Effect of panax notoginseng saponins on efficacy and hemorrhagic transformation of rt-PA intravenous thrombolysis in patients with acute ischemic stroke
LI Chun-sheng;GAO Yan-hong;CHANG Jian-jun;LI Hao;Department of Neurology, Xinyang Central Hospital;
Objective To study the effect of panax notoginseng saponins(PNS) on the efficacy andhemorrhagic transformation(HT) of recombinant tissue- type plasminogen activator(rt- PA) intravenousthrombolysis in patients with acute ischemic stroke. Methods A total of 200 patients with early acuteischemic stroke(the length of time between attack and hospital admission 4.50 h) were divided into2 groups according to random number table method: treatment group(N = 100) and control group(N = 100).The control group was treated with routine rt- PA intravenous thrombolysis treatment, and the treatmentgroup was treated with rt-PA intravenous thrombolysis plus PNS injection. The ischemia-reperfusion injuryindex [malondialdehyde(MDA) and superoxide dismutase(SOD)], hemorrhagic transformation predictionindex [matrix metalloproteinase- 9(MMP- 9) and fibronectin(FN)] and nerve function index [NationalInstitutes of Health Stroke Scale(NIHSS) and Barthel Index(BI)] were measured and compared beforetreatment, 24 h after thrombolysis and 14 d after thrombolysis. Adverse drug reactions and hemorrhagictransformation rate were observed 14 d after thrombolysis, and the prognosis(mortality and BI) wasevaluated 12 months after thrombolysis. Results Compared with control group, serum SOD(P = 0.000)and BI(P = 0.000) in treatment group were significantly higher, while serum MDA(P = 0.001), MMP-9(P =0.001), plasma FN(P = 0.000) and NIHSS score(P = 0.006) were significantly lower. In treatment group,24 h after rt-PA intravenous thrombolysis plus PNS injection, serum MDA(P = 0.000), MMP-9(P = 0.000)and BI(P = 0.000) were significantly increased, while NIHSS score(P = 0.000) was significantly decreased;14 d after treatment, serum MDA(P = 0.000) and MMP-9(P = 0.000) were decreased, serum SOD(P =0.000) and BI(P = 0.000) were continuously increased, plasma FN(P = 0.000) and NIHSS score(P = 0.000)were continuously decreased. On the 14 th day after thrombolysis, hemorrhagic transformation rate of treatment group was lower than that of control group [9 cases(9%) vs 19 cases(19%); χ2= 4.153, P =0.042]. There was no significant difference in the incidence of adverse drug reactions between 2 groups[14 cases(14%) vs 11 cases(11%); χ2= 0.411, P = 0.521]. Twelve months after thrombolysis, there were5 cases of death(5%) in control group and one case(1%) of death in treatment group. There was no significant difference in the incidence of mortality between 2 groups(χ2= 1.546, P = 0.241). The BI of treatment group was significantly higher than that of control group(88.51 ± 11.49 vs 84.47 ± 9.83; t = 2.451,P = 0.015). Conclusions PNS reduces ischemia-reperfusion injury after rt-PA intravenous thrombolysis in patients with acute ischemic stroke. It can reduce the rate of hemorrhagic transformation after rt- PA intravenous thrombolysis and improve the prognosis with good safety.