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探讨阿替普酶联合丁苯酞治疗急性脑梗死的疗效和对患者血清MMP-9和VEGF水平的影响。2014年10月至2015年12月入院的急性脑梗死患者80例,随机分为联合组和阿替普酶组各40例,阿替普酶组给予阿替普酶治疗,联合组在阿替普酶组基础上联合丁苯酞治疗,两组疗程均为14 d,比较联合组和阿替普酶组患者治疗后神经功能改善情况、炎性因子水平的变化和患者临床治疗效果的情况。酶联吸附试验检测MMP-9、VEGF浓度。治疗前联合组和阿替普酶组NIHSS评分和Barthel指数评分差异无统计学意义(p>0.05)。患者治疗后6 h、24 h、7 d和14 d,联合组NIHSS评分分别比治疗前明显降低(p<0.05),联合组Barthel指数评分均高于治疗前(p<0.05)。治疗后7 d和14 d,联合组和阿替普酶组比较,NIHSS评分和BI指数差异有统计学意义(p<0.05),阿替普酶组的总有效率为80%,低于联合组95%(x2=4.11,p=0.043),治疗前两组患者血清MMP-9、VEGF含量差异无统计学意义(p>0.05),治疗7 d和14 d后,联合组血清中的MMP-9含量明显减少且均低于阿替普酶组(p<0.05)。VEGF含量明显增加且联合组明显高于阿替普酶组(p<0.05)。阿替酶联合丁苯酞对急性脑梗死治疗后,能明显减少MMP-9炎性因子水平,使血管内皮细胞因子水平浓度增加,保护脑细胞功能,能改善神经功能。
To investigate the therapeutic effect of alteplase combined with butylphthalide on acute cerebral infarction and its effect on serum MMP-9 and VEGF levels. Eighty patients with acute cerebral infarction who were admitted to hospital from October 2014 to December 2015 were randomly divided into the combined group and the alteplase group, 40 cases each. The alteplase group was treated with alteplase, On the basis of the combination of enzyme group and butylphthalide treatment, the two groups of treatment were 14 d, the combination group and alteplase treatment of patients with neurological improvement, changes in the level of inflammatory cytokines and clinical treatment of patients. Enzyme-linked immunosorbent assay detected the concentration of MMP-9 and VEGF. There was no significant difference between NIHSS score and Barthel index score in the combination group and alteplase before treatment (p> 0.05). At 6, 24, 7 and 14 days after treatment, the NIHSS scores in the combined group were significantly lower than those before treatment (p <0.05). The Barthel index scores in the combined group were significantly higher than those before treatment (p <0.05). At 7 d and 14 d after treatment, NIHSS score and BI index were significantly different between the combined group and the alteplase group (p <0.05), and the total effective rate was 80% in the alteplase group, lower than that in the combined group (P <0.05). There was no significant difference in serum MMP-9 and VEGF levels between the two groups before treatment (p> 0.05). After 7 and 14 days of treatment, the level of MMP -9 levels were significantly decreased and were lower than the alteplase group (p <0.05). VEGF increased significantly and the combination group was significantly higher than that of alteplase group (p <0.05). After the treatment of acute cerebral infarction, the combination of amiten and butylphthalide can significantly reduce the level of MMP-9 inflammatory cytokines, increase the level of vascular endothelial cell factor, protect the function of brain cells and improve the neurological function.