低能量氦氖激光两种不同照射途径对脑梗死患者白细胞黏附功能和细胞间黏附分子1的影响

Effects of low-dosage He-Ne laser irradiation through two different pathways on leukocyte adhesion function and intercellular adhesion molecule-1 in patients with cerebral infarction

目的:观察应用两种低能量氦氖激光给予途径,对脑梗死患者白细胞黏附功能和血清可溶性细胞黏附分子1水平的影响。方法:以青岛大学医学院附属医院和第二附属医院1999-07/2001-12收治的发病7d以内急性脑梗死患者120例为观察对象,将其随机分为3组:①药物组(n=34):应用常规药物如甘露醇、706代血浆、维脑路通、胞二磷胆碱等进行治疗。②低能量氦氖激光血管内照射组(IVLIB组,n=44):在药物治疗的基础上加用低能量氦氖激光血管内照射治疗,激光波长632.8nm,功率为1.5mW,1次/d,90min/次,10次为1个疗程。③低能量氦氖激光经鼻腔脑照射组(TNLIB,n=42),在药物治疗的基础上加用低能量氦氖激光经鼻腔脑照射治疗,波长632.8nm,功率为3.5～5.5mW,经鼻腔照射,30min/次,1次/d,10次为1个疗程。检测各组患者治疗前、治疗后5和10d的白细胞黏附率和血清可溶性细胞黏附分子1浓度。以同期健康查体者40名为正常对照组。结果:按实际处理分析,进入结果分析99例。①白细胞黏附率结果:药物组、IVLIB组和TNLIB组治疗前均高于正常对照组[(63±8)%,(64±9)%,(64±8)%,(33±6)%,P<0.001]。与治疗前相比,药物组于治疗后10d显著降低[(56±9)%,t=3.18,P<0.01],而IVLIB组和TNLIB组治疗后5d即显著降低[(55±8)%,(56±7)%,P<0.001],且低于同期药物组,但两组之间无差异。②血清可溶性细胞黏附分子1浓度:药物组、IVLIB组和TNLIB组治疗前均高于正常对照组[(456±67),(460±71),(458±69),(209±58)μg/L,P<0.001]。与治疗前相比,药物组于治疗后10d显著降低[(386±70)μg/L,t=3.96,P<0.01],而IVLIB组和TNLIB组治疗后5d即显著降低[(364±56),(371±54)μg/L,P<0.001],且低于同期药物组,但两组之间无差异。结论:急性脑梗死患者白细胞黏附功能和血清可溶性细胞黏附分子1水平明显增高,而激光治疗可明显降低其水平。两种激光给予途径-低能量氦氖激光经鼻腔脑照射和血管内照射的作用无差异,且经鼻腔脑照射方法简单,操作安全。

AIM： To observe the effect of intravascular He-Ne laser irradiation on blood （IVLIB） and trans-nasal He-Ne laser irradiation on brain （TNLIB） on the leukocyte adhesion function and serum soluble intercellular adhesion molecule-1 in patients with cerebral infarction. METHODS： From July 1999 to December 2001, 120 cases of cerebral infarction within 7 days after attack, who were treated in the Affiliated Hospital and Second Affiliated Hospital, Medical College of Qingdao University, were randomly divided into three groups： drug therapy group （n=34）： the patients were treated only with drug therapy of routine drugs, including mannitol, 706-generation plasma, Venoruton and corenalin; IVLIB group （n=34）： the patients also received intravascular He-Ne laser irradiation on blood besides the drug therapy, the wave length of laser was 632.8 nm, its power was 1.5 mW, once a day, 90 minutes for each time, and 10 times as a course, and TNLIB group （n=42）： the patients also received trans-nasal He-Ne laser irradiation on brain besides the drug therapy, the wave length of laser was 632.8nm, its power was 3.5-5.5 roW, once a day, 30 minutes for each time, and 10 times as a course. The leukocyte adhesion rate and concentration of serum soluble intercellular adhesion molecule-1 were measured before therapy and 5 and 10 days after therapy respectively in all the groups. Forty healthy physical examinees at the same period were taken as controls （control group）. RESULTS： According to intention-to-treat analysis, 99 cases were involved in the analysis of results. ① The leukocyte adhesion rate： The leukocyte adhesion rates before therapy in the drug therapy group, IVLIB group and TNLIB group were all higher than that in the normal control group [（63±8）%, （64±9）%, （64±8）%, （33±6）%, P 〈 0.001]. Compared with before therapy, it was significantly decreased in the drug therapy group at 10 days after therapy [（56±9）%, t=3.18, P 〈 0,0l], but at 5 days after therapy in the IVLIB group and TNLIB group [（55±8）%, （56±7）%, P 〈0.001], and lower than that in the drug therapy group at the same period, but there was no difference between the IVLIB group and TNLIB group.②The concentration of serum soluble intercellular adhesion molecule-1： The concentration of serum soluble intercellular adhesion molecule-1 before therapy in the drug therapy group, IVLIB group and TNLIB group were all higher than that in the normal control group [（456±67）, （460±71）, （458 ±69）, （209±58） μg/L, P 〈 0.001]. Compared with before therapy, it was significantly decreased in the drug therapy group at 10 days after therapy [（386±70）μg/L, t=3.96, P 〈 0.01], but at 5 days after therapy in the IVLIB group and TNLIB group [（364±56）, （371±54） μg/L, P 〈 0.001], and lower than that in the drug therapy group at the same period, but there was no difference between the IVLIB group and TNLIB group. CONCLUSION： The leukocyte adhesion function and concentration of serum soluble intercellular adhesion molecule-1 in patients with acute cerebral infarction are obviously increased, and laser therapy can obviouslydecreased the levels. The therapeutic effects of TNLIB and IVLIB are similar, and TNLIB is simpler and safer.