重组人粒细胞刺激因子治疗急性脑梗死患者的疗效及对脑CT灌注成像的影响

Validity of granulocyte colony-stimulating factor in acute ischemic stroke patients and its effection on CT perfusion

目的探索重组人粒细胞刺激因子(rhG-CSF)治疗急性脑梗死患者的有效性及对脑缺血区CT灌注的影响。方法将82例发病48 h内的大脑中动脉区的脑梗死患者随机分成对照组(n=42)和试验组(n=40),分别皮下注射氯化钠注射液2 mL或rhG-CSF 300μg,bid,共5 d。所有患者于治疗前及治疗后1个月、2个月和3个月进行美国国立卫生研究院卒中量表(NIHSS)评分和日常生活能力评分;于治疗前和治疗3个月后行颅脑CT灌注成像,比较组内和组间各参数的变化。同时观察两组发生临床不良事件的情况。结果治疗后3个月,试验组NIHSS评分均值为5.50,低于对照组的6.56(P<0.01),但残疾程度两组间无显著差异(P=0.47);两组梗死区脑血容量和脑血流量均增加,试验组比对照组更为显著(P<0.05)。试验组皮下注射rhG-CSF期间主要的不良反应是胃肠道反应(19例)、骨骼肌肉疼痛(15例)和发热(12例)。结论发病48 h内皮下注射rhG-CSF能减轻脑梗死患者治疗后3个月的神经功能损伤程度,且改善脑梗死区域的血流灌注,但尚不足以改善残疾程度。

AIM Assessed the effectiveness of recombinant human granulocyte colony stimulating factor （rhG-CSF） after stroke and its effect on CT perfusion. METHODS The randomized, double-blinded controlled trial involving 82 patients with acute middle cerebral artery territory cerebral infarction who presented within 48 hours of onset was conducted. Patients were assigned to either placebo or rhG-CSF therapy group. The control group （n = 42） were given 0.9% sodium chloride injection 2 mL and the rhG-CSF group （n = 40） received subcutaneous rhG- CSF injections 300 μg, bid for 5 days. The National Institutes of Health Stroke Scale （NIHSS） treatment. and Barthel Index （BI） were measured at baseline, All the patients take the CT peffusion at baseline and 3 1 month, 2 months and 3 months after the months after the treatment. We also record the adverse events both of two groups. RESULTS All of the patients completed the 5-day course of treatment, and none were lost to follow-up. There was greater improvement in neurologic functioning between baseline and 3- month follow-up in the rhG-CSF group than in the control group （NIHSS from 11.44 to 5.50 vs. 11.00 to 6.56, P 〈 0.01） , while the disability grade was not different between the two groups （P = 0.47）. Cerebral blood volume （CBV） and cerebral blood flow （CBF） were increase both the two group, while the rhG-CSF group increase more at 3 months after the treatment （P 〈 0.05） . In the trial group, the main adverse effects are enteron symptoms （19/40） , muscle pain （15/40） and fever （12/40） during the period of using rhG - CSF. CONCLUSION rhG- CSF can improve neurologic function of ischemic stroke patients and increase blood perfusion at ischemic region, but not the disability level.