丁苯酞注射液对急性大面积脑梗死体积及基质金属蛋白酶-9的影响

doi:10.3969/j.issn.1673-5765.2018.01.011

摘要/Abstract

摘要：

目的研究丁苯酞注射液对急性大面积脑梗死体积及血清基质金属蛋白酶- 9（m a t r i x metalloproteinases-9，MMP-9）水平的影响。方法将58例急性大面积脑梗死患者随机分为对照组和治疗组各29例，对照组予以脑梗死常规治疗，治疗组在常规治疗基础上加用丁苯酞注射液。两组患者分别在入院时、入院3 d和10 d行头颅磁共振成像（magnetic resonance imaging，MRI），测量脑梗死体积，分别在发病12 h、48 h、72 h检测血清 MMP-9的水平。结果与对照组相比，治疗组入院3 d [（144.09±29.41）cm3 vs（170.21±33.09）cm3]及10 d （[ 116.57±25.73）cm3 vs（140.21±29.48）cm3]脑梗死体积缩小，差异有统计学意义。与对照组相比，治疗组发病后48 h（[ 212.69±10.51）ng/ml vs（247.79±8.25）ng/ml）]及72 h（[ 86.14±4.84）ng/ml vs （106.10±7.03）ng/ml] MMP-9水平下降，差异有统计学意义。结论丁苯酞注射液可以降低急性期大面积脑梗死患者MMP-9的表达，缩小脑梗死体积。

文章导读： 本病例对照研究对丁苯酞注射液治疗大面积脑梗死的短期疗效进行了分析，结果显示丁苯酞可以减少患者的脑梗死体积并降低血清基质金属蛋白酶-9的水平。

关键词: 丁苯酞; 大面积脑梗死; 基质金属蛋白酶

Abstract:

Objective To investigate the effect of butylphthalide injection on matrix metalloproteinase-9 and the volume of acute massive cerebral infarction. Methods A total of 58 cases with acute massive cerebral infarction were randomly divided into control group (n =29) and treatment group (n =29). The control group was given conventional treatment of cerebral infarction, and the treatment group was given butylphthalide injection based on the conventional treatment. Two groups of patients underwent magnetic resonance imaging (MRI) scan on admission (first day), third day and tenth day, respectively. The cerebral infarction volume were measured. The serum matrix metalloproteinase-9 levels were detected at 12 hours, 48 hours, 72 hours after onset of disease. Results Comparing with the control group, the infarct volume of the treatment group at third day [(144.09±29.41) cm3 vs (170.21±33.09) cm3] and tenth day [(116.57±25.73) cm3 vs (140.21±29.48) cm3] were significantly reduced, which had statistical significance. Comparing with the control group, the serum matrix metalloproteinase-9 level decreased significantly in the treatment group at 48th hour and 72th hour after the onset of disease [48 h: (212.69±10.51) ng/ml vs (247.79±8.25) ng/ml); 72 h: (86.14±4.84)ng/ml vs (106.10±7.03) ng/ml], which had statistical significance. Conclusion Butylphthalide injection can decrease the expression of matrix metalloproteinases-9 and reduce the volume of acute massive cerebral infarction.

Key words: Butylphthalide; Massive cerebral infarction; Matrix metalloproteinase

王喜丰, 李刚, 付群芳, 俞小梅, 张静, 汪敏, 肖瑶, 沈伟. 丁苯酞注射液对急性大面积脑梗死体积及基质金属蛋白酶-9的影响[J]. 中国卒中杂志, 2018, 13(01): 54-57.

WANG Xi-Feng, LI Gang, FU Qun-Fang, YU Xiao-Mei, ZHANG Jing, WANG Min, XIAO Yao, SHEN Wei. Effect of Butylphthalide Injection on Volume of Acute Massive Cerebral Infarction and the Matrix Metalloproteinase-9[J]. Chinese Journal of Stroke, 2018, 13(01): 54-57.

参考文献

[1] LEES K R，BLUHMKI E，VON KUMMER R，et

al. Time to treatment with intravenous alteplase

and outcome in stroke：an updated pooled analysis

of ECASS，ATLANTIS，NINDS，and EPITHET

trials[J]. Lancet，2010，375（9727）：1695-1703.

[2] FONAROW G C，SMITH E E，SAVER J L，et

al. Timeliness of tissue-type plasminogen

activator therapy in acute ischemic stroke：patient

characteristics，hospital factors，and outcomes

associated with door-to-needle times within 60

minutes[J]. Circulation，2011，123（7）：750-758.

[3] BERKHEMER O A，FRANSEN P S，BEUMER D，

et al. A randomized trial of intraarterial treatment

for acute ischemic stroke[J]. N Engl J Med，2015，372

（1）：11-20.

[4] GOYAL M，DEMCHUK A M，MENON B K，et

al. Randomized assessment of rapid endovascular

treatment of ischemic stroke [J]. N Engl J Med，2015，

372（11）：1019-1030.

[5] 徐如祥，张振海. 急性缺血性脑血管病的血管内治

疗现状与发展[J]. 中华神经医学杂志，2016，15（11）：

1081-1083.

[6] 中华医学会神经病学分会脑血管病学组. 中国急性

期缺血性脑卒中诊治指南2014[J]. 中华神经科杂志，

2015，48（4）：246-257.

[7] 中华医学会神经病学分会脑血管病学组. 中国急性

期缺血性脑卒中诊治指南2010[J]. 中华神经科杂志，

2010，43（2）：146-153.

[8] SIMS J R，GHARAI L R，SCHAEFER P W，et

al. ABC/2 for rapid clinical estimate of infarct，

perfusion，and mismatch volumes[J]. Neurology.

2009，72（24）：2104–2110.

[9] THOMALLA G，HARTMANN F，JUETTLER E，

et al. Prediction of malignant middle cerebral artery

infarction by magnetic resonance imaging within 6

hours of symptom onset：a prospective multicenter

observational study[J]. Ann Neurol，2010，68（4）：

435–445.

[10] SIMARD J M，KENT T A，CHEN M，et al.

Brain oedema in focal ischaemia：molecular

pathophysiology and theoretical implications[J].

Lancet Neurol，2007，6（3）：258–268.

[11]李晓宾，曹丽霞，李传玲，等. 依达拉奉治疗急性脑梗

死后脑水肿的MRI动态观察[J]. 神经疾病与精神卫

生，2013，13（5）：481-484.

[12] CASTELLANOS M，LEIRA R，SERENA J，et al.

Plasma metalloproteinase-9 concentration predicts

hemorrhagic transformation in acute ischemic

stroke[J]. Stroke，2003，34（1）：40–46.

[13] RAMOS-FERNANDEZ M，BELLOLIO M F，

STEAD L G. Matrix metalloproteinase-9 as a marker

for acute ischemic stroke：a systematic review[J].

Stroke Cerebrovasc Dis，2011，20（1）：47-54.

[14] 林亚楠，张亚，王玉，等. 丁苯酞治疗大面积脑梗死

的临床观察[J]. 中国新药杂志，2017，26（6）：656-

660.

[15] 杜迎春，李小磊，薛文俊. 丁苯酞氯化钠注射液联合

依达拉奉治疗急性大面积脑梗死疗效观察[J]. 中国

实用神经疾病杂志，2017，20（1）：93-96.

[16] JIN R，SONG Z，YU S，et a1. Phosphatidylinositol-

3-kinase gamma plays a central role in blood-brain

barrier dysfunction in acute experimental stroke[J].

Stroke，2011，42（7）：2033-2044.