目的 探討銀杏葉提取物注射液聯合注射用重組人TNK組織型纖溶酶原激活劑治療急性腦梗死的臨床療效。方法選取2021年4月—2024年3月華北醫(yī)療健康集團峰峰總醫(yī)院收治的108例急性腦梗死患者，按隨機數字表法分為對照組和治療組，每組各54例。對照組給予注射用重組人TNK組織型纖溶酶原激活劑，劑量為0.25 mg/kg（最大不超過25 mg），單次靜脈注射，之后繼續(xù)接受常規(guī)治療。治療組在對照組治療基礎上靜脈滴注銀杏葉提取物注射液，20 mL/次，溶于0.9%氯化鈉溶液（250 mL）中，緩慢滴注（滴速在15～30滴/min）,1次/d。兩組療程均為14 d。觀察兩組臨床療效，比較治療前后兩組美國國立衛(wèi)生研究院卒中量表（NIHSS）評分，凝血功能相關指標[凝血酶原時間（PT）、活化部分凝血活酶時間（APTT）、血漿凝血酶抗凝血酶復合物（TAT）、D-二聚體（D-D）、纖維蛋白原（FIB）]及血清基質細胞衍生因子-1(SDF-1)、CC趨化因子細胞受體5(CCR5)、堿性成纖維細胞生長因子（bFGF）、白細胞介素-33(IL-33)、神經膠質纖維酸性蛋白（GFAP）水平。比較兩組溶栓后90 d改良Rankin量表（mR S）評分。結果 治療后，治療組總有效率是96.30%，顯著高于對照組的85.19%(P<0.05)。治療后，兩組治療3、7、14 d NIHSS評分均顯著低于同組治療前（P<0.05）；且治療后，治療組治療同期NIHSS評分低于對照組（P<0.05）。治療后，兩組PT、APTT都長于同組治療前，而血漿TAT、D-D、FIB水平顯著降低（P<0.05）；治療后，治療組PT、APTT長于對照組，而血漿TAT、D-D、FIB水平低于對照組（P<0.05）。治療后，兩組血清SDF-1、CCR5、IL-33、GFAP水平顯著降低，而血清bFGF水平顯著上升（P<0.05）；治療后，治療組血清SDF-1、CCR5、IL-33、GFAP水平低于對照組，而血清bFGF水平高于對照組（P<0.05）。兩組溶栓后90 d，治療組mR S評分是（1.67±0.43）分，顯著低于對照組（2.35±0.70）分（P<0.05）。結論 銀杏葉提取物注射液聯合注射用重組人TNK組織型纖溶酶原激活劑治療急性腦梗死具有較好的臨床療效，能有效控制凝血功能紊亂，抑制機體炎癥反應，對患者神經功能恢復具有良好效果，值得臨床推廣應用。

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

邯鄲市科學技術研究與發(fā)展計劃項目(1723208070)