目的：探讨三七总皂甙(panax notoginseng saponins，PNS)对急性脑梗死重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator，rt-PA)静脉溶栓后缺血再灌注损伤及出血性转化(hemorrhagic transformation，HT)的影响。方法：回顾性分析131例早期(发病后就诊时间<4.5 h)急性脑梗死患者，其中PNS + rt-PA静脉溶栓治疗(PNS组)66例和rt-PA静脉溶栓治疗(对照组)65例。两组均常规治疗，PNS组中PNS注射液400 mg + 5%葡萄糖注射液500 mL，1次/d，静脉滴注。观察两组治疗24 h和15 d后的治疗效果，用试剂盒检测两组患者血液中超氧化物歧化酶(superoxide dismutase，SOD)、丙二醛(malondialdehyde，MDA)、基质金属蛋白酶9(matrix metalloproteinase 9，MMP-9)、细胞纤维连接蛋白(human cellular fibronectin，c-Fn)，CT检测两组HT情况，用美国国立卫生研究院卒中量表(NIH Stroke Scale，NIHSS)和Barthel指数评价其神经功能。结果：溶栓后24 h，与溶栓前相比，两组MDA，MMP-9，c-Fn及Barthel指数均显著升高，SOD及NIHSS评分均显著降低，PNS组的各项指标较对照组明显改善(t=2.54，2.50，2.52，2.55，2.55，2.57，均P<0.05)。治疗15 d后，两组患者的各项指标(MDA，SOD，MMP-9，c-Fn，NIHSS评分及Barthel指数)较治疗前均显著改善(均P<0.01)，且PNS组较对照组显著改善(t=4.61，4.98，4.46，4.68，4.38，5.87，均P<0.01)；CT检测显示PNS组患者出血性转化率显著低于对照组(χ2=4.15，P<0.05)。结论：PNS减轻急性脑梗死患者rt-PA静脉溶栓后缺血再灌注损伤可能与降低溶栓后出血转化率有关。
Effects of panax notoginseng saponins on ischemia reperfusion injury and hemorrhagic transformation after recombinant tissue plasminogen activator intravenous thrombolysis in patients with acute cerebral infarction
Objective: To study the effect of panax notoginseng saponins (PNS) on ischemia reperfusion injury and hemorrhagic transformation (HT) after recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis in patients with acute cerebral infarction. Methods: We conducted retrospective analysis on 131 patients with early acute cerebral infarction (the time of disease attack to reception no less than 4.5 h), including the PNS group with 66 cases and the control group with 65 cases. The control group was treated with rt-PA + routine treatment, on the basis of the control group treatment, the PNS group was treated with PNS injections 400 mg + 5% glucose injection, intravenous drip, once a day. Two groups were treated for 15 days, and we investigated the clinic effective of two treatment after 24 h and 15 d. The ischemia reperfusion injury index superoxide dismutase (SOD), malondialdehyde (MDA), and the hemorrhagic transformation prediction index matrix metalloproteinase 9 (MMP-9), fibronectin (c-Fn) were test by regent kit according Operation instructions for blood sample of patients. The HT was test by computerized tomographic scanning, and stroke scale (NIHSS) and index Barthel were used to evaluate the nerve function. Results: Compared with thrombolysis before, at post-thrombolysis 24 h, the result of MDA, MMP-9, c-Fn and Barthel index in the two groups were significantly increased, the scores of SOD and NIHSS were significantly decreased, and the clinical index of the PNS group was significantly improved compared with the control group (t=2.54, 2.50, 2.52, 2.55, 2.55, 2.57, all P<0.05). Clinical indicators (MDA, SOD, MMP-9, c-Fn, NIHSS score and Barthel index) improved compared with before treatment in patients of two groups (all P<0.01), and the PNS group improved more significantly than the control group (t=4.61, 4.98, 4.4589, 4.68, 4.38, 5.87, all P<0.01). The result of CT showed that Hemorrhagic transformation rate of the PNS group was lower than those of the control group within 15 days of treatment (χ2= 4.15, P<0.05). Conclusion: PNS reduces ischemia reperfusion injury after intravenous thrombolysis with rt-PA intravenous thrombolysis in patients with acute cerebral infarction, and it may be related with reducing the rate of hemorrhagic transformation after thrombolysis.