of control group. NTF content and NGF content of observation group were higher than those of control group. The differences had statistical significance (p?<?0.05). The levels of CXCL16, CD40L, Fibulin-5 and HMGB1 declined obviously, compared with pre-treatment, and the levels of observation groups were significantly lower than those of control grip. The differences had statistical significance (p?<?0.05). ET-1 level rose significantly after treatment, and NO level declined obviously after treatment. ET-1 level of observation group was significantly higher than that of control group, and NO level of observation group was significantly lower than that of control group. The difference had statistical significance (p?<?0.05). Clinical effect of observation group was significantly higher than that of control group. The difference had statistical significance (p?<?0.05). The comparison difference of both groups in the occurrence rate of adverse effects had no statistical significance (p?>?0.05).

Conclusion: The application of butyphthalide combined with urinary kallikrein in ACI treatment can effectively inhibit secretion and release of neuro-cytokines, and improve patients’ vascular endothelial function, with significant treatment effect and high safety. Therefore, it deserves to be promoted clinically.     

急性脑梗死患者血浆纤溶酶原激活物及其抑制剂-1水平的动态变化及其与梗死面积的关系

目的 探讨急性脑梗死患者血浆组织型纤溶酶原激活物(t-PA)及其抑制剂-1(PAI-1)水平的动态变化及其与梗死面积的关系.方法 急性脑梗死患者100例,其中大面积脑梗死22例、小面积脑梗死36例、腔隙性脑梗死42例,采用发色底物显色法检测脑梗死患者病后24 h、2 d、14 d、21 d的血浆t-PA、PAI-1水平,与正常对照组比较;并比较不同面积脑梗死患者血桨t-PA、PAI-1水平.结果 与正常对照组比较,急性脑梗死患者病后24 h、2 d、14 d血浆t-PA水平显著降低,血浆PAI-1水平明显升高(均P＜0.01);病后21 d两者与正常对照组差异无统计学意义(均P＞0.05);大面积脑梗死患者t-PA水平明显低于小面积和腔隙性脑梗死患者,小面积脑梗死患者又明显低于腔隙性脑梗死患者(均P＜0.01);不同面积脑梗死组之间PAI-1水平未见明显差异(均P＞0.05).结论 脑梗死患者急性期血浆t-PA水平降低及PAI水平升高;脑梗死面积越大的患者血浆t-PA水平降低程度越明显,而血浆PAI-1水平与梗死面积无关.     

超声波对急性脑梗死患者血浆t-PA、PAI-1和D-dimer含量和预后的影响及卫生经济学评价

目的 探讨超声波对急性脑梗死患者的纤溶系统指标t-PA(组织纤溶酶原激活物)、PAI-1(血浆纤溶酶原激活物抑制物-1)、D-dimer(D-二聚体)及患者预后的影响,并进行卫生经济学评价,为制定出经济有效的、符合我国国情的康复治疗方法提供临床依据.方法 共选取发病72h内入院的急性脑梗死患者120例,随机分为超声波治疗组(治疗组)及常规治疗组(对照组),各60例;另外同期选取88例正常健康者纳入健康人组.两组患者均接受神经内科常规药物治疗,治疗组同时给予超声波治疗.所有患者在入院时及治疗3周后进行血浆t-PA、PAI-1、D-dimer的检测及美国国立卫生院卒中量表(NIHSS)评分.随访1年,将死亡及再发缺血性血管病记录为终点事件,对两组患者进行生存分析.采用成本-效果分析进行卫生经济学评价.结果 经3周治疗后,发现治疗组疗效明显优于对照组(P<0.05);比较两组患者生存曲线发现,治疗组终点事件发生率(11.7%)明显低于对照组(31.7%),差异具有显著性(P<0.05).两组患者入院时t-PA水平低于健康人组(P<0.05),PAI-1、D-dimer水平高于健康人组(P<0.05),3周后两组t-PA水平较入院时升高(P<0.05);PAI-1、D-dimer较入院时降低(P<0.05),且治疗组变化幅度较对照组显著(P<0.05).治疗组患者NIHSS评分每减少1分,需花费人民币1013.5元;而对照组花费1712.2元.结论 超声波治疗能上调t-PA及下调PAI-1、D-dimer,对脑梗死患者的疗效及预后具有显著改善作用,而且更为经济.

Abstract：

Objective To elucidate whether the ultrasonic wave can affect the content of the t-PA/PAI-1 and D-dimer and improve the prognosis with regard to health economic evaluation in the patients with acute cerebral infarction. Methods All 120 patients with cerebral infarction within the first 72 hours from stroke onset were randomly divided into the control group and therapy group (60 patients respectively). All patients received routine treatment, while patients in the therapy group were given additional cerebral ultrasonic wave. In both groups, the blood t-PA/PAI-1 and D-dimer were measured by double antibodies sandwich enzyme linked immunosorbent assay (ELISA) at the time of admission and 3 weeks later. According to National Institute of Health Stroke Scale (NIHSS) ,the prognosis was evaluated at the time of admission and 3 weeks later. 88 healthy persons were acted as the negative control. The prognosis was evaluated at the time of 1 year later,and the Kappa-Meier technique in survival analysis were used to evaluate the associations between the two groups. The health economic evaluation was determined by using the cost-effectiveness analysis. Results The National Institute of Health Stroke Scale (NIHSS) were significantly lower after therapy than before therapy in each group (P <0.05) ,and lower in the therapy group than in the control group (P < 0. 05). Survival analysis found the patients in the therapy group had a better prognosis (log-rank test,P <0.05). The cost in therapy group was 1013. 5 RMB for one point increment of NIHSS, however, those in control group was 1712. 2 RMB. Conclusion Ultrasonic wave could improve the prognosis of patients with acute cerebral infarction through affecting the content of t-PA and PAI-1, and be more economic.     

厄贝沙坦对急性脑梗死患者血浆溶血磷脂酸、内皮素-1和血清一氧化氮含量的影响

目的研究厄贝沙坦对急性脑梗死患者血浆溶血磷脂酸（LPA）、内皮素-1（ET-1）和血清一氧化氮（NO）含量的影响。方法将53例急性脑梗死患者随机分为厄贝沙坦治疗组（25例）和常规治疗组（28例）,并以23例非脑血管病患者和7名健康志愿者作为对照组。厄贝沙坦治疗组给予厄贝沙坦150mg＋阿司匹林100mg,常规治疗组给予阿司匹林100mg,每天1次,其余治疗方法相同,连续治疗14d。分别在治疗前后抽取静脉血检测LPA、ET-1和NO含量,并对两脑梗死组治疗前后进行神经功能缺损程度评分（NDS）。结果（1）脑梗死患者血LPA、ET-1含量较对照组显著升高（均P〈0.05）,NO含量显著降低（P〈0.05）;NDS与NO含量呈负相关（r=-0.4345,P〈0.05）。（2）厄贝沙坦治疗组和常规治疗组治疗后血LPA、ET-1含量和NDS较治疗前显著降低（均P〈0.05）,NO含量显著升高（均P〈0.05）。（3）治疗后厄贝沙坦治疗组与常规治疗组相比,血LPA、ET-1、NO含量改善更为明显（均P〈0.05）。结论厄贝沙坦能显著降低急性脑梗死患者血LPA、ET-1含量,提高血NO水平,显示其有抗血小板活化及内皮保护作用。     

Evidence of a net release of tissue-type plasminogen activator across the human cerebral vasculature

We have earlier described models for measuring local net release rates of tissue-type plasminogen activator (t-PA) in vivo across skeletal, coronary, pulmonary, and splanchnic vascular beds. Aim of the present study was to investigate whether there is a net release of t-PA across the human cerebral vascular bed and whether an acute regulated release can be induced by sympathoadrenal activation. Fourteen male subjects undergoing elective coronary artery bypass grafting were investigated prior to surgery and during sternotomy-induced sympathoadrenal activation. Blood samples were obtained simultaneously from the radial artery and the jugular bulb. Blood flow velocity in the middle cerebral artery (V(MCA)) was determined by transcranial Doppler. Cerebral net release of t-PA was calculated as the arterio-venous concentration gradient times V(MCA). Prior to surgery there was a significant cerebral net release of t-PA (131 and 42 ng/min for t-PA antigen and activity, respectively). The release was significantly induced by sternotomy (to 271 and 80 ng/min, respectively). No significant cerebral net release of plasminogen activator inhibitor type 1 (PAI-1) was detected throughout the experiment. The results show that there is a basal net release of t-PA across the human cerebral vascular bed and that sympathoadrenal activation induces a local regulated release of t-PA.