Cai Xiao-bin, Zhu Zhi-shan, Zhang Ming-zhi, Guo Jin, Wang Hui-lan
Department of Neurology, Shenzhen Fifth People's Hospital, Shenzhen 518001, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2009 Oct;29(10):2124-7.
To evaluate the therapeutic effect of individualized defibrase therapy according to the level of plasma fibrinogen (FIB) in patients with acute cerebral infarction (ACI).
Sixty patients with ACI (within 72 h after onset) were randomly divided into defibrase group (n=30) and control group (n=30). The patients in defibrase group received intravenous defibrase infusion at different first doses (15, 10, and 5 U) according to plasma FIB level (>4 g/L, 2-4 g/L, and 1.3-2 g/L) before treatment. Plasma FIB was measured every 12 h after the first dose of defibrase, and when plasma FIB was over 1.3 g/L, intravenous infusion of 5 U defibrase was given to maintain plasma FIB within the range of 0.70-1.13 g/L over a period of 7 days. The plasma prothrombin time (PT), activated partial thromboplastin time (APTT) and FIB before and after the 7-day treatment were measured, and the scores of Chinese stroke scale (CSS) after 14 days of treatment and Activity of Daily Living (ADL) after 3 months were recorded.
After 7 days of treatment, plasma PT and APTT were significantly prolonged lengthened and plasma FIB was lowered in defibrase group. The scores of CSS improved in defibrase group after 14 days of treatment, showing significant difference from those of the control group. The clinical effective rate was 80% in defibrase group, significantly higher than that in the control group (50%). The scores of ADL after 3 months were similar between the 2 groups, but the percentage of independent living and mild dependency was significantly higher in defibrase group (93.3% vs 70.0%). No intracerebral and extracerebral hemorrhage occurred in defibrase group the during treatment, no did death occur after 3 months of treatment.
Defibrase therapy based on plasma FIB level can rapidly and effectively lower plasma FIB, reduce neurological impairment and improve the quality of life in patients with ACI.
评估根据血浆纤维蛋白原（FIB）水平进行个体化降纤酶治疗对急性脑梗死（ACI）患者的疗效。
将60例急性脑梗死患者（发病72小时内）随机分为降纤酶组（n = 30）和对照组（n = 30）。降纤酶组患者根据治疗前血浆FIB水平（>4 g/L、2 - 4 g/L、1.3 - 2 g/L）给予不同首剂（15、10和5 U）静脉输注降纤酶。首剂降纤酶后每12小时检测血浆FIB，当血浆FIB超过1.3 g/L时，静脉输注5 U降纤酶，维持血浆FIB在0.70 - 1.13 g/L范围内7天。检测治疗7天后的血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和FIB，并记录治疗14天后的中国脑卒中量表（CSS）评分及治疗3个月后的日常生活活动能力（ADL）评分。
治疗7天后，降纤酶组血浆PT和APTT显著延长，血浆FIB降低。治疗14天后，降纤酶组CSS评分改善，与对照组相比差异有统计学意义。降纤酶组临床有效率为80%，显著高于对照组（50%）。两组3个月后的ADL评分相似，但降纤酶组独立生活和轻度依赖的比例显著更高（93.3%对70.0%）。降纤酶组治疗期间未发生颅内和颅外出血，治疗3个月后无死亡病例。
基于血浆FIB水平的降纤酶治疗可快速有效降低血浆FIB，减轻神经功能缺损，提高急性脑梗死患者的生活质量。
