丁苯酞序贯疗法联合双联抗血小板治疗老年急性脑梗死的临床疗效及其对血浆巯基丙酮酸硫基转移酶、β淀粉样蛋白42水平的影响研究

摘要

目的 观察丁苯酞序贯疗法联合双联抗血小板治疗老年急性脑梗死(ACI)的临床疗效,并探讨其对血浆巯基丙酮酸硫基转移酶(3-MST)、β淀粉样蛋白42(Aβ42)水平的影响.方法 选取2014年9月—2016年1月马鞍山市人民医院神经内科收治的老年ACI患者1 16例,采用随机数字表法分为对照组和观察组,每组58例.在常规治疗基础上,对照组患者给予双联抗血小板(阿司匹林肠溶片+硫酸氢氯吡格雷片)治疗,观察组患者在对照组基础上给予丁苯酞序贯疗法;两组患者均连续治疗4周.比较两组患者临床疗效,治疗前后美国国立卫生研究院卒中量表(NIHHS)评分、血小板表面活化因子[包括血小板P选择素(CD62P)和血小板激活复合物1(PAC-1)]阳性率及血浆3-MST、Aβ42水平,并记录两组患者治疗期间不良反应发生情况.结果 观察组患者临床疗效优于对照组(P＜0.05).治疗前两组患者NIHSS评分比较,差异无统计学意义(P＞0.05);治疗后观察组患者NIHSS评分低于对照组(P＜0.05).治疗前两组患者CD62P、PAC-1阳性率比较,差异无统计学意义(P＞0.05);治疗后观察组患者CD62P、PAC-1阳性率低于对照组(P＜0.05).治疗前两组患者血浆3-MST和Aβ42水平比较,差异无统计学意义(P＞0.05);治疗后观察组患者血浆3-MST水平高于对照组,血浆A艮水平低于对照组(P＜0.05).两组患者治疗期间均未发生严重不良反应.结论 丁苯酞序贯疗法联合双联抗血小板治疗老年ACI的临床疗效确切,可有效抑制血小板聚集及血栓形成,提高血浆3-MST水平,降低血浆Aβ42水平,有利于改善患者神经功能,且安全性较高.%Objective To observe the clinical effect of butyphthalide sequential therapy combined with dual anti-platelet therapy in treating elderly patients with acute cerebral infarction,to investigate the impact on plasma levels of 3-MST and Aβ42.Methods From September 2014 to January 2016,a total of 116 elderly patients with acute cerebral infarction were selected in the Department of Neurology,the People's Hospital of Maanshan,and they were divided into control group and observation group,each of 58 cases.Based on conventional treatment,patients of control group received dual anti-platelet therapy (aspirin enteric-coated tablets combined with clopidogrel hydrogen sulfate),while patients of observation group received butyphthalide sequential therapy combined with dual anti-platelet therapy;both groups continuously treated for 4 weeks.Clinical effect,NIHSS score,positive rate of platelet surface activation factors (including CD62P and PAC-1),plasma levels of 3-MST and Aβ42 before and after treatment were compared between the two groups,and incidence of adverse reactions was recorded during the treatment.Results Clinical effect of observation group was statistically significantly better than that of control group (P ＜ 0.05).No statistically significant differences of NIHSS score was found between the two groups before treatment (P ＞0.05),while NIHSS score of observation group was statistically significantly lower than that of control group after treatment (P ＜0.05).No statistically significant differences of positive rate of CD62P or PAC-1 was found between the two group before treatment (P ＞0.05),while positive rates of CD62P and PAC-1 of observation group were statistically significantly lower than those of control group (P ＜ 0.05).No statistically significant differences of plasma level of 3-MST or Aβ42 was found between the two groups before treatment (P ＞ O.05);after treatment,plasma 3-MST level of observation group was statistically significantly higher than that of control group,while plasma Aβ42 level of observation group was statistically significantly lower than that of control group (P ＜ 0.05).No one the two groups occurred any severe adverse reactions during the treatment.Conclusion Butyphthalide sequential therapy combined with dual anti-platelet therapy has certain clinical effect in treating elderly patients with acute cerebral infarction,can effectively inhibit the platelet aggregation and thrombosis,improve the plasma 3-MST level and reduce the plasma Aβ42 level,is helpful to improve the neurological function,with relatively high safety.