目的 探讨银杏叶提取物注射液联合注射用重组人TNK组织型纤溶酶原激活剂治疗急性脑梗死的临床疗效。方法选取2021年4月—2024年3月华北医疗健康集团峰峰总医院收治的108例急性脑梗死患者，按随机数字表法分为对照组和治疗组，每组各54例。对照组给予注射用重组人TNK组织型纤溶酶原激活剂，剂量为0.25 mg/kg（最大不超过25 mg），单次静脉注射，之后继续接受常规治疗。治疗组在对照组治疗基础上静脉滴注银杏叶提取物注射液，20 mL/次，溶于0.9%氯化钠溶液（250 mL）中，缓慢滴注（滴速在15～30滴/min）,1次/d。两组疗程均为14 d。观察两组临床疗效，比较治疗前后两组美国国立卫生研究院卒中量表（NIHSS）评分，凝血功能相关指标[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、血浆凝血酶抗凝血酶复合物（TAT）、D-二聚体（D-D）、纤维蛋白原（FIB）]及血清基质细胞衍生因子-1(SDF-1)、CC趋化因子细胞受体5(CCR5)、碱性成纤维细胞生长因子（bFGF）、白细胞介素-33(IL-33)、神经胶质纤维酸性蛋白（GFAP）水平。比较两组溶栓后90 d改良Rankin量表（mR S）评分。结果 治疗后，治疗组总有效率是96.30%，显著高于对照组的85.19%(P<0.05)。治疗后，两组治疗3、7、14 d NIHSS评分均显著低于同组治疗前（P<0.05）；且治疗后，治疗组治疗同期NIHSS评分低于对照组（P<0.05）。治疗后，两组PT、APTT都长于同组治疗前，而血浆TAT、D-D、FIB水平显著降低（P<0.05）；治疗后，治疗组PT、APTT长于对照组，而血浆TAT、D-D、FIB水平低于对照组（P<0.05）。治疗后，两组血清SDF-1、CCR5、IL-33、GFAP水平显著降低，而血清bFGF水平显著上升（P<0.05）；治疗后，治疗组血清SDF-1、CCR5、IL-33、GFAP水平低于对照组，而血清bFGF水平高于对照组（P<0.05）。两组溶栓后90 d，治疗组mR S评分是（1.67±0.43）分，显著低于对照组（2.35±0.70）分（P<0.05）。结论 银杏叶提取物注射液联合注射用重组人TNK组织型纤溶酶原激活剂治疗急性脑梗死具有较好的临床疗效，能有效控制凝血功能紊乱，抑制机体炎症反应，对患者神经功能恢复具有良好效果，值得临床推广应用。

Objective To investigate the clinical efficacy of Extract of Ginkgo Biloba Leaves Injection combined with recombinant human TNK tissue-type plasminogen activator in treatment of acute cerebral infarction. Methods A total of 108 patients with acute cerebral infarction admitted to North China Medical Health Group Fengfeng General Hospital from April 2021 to March 2024 were selected and divided into control group and treatment group according to random number table method, with 54 cases in each group. Patients in control group were given Recombinant Human TNK Tissue-type Plasminogen Activator for injection, the dosage was 0.25 mg/kg（maximum 25 mg）, given as a single intravenous injection, after which the usual treatment continues. Patients in treatment group were iv administered with Extract of Ginkgo Biloba Leaves Injection on the basis of control group, 20 mL/time, dissolved in 0.9% sodium chloride solution（250 mL）, slowly（drop rate of 15 — 30 drops/min）, once daily. The treatment course of both groups was 14 d. After treatment, the clinical efficacy was evaluated, NIHSS scores, coagulation function related indicators（PT, APTT, TAT, D-D, FIB） and serum SDF-1, CCR5, bFGF, IL-33, and GFAP levels were compared between two groups before and after treatment. The modified Rankin Scale（mRS） scores at 90 d after thrombolysis were compared between two groups. Results After treatment, the total effective rate of the treatment group was 96.30%, which was significantly higher than that of the control group 85.19%（P＜0.05）. After treatment, NIHSS scores in two groups at 3, 7 and 14 d after treatment were significantly lower than those before treatment（P＜0.05）. After treatment, the NIHSS score of treatment group was lower than that of control group（P＜0.05）. After treatment, PT and APTT in two groups were longer than those before treatment, but plasma TAT, D-D, and FIB levels were significantly decreased（P＜0.05）. After treatment, PT and APTT in treatment group were longer than those in control group, but plasma TAT, D-D, and FIB levels were lower than those in control group（P＜0.05）. After treatment, the serum levels of SDF-1, CCR5, IL-33, and GFAP were significantly decreased, but the serum level of bFGF was significantly increased（P＜0.05）. After treatment, the serum levels of SDF-1, CCR5, IL-33, and GFAP in treatment group were lower than those in control group, but the serum level of bFGF was higher than that in control group（P＜0.05）. 90 D after thrombolysis, the mRS score of treatment group was（1.67±0.43）, which was significantly lower than that of control group（2.35±0.70）（P＜0.05）. Conclusion Extract of Ginkgo Biloba Leaves Injection combined with recombinant human TNK tissue-type plasminogen activator has good clinical effect in treatment of acute cerebral infarction, and can effectively control coagulation disorder, inhibit body inflammation, and has a good effect on the recovery of neurological function in patients, which is worthy of clinical promotion and application.

R971

邯郸市科学技术研究与发展计划项目(1723208070)