目的 探讨阿替普酶联合丁苯酞序贯疗法治疗急性脑梗死患者对其病情的影响。方法 选取海南省儋州市人民医院神经内科2020年9月—2021年3月期间收治的94例急性缺血性脑卒中患者作为研究对象，按治疗方法不同将其分为对照组（n＝47）和试验组（n＝47）。对照组患者阿替普酶进行静脉溶栓治疗，试验组患者在对照组基础上联合丁苯酞序贯疗法进行治疗。比较两组临床疗效、治疗前后神经功能评分、血清人泛素C末端水解酶（UCH-L1）、血清胶质纤维酸性蛋白（GFAP）水平变化、血清炎性因子水平变化［高敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、正五聚蛋白3（PTX-3）］以及牛津残障评分（OHS）情况。结果 治疗前两组患者美国国立卫生研究院卒中量表（NIHSS）评分比较，差异不显著（P＞0.05）；试验组治疗后NIHSS评分明显低于对照组（P＜0.05）。试验组临床总有效率（91.49%）明显高于对照组（74.47%）（P＜0.05）。治疗前，两组患者血清UCH-L1、GFAP、hs-CRP、IL-6、TNF-α、PTX-3水平比较，差异均不显著（P＞0.05）；试验组治疗后血清UCH-L1、GFAP、hs-CRP、IL-6、TNF-α、PTX-3水平均显著低于对照组（P＜0.05）。试验组OHS评分1级、2级患者占比显著高于对照组（P＜0.05）。结论 对急性缺血性脑卒中患者采用阿替普酶联合丁苯酞序贯疗法进行治疗效果较好，可以明显降低患者机体内UCH-L1、GFAP含量，抑制炎性水平，改善神经功能缺损程度，且病情预后良好，值得在临床进行推广应用。

Objective To explore the effect of sequential therapy with ateplase combined with butyphthalide on the condition of patients with acute cerebral infarction. Methods A total of 94 patients with acute cerebral infarction admitted to the Department of Neurology from September 2020 to March 2021 were selected as the study subjects and divided into control group (n = 47) and observation group (n = 47) according to the dynamic randomization method. The control group was treated with intravenous thrombolysis, and the patients in the observation group were treated with sequential therapy on the control basis. The clinical efficacy, neurological function scores before and after treatment, serum human ubiquitin C terminal hydrolase (UCH-L1), serum glial fibrillary acidic protein (GFAP) levels, serum inflammatory factor levels [hypersensitive C reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), n-pentamerin 3 (PTX-3)] and oxford disability score (OHS) were compared. Results After treatment, the neurological deficit score (NIHSS) points] in the observation group was significantly lower than that in the control group (P < 0.05). The clinical efficacy of the observation group (91.49%) was significantly higher than that of the control group (74.47%) (P < 0.05). After treatment serum UCH-L1, GFAP, hs-CRP, IL-6, TNF- α, PTX-3 levels were significantly lower than those in the control group . Level 1\ and level 2\ of OHS in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion Ateplase combined with butyphthalide sequential therapy has a good therapeutic effect on patients with acute cerebral infarction. It can significantly reduce the content of UCH-L1 and GFAP in the body of patients, inhibit the inflammatory level, improve the degree of neural function defect, and has a good prognosis. It is worth promoting in clinical application.

R971

国家自然科学基金资助项目（81971092）