不同治疗时间脑梗死患者血小板膜细胞凋亡与预后的关系

背景临床研究表明,脑梗死发作如能早期得到有效治疗,尤其是在发病后6h内或更早时间接受正规专科治疗,其预后明显优于延迟治疗时间组.而细胞促抑凋亡指标改变是否可做为预后不良判断标准尚不清楚.目的通过对住院不同时间接受治疗的脑梗死患者细胞凋亡因子含量测定与预后研究,进一步明确疾病的治疗时机窗.设计以患者为研究对象,随机化同期对照研究.单位一所军区总医院的神经科病房.对象2000/2002解放军济南军区总医院神经内二科住院的男性患者144例.按住院不同时间接受治疗分为4组6,24,72,96h组.方法采用蚓激酶400 mg,肝素钠(抗栓灵)2片,尼莫地平60 mg,维生素E100mg,3次/d口服,银杏叶提取物(金钠多)525mg加生理盐水150mL,脑多肽10mL加生理盐水150mL,1次/d静脉点滴,10 d为1个疗程,共2个疗程.对大面积梗死(＞7 cm2)给200 g/L甘露醇脱水,4组受试者分别在治疗前后进行检测血小板膜Fas,Apo2.7,Bcl-2百分含量及预后评估.主要观察指标不同治疗时间组患者外周血小板膜Fas,Apo2.7,Bcl-2百分含量及预后评估.结果6 h组血小板膜Fas,Apo2 7,Bcl-2百分含量治疗后明显低于或高于治疗前(P＜0.05).而与其他各组比,差异有显著性意义(P＜0.05).在疾病预后的统计分析中显示,发病后6h内接受治疗的患者有效率较96 h治疗组明显增高,而病死率显著下降.结论发病后6h住院接受正规治疗确有提高疾病预后、降低致残率的作用,而Fas,Apo2.7,Bcl-2指标异常,程度与疾病预后密切相关.

Relationship between platelet membrane cell apoptosis and prognosis in patients with cerebral infarction at different therapeutic period

BACKGROUND: As indicated by clinical research, if cerebral infarction could be effectively treated at early stage, especially normal specific therapy provided within 6 hours or even earlier after attack, the prognosis would be significantly better than delayed therapy. However, it is still unclear that whether the changes of cellular apoptosis-inducing or -inhibiting indicators could be used as criteria in the judgment of prognosis.OBJECTIVE: To test the content of cell apoptotic factor and to investigate the prognosis in hospitalized patients with cerebral infarction who received treatment at different time for further verification of the therapeutic timing for the disease.DESIGN: A same term randomized controlled study based on patients.SETTING: Department of neurology of a general hospital of a military area command of Chinese PLA.PARTICIPANTS: Totally 144 male patients admitted in the Second Department of Neurology, General Hospital of Jinan Military Area Command of Chinese PLA between 2000 and 2002 were divided into four groups including 6 hours, 24 hours, 72 hours and 96 hours group according to different time of therapy provided.METHODS: Oral administration of 400 mg Lumbrokinase, 2 tablets of heparin sodium, 60 mg of nimodipine, and 100 mg of vitamin E, three times a day. 150 mL of normal saline(NS) containing 52.5 mg of Ginkgo biloba L extractive(Jin Na Duo) and 150 mL of NS containing 10 mL of Cerebroprotein Hydeolysate were used through intravenous drop once a day. Ten days were set as one therapeutic course and 2 courses were given. 200 g/L of mannite was given to dehydrate for patients with large area infarction(＞ 7 cm2) . Platelet membrane Fas, Apo2.7 and Bcl-2 percentage and prognostic assessment were tested in patients of four groups before and after therapy.MAIN OUTCOME MEASURES: Peripheral platelet membrane Fas,Apo2.7 and Bcl-2 percentage in patients of different group and prognosis evaluation.RESULTS: Percentage of platelet membrane Fas, Apo2.7 and Bcl-2 of 6 hours group was significantly higher or lower after therapy than before therapy ( P ＜ 0.05 ), and moreover, the difference with other groups was significant( P ＜ 0.05), As revealed in the analysis of prognosis, the effectiveness of patients who received therapy within 6 hours was significantly better than that of 96 hours group and the mortality reduced significantly.CONCLUSION: Normal hospitalizing therapy provided within 6 hours after attack could surely improve the prognosis and reduce the disability rate, and the abnormity and extent in Fas, Apo2.7 and Bcl-2 are closely correlated with prognosis.