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背景:反映血小板活化程度的特异性分子血小板颗粒膜糖蛋白和肿瘤坏死因子α在正常全血中含量很少,在脑梗死患者血浆中含量增高,元活苏对脑缺血的保护作用是否与此有关?目的:通过测定急性脑卒中患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α的含量及元活苏对缺血性脑卒中患者的脑保护作用,并与复方丹参的治疗效果比较。设计:病例分析。单位:平顶山煤业集团公司总医院内科和郑州大学第二附属医院神经内科。对象:选择2001-01/2003-10平顶山煤业集团公司总医院内科住院的高血压合并急性脑卒中患者144例。随机分为2组:观察组72例,男47例,女25例;年龄90～42岁,平均(69±11)岁。对照组72例,男49例,女23例;年龄85～37岁,平均(68±10)岁。方法:两组患者均进行常规吸氧、降压、脱水、抗凝等方法治疗,对照组给予复方丹参注射液500mL,1次/d,用药14d。治疗组给予复方丹参注射液500mL,1次/d,共14d和元活苏20mL+生理盐水250mL1次/d,共14d。①入院时和治疗3周后采用欧洲卒中量表(总分最低为0分,最高为100分,分值越高,说明神经功能恢复程度越好)评估两组患者神经功能恢复情况。②入院时(时间窗24～72h)以及治疗后3周分别抽肘静脉血5mL,采用放免法分析血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量,分析两者水平及元活苏干预后神经功能变化。主要观察指标:治疗前和治疗3周后,①两组患者神经功能恢复情况。②两组患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量。结果:144例患者全部进入结果分析。①欧洲卒中量表评分结果:两组患者治疗后明显高于治疗前犤观察组:(79.95±18.64)分,(59.65±19.87)分;对照组:(74.66±15.88)分,(61.25±18.68)分,(t=2.678～4.351,P<0.01)犦;治疗后观察组高于对照组(t=2.016～2.158,P<0.05)。②血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量:两组患者治疗后明显低于治疗前犤观察组:(22.12±9.52)μg/L,(50.41±22.35)μg/L;(1.05±0.24)μg/L,(1.62±0.50)μg/L;对照组:(26.66±8.22)μg/L,(48.63±21.54)μg/L;(1.35±0.44)μg/L,(1.66±0.48)μg/L,(t=2.678～4.351,P<0.001)犦,治疗后观察组低于对照组(t=2.016～2.158,P<0.05)。结论:元活苏能显著能降低急性脑卒中患者血浆血小板颗粒膜糖蛋白、肿瘤坏死因子α含量,提高神经功能评分,显著改善神经功能缺损症状。
Background: Specific molecules that reflect the degree of platelet activation Platelet granulocyte membrane glycoprotein and tumor necrosis factor-α, which are present in normal whole blood, are present in the plasma of patients with cerebral infarction, and whether the protective effect of methotrexate on cerebral ischemia is The purpose of this study was to determine the plasma platelet granulosa membrane glycoprotein, tumor necrosis factor-α in patients with acute stroke and the neuroprotective effect of methotrexate on ischemic stroke in patients with acute stroke. The therapeutic effect was compared with that of compound salvia miltiorrhiza. Design: Case Analysis. Unit: Pingdingshan General Hospital of Coal Mining Group Corporation and the Second Affiliated Hospital of Zhengzhou University Department of Neurology. PARTICIPANTS: A total of 144 patients with hypertension complicated with acute stroke hospitalized in Pingdingshan General Hospital of Chinese Medicine from January 2001 to October 2003 were selected. Randomly divided into two groups: observation group of 72 cases, 47 males and 25 females; aged 90 to 42 years, mean (69 11) years. Control group, 72 cases, 49 males and 23 females; aged 85 to 37 years, mean (68 ± 10) years. Methods: Two groups of patients were treated by routine oxygen inhalation, hypotension, dehydration, anticoagulation and other methods. The control group was given Fufang Danshen injection 500mL once a day for 14 days. The treatment group was given Fufang Danshen injection 500mL, 1 time / d, a total of 14d and Yuan Huosu 20mL + saline 250mL1 times / d, a total of 14d. ① The admission to hospital and after 3 weeks of treatment using the European stroke scale (the lowest score of 0 points, up to 100 points, the higher the score, indicating that the better the recovery of neurological function) to evaluate the recovery of neurological function in both groups. ② At admission (time window 24 ~ 72h) and 3 weeks after treatment, 5 mL of elbow venous blood was drawn respectively. Plasma platelet granulosa membrane glycoprotein and tumor necrosis factor α were assayed by radioimmunoassay. Function changes. MAIN OUTCOME MEASURES: Before treatment and after 3 weeks of treatment, ① nerve function recovery in both groups. ② The two groups of patients with plasma platelet membrane glycoprotein, tumor necrosis factor alpha content. Results: All 144 patients entered the result analysis. Results of the European Stroke Scale: The scores of the two groups after treatment were significantly higher than those before treatment (79.95 ± 18.64) and (59.65 ± 19.87) points respectively, while those in the control group were (74.66 ± 15.88) and (61.25 ± 18.68) ) (T = 2.678 ~ 4.351, P <0.01). After treatment, the observation group was higher than the control group (t = 2.016-2.1580, P <0.05). (2) Plasma platelet granulosa membrane glycoprotein and tumor necrosis factor-α content in the two groups were significantly lower than those in the observation group before treatment (22.12 ± 9.52) μg / L, (50.41 ± 22.35) μg / L; (1.05 ± 0.24 (1.62 ± 0.48) μg / L and (1.62 ± 0.50) μg / L respectively in the control group, (26.66 ± 8.22) μg / L and /L,(t=2.678~4.351,P<0.001) 犦, after treatment, the observation group was lower than the control group (t = 2.016 ~ 2.158, P <0.05). CONCLUSION: Yuan-yuan-su-ning can significantly reduce plasma platelet granulosa membrane glycoprotein, tumor necrosis factor-α content, improve neurological function scores and significantly improve the symptoms of neurological deficits in patients with acute stroke.