| Objective: Recently years study has indicated that inflammatory factor including IL-1, IL-6, TNF-αand so on work importantly on acute cerebral infarction. These cellular factors are significant medium of inflammatory action after ischemic stroke, and they can be the independent indexes to tell the prognosis of acute cerebral infarction patients. Melt-embolus therapy is the most effective way to cure acute ischemic stroke recently. There are plenty of inland and overseas clinical evidence show that recombinant tissue plasminogen activator (rt-PA) is the most effective melt-embolus medicine. It still stays in the exploring period to apply rt-PA in Chinese clinical practice. And the reports about the relation between the variation of serum level of TNF-α, IL-6 and rt-PA melt-embolus therapy are very few. In order to access the security and effectivity of melt-embolus therapy in super-early period and provide the theoretic and practical evidence for clinical treatment of acute cerebral infarction and discuss problems of rt-PA application that wait to be resolved, we study the variation of serum level of TNF-α, IL-6 of patients after rt-PA melt-embolus therapy.Methods: Cases of acute cerebral infarction first time within 6 hours who were treated with rt-PA and with Batroxobin respectively were measured the level of serum level of TNF-α, IL-6 with immunoradiology before and after treatment. The serum of healthy person was the control group. Noted the NIHSS grades of two groups before and after treatment in deferent period of after 2 hours,12 hours,24 hours,7 days,14 days and 30 days. And the Barthel index after treatment 90 days was also recorded. The level of TNF-α, IL-6 of two treatment groups and control group werecompared. The level of TNF-α, IL-6 and NIHSS about two treatment groups were compared with each other also. Thus discussed if the two cellular factors, TNF-αand IL-6, had taken part in the procedure of acute ischemic stroke, and access the security and effectivity of rt-PA melt-embolus therapy.Results:1. Compared the serum level of IL-6,TNF-αof deferent curative groups with the control groupThe level of TNF-α, IL-6 of two treatment groups increased compared with control group( P< 0.05) before treatment. The level of curative groups went down to a certain extent after treatment, but there was statistical deference also compared with control group(P<0.05).2. Impacts of the serum level of IL-6,TNF-αof patients with the two therapy.Serum level of TNF-α, IL-6 of two treatment groups with no deference before treatment (P>0.05) declined after 24 hours of treatment(P<0.05), and rt-PA melt-embolus group felt down more obviously(P<0.05) than Batroxobin group. It suggested the two treatment could restrain the inflammatory cellular factors of TNF-α, IL-6, and the restraining action of rt-PA melt-embolus therapy is more obviously.3. Observed the NIHSS grades of deferent curative group patients dynamically.The NIHSS grades of two treatment groups increases with no statistic deference before treatment. They improved after treatment, while the melt-embolus group were better than the Batroxobin group. The NIHSS grades of rt-PA melt-embolus group showed the statistic deference(P<0.05) after treatment of 2 hours, 12 hours, 24 hours, 7 days, 14 days and 30 days compared with Batroxobin group. It implied that short-dated and long-dated curative effect of melt-embolus therapy was superior to Batroxobin.4. The Barthel index after treatment 90 days with deferent therapy was compared.The Barthel index of rt-PA melt-embolus group after treatment 90 days was superior to Batroxobin group with statistic deference(P< 0.05). Itindicated the long-dated curative effect of rt-PA melt-embolus therapy was better than Batroxobin.5. The security of deferent therapy was compared.There were one case of cerebral hemorrhage, one case of stress associated ulcer after rt-PA melt-embolus therapy. There was one case of stress associated ulcer after Batroxobin therapy. There was no case of death of the two groups, and no statistic deference.Conclusions:1. The level of TNF-α, IL-6 of acute cerebral infarction patients increased obviously, that indicated that the two cellular factors had taken part in the early period inflammatory reaction of cerebral ischemia.2. The level of deleterious inflammatory cellular factors, TNF-α, IL-6, went down more remarkably of rt-PA melt-embolus therapy than Batroxobin therapy.3. NIHSS grades and Barthel index would be improved obviously by rt-PA melt-embolus therapy, and short-dated and long-dated curative effect of melt-embolus therapy was superior to Batroxobin therapy4. rt-PA melt-embolus therapy was secure and effective. So we should apply this therapy extensively when the patient meets the melt-embolus requirement. The rt-PA melt-embolus therapy should be chosen first in treating acute ischemic stroke super-early period.
|
PDF Full Text Request