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

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。

The effects of edaravone on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction

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.