他汀给药时机对行rt-PA溶栓急性脑梗死患者神经功能损伤程度、实验室指标及并发症发生风险的影响

目的探讨他汀给药时机对行rt-PA急性脑梗死患者神经功能损伤程度、实验室指标及并发症发生风险的影响。方法选择行rt-PA急性脑梗死患者共130例,以随机数字表法分为A组(65例)和B组(65例);其中A组患者在rt-PA溶栓后给予他汀10 mg/d口服治疗,B组患者在rt-PA溶栓前给予他汀10 mg/d口服治疗;比较两组患者预后良好率、症状性颅内出血发生率,以及治疗前后NIHSS评分、Barthel指数评分、MMP-9、HMGB1、IL-17水平等。结果 B组患者预后良好率显著高于A组(P<0.05);B组患者治疗后NIHSS评分和Barthel指数评分均显著优于A组、治疗前(P<0.05);B组患者治疗后HMGB1、MMP-9及IL-17水平均显著低于A组及治疗前(P<0.05);两组患者症状性颅内出血发生率比较差异无统计学意义(P>0.05)。结论他汀溶栓前给药用于行rt-PA急性脑梗死患者,可有效降低患者神经功能损伤程度,提高其日常生活质量,下调HMGB1、MMP-9及IL-17水平,改善其临床预后,且未增加症状性颅内出血风险,优于溶栓后给药。

Influence of statins administration timing on the neurological impairment degree,laboratory indexes and the risk of complications of patients with acute cerebral infarction undergoing thrombolysis with rt-PA

Objective To investigate the influence of statins administration timing on the neurological impairment degree,laboratory indexes and the risk of complications of patients with acute cerebral infarction undergoing thrombolysis with rt-PA.Methods Totally 130 patients with acute cerebral infarction undergoing thrombolysis with rtPA were chosen and randomly divided into two groups,including group A (n =65) with statins at 10 mg/d after rt-PA and group B (n =65) with statin for 10 mg/d before rt-PA.The rate of good prognosis,NIHSS scores,Barthel index scores,the levels of MMP-9,HMGB1 and IL-17 before and after treatment and the incidence of symptomatic intracranial hemorrhage in both groups were compared.Results The rate of good prognosis of group B was significantly higher than that of group A(P ＜0.05).After treatment,the NIHSS score and Barthel index score of group B were improved,which were better than group A (P ＜0.05);the levels of HMGB1,MMP-9 and IL-17 of group B after treatment were decreased,which were lower than those of group A(P ＜ 0.05).There was no significant difference in the incidence of symptomatic intracranial hemorrhage between the two groups (P ＞ 0.05).Conclusion Compared with statins used after rt-PA,statins used before rt-PA in the treatment of patients with acute cerebral infarction receiving thrombolysis with rt-PA can efficiently reduce the degree of neurological impairment,improve the quality of dally life,down-regulate the levels of HMGB1,MMP-9 and IL-17,and improve the clinical prognosis without increasing the risk of symptomatic intracranial hemorrhage,so its better than the application after thrombolysis.