Clinical Observation Of Fibrinolyic Enzyme In Treatment Of Progressive Ischemic Stroke Patients Complicated With Diabetes Mellitus

Objectives:To observe the changes of prothrombin time, activated partial thromboplastintime, fibrinogen and neurologic impairment score of progressive ischemicstroke patients complicated with diabetes mellitus and nondiabetes mellitus duringthe treatment process, then investigating the changes of above indexes betweenthem and those who were treated with fibrinolyic enzyme injection, thenspeculating the possible mechanisms of fibrinolyic enzyme injection preventsthe thrombus from progressing.Methods:60progressive ischemic stroke patients comlicated with diabetes mellituswere divided into conventional treatment group and fibrinolyic enzymetreatment,each group30cases included, another28progressive ischemic strokepatients without diabetes mellitus were given conventional treatment and weretaken as control group. The conventional treatment group was given based onthe improved circulation, nerve nutrition and supportive treatment. Fibrinolyicenzyme treatment group was given based on the use of above drugs and the useof fibrinolyic enzyme injection (diagnosed and within24hours of delivery, time ofmedication for10days). The three groups were administered the coagulation andneurologic impairment score after24hours,4days,7days,10days.Results:Every drug treatment group of progressive ischemic stroke patients’ PT andAPT T had a tendency to rise after24hours,4days,7days,10days, but thepatients complicated with diabetes mellitus combined with fibrinolyic enzymeinjection treatment had the significantly increased levels of PT, APTT (P<0.05).The conventional treatment group and the control group were found significant increasing in the levels of FBG after medicine treatment on the4thday,then declined after the4th day, but did not decrease to24hours’ level(P<0.05); The fibrinolyic enzyme injection treatment group had the significantlydecreasing level of FBG excepting the4th day’s(P<0.01).The level of NIHSS score of the conventional treatment group and thecontrol group were increasing significantly on the4th day than the24hours’(P<0.05); Then it decreased after7days and10days, but it hadn’t statisticalsignificance comparing with the4th day’s (P>0.05).At the same time,comparingwith the24hour’s,the level of NIHSS score of the fibrinolytic enzyme injectiontreatment group increased on the4th day,but it wasn’t significant,it hadn’t statisticalsignificance after comparing with each other (P>0.05); The level of NIHSS score of7days and10days later measured was significantly decreased than the4thday’s(P<0.01).These changes may suggest that the4th day around the time was the peak ofthe disease progression, and fibrinolytic enzyme injection could effectively controlthe levels of fibrinogen in the process of progression.The conventional treatment group compared with the control group, theneurologic impairment score of the diabetic mellitus ones and the ones withoutdiabetic mellitus in4days had no significant differences in the degree ofincreasing at any point time in the same treatment conditions andtreatment methods, as well as the degree of decreasing of the neurologicimpairment score after4days(P>0.05).At the same time, the fibrinolyic enzymeinjection treatment group had no significantly increasing degree in4days,but it had significantly decreasing degree after4days(P<0.01).It tells usabout that the neurologic impairment degreedecreased more significantly comparedwith conventional treatment after the application of fibrinolyic enzyme injectiontreatment whether the patients complicated with diabetes mellitus or not(P<0.01).In addition, after four days’ treatment, the fibrinolytic enzyme injectiontreatment group could prevent the disease from progressing significantly by comparing with other two groups(P <0.05).Conclusion:1. Fibrinogen was the main risk factor of the formation and progressionof thrombosis,and it closely related to the progression of progressive ischemicstroke patients complicated with diabetes mellitus.2. Fibrinolytic enzyme injection could reduce the level of fibrinogen, so thenreduce the blood viscosity and the incidence of vascular stenosis,at last,itplays the role of antithrombotic effect.Then it could control the progression ofprogressive ischemic stroke patients,and treat the disease and improve theprognosis.3. Fibrinolytic enzyme injection had a good therapeutic effect for progressiveischemic stroke patients complicated with diabetes mellitus, it could effectivelyimprove microcirculation,prevent the disease from progressing andsignificantly reduce the neurologic impairment score, and it is safe, at the same timeit hasn’t bleeding risk.So far it isn’t found any case of hemorrhage caused by it, soit is suitable for use.