益气复脉粉针剂对缺血性脑卒中tPA溶栓后出血转换的治疗作用文献综述

课题名称 益气复脉粉针剂对缺血性脑卒中tPA溶栓后出血转化的治疗作用课题性质 radic; 基础研究应用课题 设计型 调研综述 理论研究开题报告一、拟研究问题本课题拟在课题组前期研究的基础上，考察益气复脉粉针剂与tPA联用通过减轻血脑屏障的破坏，从而改善tPA导致的脑出血转化，为临床上益气复脉粉针剂与tPA联用改善tPA溶栓后出血转化提供药理学参考依据。

二、研究手段1、 采用伊文思蓝渗透率实验检测益气复脉粉针剂对缺血性脑卒中tPA溶栓后的血脑屏障通透性的影响。

2、 采用H) [31]、调节性T细胞[32]等药物和tPA联合用药亦可改善tPA所致的出血转化，提高tPA的用药安全性。

4、结语tPA对于缺血性脑卒中的治疗是一把双刃剑。

了解tPA溶栓治疗缺血性脑卒中后出血转化的机制和危险因素有助于开发更有效的药物。

现已有很多中药复方显示具有治疗缺血性脑卒中的作用。

中药具有多靶点，多环节综合防治疾病的优势，因此，将有脑保护作用的中药复方与tPA联合用药治疗缺血性脑卒中可能是个有效的途径。

进一步探究临床上对于缺血性脑卒中有较好疗效的药物与tPA联用改善tPA出血转化的作用，可以为临床用药提供更多的指导。

参考文献[1]Mozaffarian D, Benjamin EJ, Go AS,et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association [J]. Circulation, 2016, 133: 447-454.[2]Romero JR, Preis SR, Beiser A,et al. Risk factors, stroke prevention treatments, and prevalence of cerebral microbleeds in the Framingham Heart Study [J]. Stroke, 2014, 45(5): 1492-1494.[3]Moskowitz MA, Lo EH and Iadecola C. The science of stroke: mechanisms in search of treatments [J]. Neuron, 2010, 67(2): 181-198.[4]Shi ZS, Duckwiler GR, Jahan R,et al. Early Blood-Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke [J]. J Neuroimaging, 2018.[5]Schmitz ML, Simonsen CZ, Hundborg H,et al. Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study [J]. Stroke, 2014, 45(10): 3070-3072.[6]Parker S and Ali Y. Changing contraindications for t-PA in acute stroke: review of 20 years since NINDS [J]. Curr Cardiol Rep, 2015, 17(10): 81.[7]Hatcher MA and Starr JA. Role of tissue plasminogen activator in acute ischemic stroke [J]. Ann Pharmacother, 2011, 45(3): 364-371.[8]Barber PA, Zhang J, Demchuk AM,et al. Why are stroke patients excluded from TPA therapy? [J]. An analysis of patient eligibility, 2001, 56(8): 1015-1020.[9]Saver JL, Goyal M, Bonafe A,et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke [J]. The new england journal of medicine, 2015, 372(24): 2285-2295.[10]James B, Chang AD, McTaggart RA,et al. Predictors of symptomatic intracranial haemorrhage in patients with an ischaemic stroke with neurological deterioration after intravenous thrombolysis [J]. Journal of Neurology, Neurosurgery 198.[28] Li M, Zhang Z, Sun W, et al. 17beta;-estradiol attenuates breakdown of bloodbrain barrier and hemorrhagic transformation induced by tissue plasminogen activator in cerebral ischemia[J]. Neurobiology of Disease, 2011, 44(3):277.[29] Adeoye O, Sucharew H, Khoury J, et al. Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke-Full Dose Regimen Stroke Trial[J]. Stroke; a journal of cerebral circulation, 2015, 46(9):2529-2533.[30] 杨新忠, 曾宪珠, 张静,等. r-tPA静脉溶栓后追加巴曲酶治疗急性脑梗死的疗效观察[J]. 中风与神经疾病杂志, 2007, 24(3):354-355.[31] 曲东锋. 静脉应用血小板糖蛋白Ⅱb/Ⅲa受体抑制剂可延长大鼠卒中模型动脉替奈替普酶-tPA的治疗时间窗[J]. 国际脑血管病杂志, 2005, 13(1):58-58.[32] 毛蕾蕾. 调节性T细胞输注移植对缺血性脑卒中tPA溶栓后出血转换的治疗作用及其机制探讨[D]. 复旦大学, 2014.