目的 探討阿加曲班聯(lián)合尤瑞克林治療急性缺血性腦卒中的臨床效果及對神經(jīng)損傷標(biāo)志物的影響。方法 前瞻性選擇2018年10月—2021年1月邢臺市第三醫(yī)院收治的202例急性缺血性腦卒中患者，隨機將患者分成對照組和試驗組，每組各101例，對照組患者在基礎(chǔ)治療的同時加用注射用尤瑞克林，應(yīng)用100 mL 0.9%氯化鈉注射液稀釋0.15 PNA注射用尤瑞克林，靜脈滴注，每日1次，療程為30 d。試驗組患者在對照組的基礎(chǔ)上應(yīng)用阿加曲班注射液，治療前2 d，使用60 mg阿加曲班，稀釋液為1 500 mL 0.9%氯化鈉注射液，靜脈滴注24 h；從第3天開始，阿加曲班劑量更改為10 mg，100 mL 0.9%氯化鈉注射液稀釋，靜脈滴注持續(xù)3 h，每日1次，阿加曲班和尤瑞克林均持續(xù)用藥30 d。比較兩組患者神經(jīng)功能、日常生活能力、生活質(zhì)量、臨床療效、炎性因子、血液流變學(xué)、神經(jīng)損傷標(biāo)志物、安全性及預(yù)后等指標(biāo)。結(jié)果 治療后，兩組反映患者神經(jīng)功能的美國國立衛(wèi)生研究院卒中量表（NIHSS）評分較治療前均顯著降低（P＜0.05），反映患者日常生活能力的改良版Barthel指數(shù)（MBI）評分和反映患者生活質(zhì)量的世界衛(wèi)生組織生存質(zhì)量測定量表（WHOQOL-100）評分均顯著升高（P＜0.05）。治療后，試驗組NIHSS評分明顯低于對照組（P＜0.01），且MBI評分和WHOQOL-100評分明顯高于對照組（P＜0.01）。試驗組患者臨床總有效率（88.12%）明顯高于對照組（68.32%），經(jīng)χ²檢驗，差異具有統(tǒng)計學(xué)意義（P＜0.01）。治療后，試驗組患者血清炎性因子C反應(yīng)蛋白（CRP）、白細(xì)胞介素-2（IL-2）水平及血小板聚集率、纖維蛋白原、紅細(xì)胞比容、血漿黏度等血液流變學(xué)指標(biāo)均顯著低于對照組（P＜0.01），試驗組血清谷氨酸、S100β蛋白、神經(jīng)元特異性烯醇化酶等神經(jīng)損傷標(biāo)志物水平均顯著低于對照組（P＜0.01）。試驗組患者不良反應(yīng)發(fā)生率與對照組比較，差異不顯著（P＞0.05）。試驗組患者預(yù)后良好率（60.00%）顯著高于對照組（41.41%），差異具有統(tǒng)計學(xué)意義（P＜0.01）。結(jié)論 阿加曲班聯(lián)合尤瑞克林治療急性缺血性腦卒中，可有效改善患者神經(jīng)功能，增強日常生活能力，提高生活質(zhì)量，消除炎癥反應(yīng)，改善血液流變學(xué)指標(biāo)，降低神經(jīng)損傷標(biāo)志物的水平，臨床應(yīng)用有效。

Objective To investigate the clinical effect of argatroban combined with urinary kallindinogenase in treatment of acute ischemic stroke and its effect on nerve injury markers. Methods A total of 202 patients with acute ischemic stroke treated in Xingtai Third Hospital from October 2018 to January 2021 were prospectively selected. The patients were randomly divided into control group and experimental group, with 101 patients in each group. The patients in the control group were treated with Urinary Kallindinogenase for Injection while basic treatment, diluted with 100 mL of 0.9% Sodium Chloride Injection for 0.15 PNA, intravenous drip once a day, the course of treatment was 30 d. The patients in the experimental group were treated with Argatroban Injection on the basis of the control group. Two days before treatment, 60 mg Argatroban Injection was used, and the diluent was 1 500 mL of 0.9% Sodium Chloride Injection, intravenous drip for 24 h, from the third day, the dose of Argatroban Injection was changed to 10 mg, 100 mL of 0.9% Sodium Chloride Injection was diluted, intravenous drip lasted for three hours, once a day, and argatroban and urinary kallindinogenase were used for 30 d. The neurological function, activities of daily living, quality of life, clinical efficacy, inflammatory factors, hemorheology, markers of nerve injury, safety and prognosis were compared between the two groups. Results After treatment, the NIHSS score reflecting the neurological function of the patients in the two groups was significantly lower than that before treatment (P < 0.05), and the modified Barthel Index (MBI) score reflecting the ability of daily living and the WHO quality of life scale (WHOQOL-100) score reflecting the quality of life of the patients were significantly higher (P < 0.05). After treatment, the NIHSS score in the experimental group was significantly lower than that in the control group (P < 0.01), and MBI score and the WHOQOL-100 score were significantly higher than those in the control group (P < 0.01). The total clinical effective rate of the experimental group (88.12%) was significantly higher than that of the control group (68.32%), χ² test, the difference was statistically significant (P < 0.01). After treatment, the levels of serum inflammatory factor C-reactive protein (CRP), interleukin-2 (IL-2) and hemorheological indexes such as platelet aggregation rate, fibrinogen, hematocrit and plasma viscosity in the experimental group were significantly lower than those in the control group (P < 0.01). Markers of nerve injury such as glutamic acid, S100β protein, and neuron specific enolaseand were significantly lower than those in the control group (P < 0.01). The total incidence of adverse reactions in the two groups was not statistically significant (P > 0.05). The rate of good prognosis in the experimental group (60.00%) was significantly higher than that in the control group (41.41%). The difference was statistically significant (P < 0.01). Conclusion Argatroban combined with urinary kallindinogenase in treatment of acute ischemic stroke can effectively improve the neurological function, enhance the ability of daily living, improve the quality of life, eliminate inflammatory reaction, improve hemorheological indexes and reduce the level of nerve injury markers.The clinical application is effective.

R971

邢臺市重點研發(fā)計劃項目（2020ZC185）