重组人组织纤溶酶原激活物联合尿激酶治疗急性脑梗死的效果分析(1)
[摘要] 目的 探讨重组人组织纤溶酶原激活物(rtPA)联合尿激酶静脉溶栓治疗发病6 h内的急性脑梗死的有效性及安全性。 方法 回顾性收集本院2005年11月～2012年12月所有接受静脉溶栓治疗的患者，共纳入129例患者，根据用药史分为rtPA组(63例)及rtPA联合尿激酶组(66例)，记录患者的一般临床资料及发病到用药时间；基线及用药7、30、90 d的美国国立卫生院卒中评分(NIHSS)、Barthel指数(BI)；溶栓后的出血率及死亡率。 结果 两组患者静脉溶栓后各随访时间点NIHSS及BI均较治疗前改善，差异有统计学意义(P<0.05)；随访90 d，rtPA组与rtPA加尿激酶组相比，NIHSS改善略明显，但两组间差异无统计学意义(P>0.05)。两组间在安全性和有效性上差异无统计学意义(P>0.05)。 结论 发病6 h内无禁忌证的急性脑梗死患者rtPA联合尿激酶静脉溶栓的疗效和安全性与rtPA静脉溶栓无显著性差异。
[关键词] 急性脑梗死；静脉溶栓；重组人组织纤溶酶原激活物；尿激酶；时间窗
[中图分类号] R971 [文献标识码] A [文章编号] 1674-4721(2015)01(b)-0076-04
The effect of recombinant tissue plasminogen combined with urokinaseon in treatment of acute cerebral infarction
LI Ying CHEN Hui LIU Nan HUANG Yong-hua▲
Department of Neurology，Military General Hospital of Beijing City，Beijing 100700，China
[Abstract] Objective To investigate the effect and safety of recombinant tissue plasminogen (rtPA) combined with urokinaseon in treatment of acute cerebral infarction. Methods 129 patients who received thrombolytic therapy in our hospital from November 2005 to December 2012 were selected，and were divided into rtPA group (63 cases) and rtPA combined with urokinaseon group (66 cases).The demographic data，onset-to-needle time and baseline clinical characteristics (symptoms，medical history，blood pressure，blood glucose，blood lipids，National Institutes of Health Stroke Scale (NIHSS) score，Barthel index (BI) were recorded at baseline.The NIHSS and BI were recorded at 7 days，30 days and 90 days after thrombolysis.The mortality rate and theincidences of intracerebral and other hemorrhages were recorded. Results After intravenous thrombolysis each follow-up time point，NIHSS and BI of two groups was improved than that before treatment，the difference was significant (P<0.05)；Follow-up for 90 days，the improvement of NIHSS in rtPA group was better than that of rtPA combined with urokinase group，but there was no significant difference (P>0.05).There was no significant difference on the safety and efficacy between the two groups (P>0.05). Conclusion For patients with acute cerebral infarction and no contraindications onset within 6 hours，the efficacy and safety of rtPA combined with urokinase is similar to urokinase thrombolytic.
[Key words] Acute cerebral infarction；Thrombolysis；Recombinant tissue plasminogen；Urokinase；Time window
脑卒中是我国目前致死率和致残率最高的疾病[1]，高血压、糖尿病、高脂血症是脑卒中的常见危险因素[2-4]。大规模研究显示，控制血压、抗血小板和降脂治疗对于预防脑梗死有效[5]。抗凝治疗可用于阻止脑卒中急性期血栓进展，但其有效性和安全性仍需进一步验证。目前，静脉溶栓和动脉溶栓仍是脑梗死急性期内科治疗唯一被证明有效的手段[6]。静脉注射重组人组织纤溶酶原激活物(recombinant tissue plasminogen，rtPA)治疗急性脑梗死已获得美国、欧洲以及中国食品与药品管理部门(the Food and Drug Administration，FDA)批准。急性脑梗死静脉溶栓治疗能有效改善神经功能预后，减少因神经功能缺损而带来的残疾[7-8]。然而，静脉溶栓治疗在临床的应用仍因种种原因而受限，例如溶栓治疗均要求有严格的时间窗、溶栓后脑出血的风险、高龄患者的溶栓问题、溶栓治疗的费用问题等。 (李莹等)
[关键词] 急性脑梗死；静脉溶栓；重组人组织纤溶酶原激活物；尿激酶；时间窗
[中图分类号] R971 [文献标识码] A [文章编号] 1674-4721(2015)01(b)-0076-04
The effect of recombinant tissue plasminogen combined with urokinaseon in treatment of acute cerebral infarction
LI Ying CHEN Hui LIU Nan HUANG Yong-hua▲
Department of Neurology，Military General Hospital of Beijing City，Beijing 100700，China
[Abstract] Objective To investigate the effect and safety of recombinant tissue plasminogen (rtPA) combined with urokinaseon in treatment of acute cerebral infarction. Methods 129 patients who received thrombolytic therapy in our hospital from November 2005 to December 2012 were selected，and were divided into rtPA group (63 cases) and rtPA combined with urokinaseon group (66 cases).The demographic data，onset-to-needle time and baseline clinical characteristics (symptoms，medical history，blood pressure，blood glucose，blood lipids，National Institutes of Health Stroke Scale (NIHSS) score，Barthel index (BI) were recorded at baseline.The NIHSS and BI were recorded at 7 days，30 days and 90 days after thrombolysis.The mortality rate and theincidences of intracerebral and other hemorrhages were recorded. Results After intravenous thrombolysis each follow-up time point，NIHSS and BI of two groups was improved than that before treatment，the difference was significant (P<0.05)；Follow-up for 90 days，the improvement of NIHSS in rtPA group was better than that of rtPA combined with urokinase group，but there was no significant difference (P>0.05).There was no significant difference on the safety and efficacy between the two groups (P>0.05). Conclusion For patients with acute cerebral infarction and no contraindications onset within 6 hours，the efficacy and safety of rtPA combined with urokinase is similar to urokinase thrombolytic.
[Key words] Acute cerebral infarction；Thrombolysis；Recombinant tissue plasminogen；Urokinase；Time window
脑卒中是我国目前致死率和致残率最高的疾病[1]，高血压、糖尿病、高脂血症是脑卒中的常见危险因素[2-4]。大规模研究显示，控制血压、抗血小板和降脂治疗对于预防脑梗死有效[5]。抗凝治疗可用于阻止脑卒中急性期血栓进展，但其有效性和安全性仍需进一步验证。目前，静脉溶栓和动脉溶栓仍是脑梗死急性期内科治疗唯一被证明有效的手段[6]。静脉注射重组人组织纤溶酶原激活物(recombinant tissue plasminogen，rtPA)治疗急性脑梗死已获得美国、欧洲以及中国食品与药品管理部门(the Food and Drug Administration，FDA)批准。急性脑梗死静脉溶栓治疗能有效改善神经功能预后，减少因神经功能缺损而带来的残疾[7-8]。然而，静脉溶栓治疗在临床的应用仍因种种原因而受限，例如溶栓治疗均要求有严格的时间窗、溶栓后脑出血的风险、高龄患者的溶栓问题、溶栓治疗的费用问题等。 (李莹等)