缺血性脑卒中治疗时间窗后辅助溶栓治疗的进展

doi:10.16098/j.issn.0529-1356.2019.06.028

摘要/Abstract

摘要：

组织纤溶酶原激活物（tPA）溶栓是缺血性脑卒中治疗的金标准，然而，tPA的治疗时间窗和超过治疗时间窗后再应用所致的致命性副作用限制其的临床应用。为了解决tPA应用的限制性，可联合应用tPA与其他药物或非药物的介入方式治疗，且部分联合治疗方案经实验验证可以减轻治疗时间窗外应用tPA所致并发症，尤其是出血性转化（HT）。联合应用药物的作用机制包括保护血脑屏障，增强血管生成作用和保护脑血管。非药物介入方式则包括干细胞移植和有多方面生物效应的气体治疗。tPA与上述治疗方式的联合应用旨在减轻滞后tPA治疗所致的副作用和脑卒中所诱发的神经性缺损和行为损伤。因此，辅助治疗是一种创新的治疗形式，可解决tPA治疗的限制因素，并可能延长缺血性脑卒中的治疗时间窗。

关键词: 辅助治疗, 组织纤溶酶原激活物, 治疗时间窗, 出血性转化, 基质金属蛋白酶

Abstract:

Tissue plasminogen activator (tPA) thrombolysis remains the gold standard for the treatment of ischemic stroke. However, the time window of tPA treatment and the fatal side effects caused by application beyond the time window limit clinical application of tPA. In order to address the limitations, combined use of tPA with other drug or non-drug interventional approaches has been proposed and some combination therapies have been experimentally validated to decrease the complications beyond the time window, especially hemorrhagic transformation (HT). The mechanisms by which the combined drugs act include protecting the blood-brain barrier, enhancing angiogenesis, protecting cerebral blood vessels, etc. Non-drug interventions include stem cell transplantation and gas therapy with multiple biological effects. The combination of tPA and the above treatments intends to alleviate the side effects of delayed tPA treatment and the neurological deficits and behavioral impairment induced by stroke. Therefore, adjuvant therapy is an innovative form of treatment which addresses the limiting factors of tPA therapy and may prolong the time window of ischemic stroke.

Key words: Adjuvant therapy, Tissue plasminogen activator, Time window, Hemorrhagic transformation, Matrix metalloproteinase

吴冶君陈春花. 缺血性脑卒中治疗时间窗后辅助溶栓治疗的进展[J]. 解剖学报, 2019, 50(6): 850-856.

WU Ye-jun CHEN Chun-hua. Progress of adjuvant treatment with tissue plasminogen activator beyond time window in ischemic stroke[J]. Acta Anatomica Sinica, 2019, 50(6): 850-856.

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