Zhongguo cuzhong zazhi (Nov 2023)
桥接治疗对急性脑梗死患者神经元特异性烯醇化酶、S100钙结合蛋白B、胶质纤维酸性蛋白的影响 Effect of Bridging Therapy on Neuron-Specific Enolase, S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein in Patients with Acute Cerebral Infarction
Abstract
目的 探讨桥接治疗对前循环大血管闭塞急性脑梗死患者血清神经损伤相关生化标志物的影响以及临床疗效，为急性脑梗死治疗方式的选择提供参考依据。 方法 回顾性分析2018年10月—2020年6月前循环大血管闭塞的急性脑梗死患者的病历资料，根据是否采取桥接治疗分为对照组（静脉溶栓组）和观察组（桥接治疗组）。统计两组在治疗后24 h、14 d的治疗有效（NIHSS评分下降≥4分或NIHSS评分0分）率，治疗后30 d、90 d及180 d的良好预后 （mRS评分≤2分）率及日常生活能力自理（Barthel指数＞60分）率，住院期间脑出血发生率，治疗前以及治疗后3 d、7 d及14 d神经元特异性烯醇化酶（neuron-specific enolase，NSE）、S100钙结合蛋白B（S100 calcium-binding protein B，S100B）及胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP）水平。采用基于混合效应的logistic回归模型、线性混合效应模型进行预后指标的统计分析。 结果 多因素分析结果显示：观察组的治疗有效率是对照组的3.35倍（OR 3.35，95%CI 1.10～10.13，P=0.041）；观察组的良好预后率是对照组的4.12倍（OR 4.12，95%CI 1.14～14.82，P=0.035）；观察组的日常生活能力自理率与对照组相当（OR 1.47，95%CI 0.28～7.68，P=0.648）；观察组与对照组脑出血发生率差异无统计学意义（7.4% vs. 8.7%，P=1.000）；观察组NSE、S100B、GFAP水平低于对照组，差异具有统计学意义（P60) rate of normal living ability between two groups at 30 d, 90 d and 180 d after treatment, the incidence of intracerebral hemorrhage during hospitalization, and the related biochemical markers of serum nerve injury [neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B) and glial fibrillary acidic protein (GFAP)] before and at 3 d, 7 d and 14 d after treatment were also analyzed. Logistic regression model based on mixed effects and linear mixed effects model were used for statistical analysis of prognostic indicators. Results Multivariate analysis showed that the treatment effective rate of the observation group was 3.35 times higher than that of the control group (OR 3.35, 95%CI 1.10-10.13, P=0.041). The good prognosis rate of the observation group may be 4.12 times higher than that of the control group (OR 4.12, 95%CI 1.14-14.82, P=0.035). The self-care rate of normal living ability in the observation group was similar to that in the control group (OR 1.47, 95%CI 0.28-7.68, P=0.648). There was no significant difference in the incidence of intracerebral hemorrhage between the observation group and the control group (7.4% vs. 8.7%, P=1.000). The levels of NSE, S100B and GFAP in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.001). Conclusions Compared with simple intravenous thrombolysis, bridging therapy can significantly reduce NSE, S100B and GFAP in acute cerebral infarction patients with anterior circulation large vessel occlusion, and improve clinical efficiency.
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