早期应用前列地尔对急性脑梗死合并2型糖尿病患者颈动脉斑块性质、血管内皮功能及炎症介质水平的影响

摘要

Objective To observe the effects of early application of alprostadil on carotid plaque,vascular endothelial function and inflammatory mediator levels in patients with acute cerebral infarction complicated with type 2 diabetes mellitus.Methods One hundred and twenty patients with acute cerebral infarction complicated with type 2 diabetes mellitus were divided into the control and observation groups according to the random number table method,60 cases in each group.The control group was treated with routine therapy,while the observation group was given the alprostadil based on the control group.The carotid plaque property,vascular endothe-lial function indexes such as endothelin 1 (ET-1),nitric oxide (NO) and von Willebrand factor(vWF),inflammation mediators such as high sensitive C reactive protein (hs-CRP),tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6),kidney function indexes such as 24 h urinary protein(24 h Upro),hematuria nitrogen(BUN) and serum creatinine(SCr),neurological deficit(NIHSS) score and adverse reaction were compared between the two groups before and after treatment.Results The unstable plaques rate,levels of ET-1,vWF,hs-CRP,TNF-α and IL-6 in the observation group were significantly lower while the level of NO was significantly higher than that in the control group (P<0.05).The concentrations of 24 h Upro,BUN,SCr and NIHSS score in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reac-tions between the two groups (P>0.05).Conclusion The early application of alprostadil in patients with acute cerebral infarction complicated with type 2 diabetes mellitus can effectively reduce the carotid plaque,improve the vascular endothelial function and in-flammation status,and promote the recovery of renal and nerve function with little adverse reactions.%目的 观察早期应用前列地尔对急性脑梗死合并2型糖尿病患者颈动脉斑块性质、血管内皮功能及炎症介质水平的影响.方法 120例急性脑梗死合并2型糖尿病患者,按随机数字表法分为两组各60例,对照组早期给予常规治疗,治疗组在对照组基础上应用前列地尔,比较两组治疗前后颈动脉斑块性质、血管内皮功能[内皮素1(ET-1)、一氧化氮(NO)及血管性血友病因子(vWF)]、炎症介质[高敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)及白介素6(IL-6)]、肾功能[24 h尿蛋白定量(24 h Upro)、血尿氮素(BUN)及血清肌酐(SCr)]、神经功能缺损(NIHSS)评分、不良反应.结果 治疗组不稳定斑块率、ET-1、vWF、hs-CRP、TNF-α、IL-6水平、24 h Upro、BUN、SCr浓度、NIHSS评分低于对照组,NO水平高于对照组(P <0.05);两组不良反应总发生率比较差异无统计学意义(P>0.05).结论 对急性脑梗死合并2型糖尿病患者早期应用前列地尔,可有效减少颈动脉斑块,提高血管内皮功能,改善机体炎症,促进肾功能及神经功能的恢复,且不良反应少.