纳洛酮对急性脑梗死患者侧支循环建立的影响

Effects of naloxone on acute cerebral collateral circulation in patients with established

目的探讨纳洛酮治疗急性脑梗死患者侧支循环建立的影响。方法选取2013年12月—2014年4月的急性脑梗死72 h内入院,经头颅CT或MRI证实符合临床表现及相应影像学改变的80例患者,采用完全随机分组分为对照组和纳洛酮组。对照组依据其发病情况、并发疾病等给予抗血小板聚集药、调脂、扩血管、活血化瘀中药及脑保护药物等治疗,治疗组在对照组治疗基础上加用纳洛酮2.4 mg+5%葡萄糖250 m L(糖尿病患者用9%Na Cl 250 m L)静点1次/d,连续应用7 d。两组研究对象分别于入院第1天、7天时抽取卧位静脉血,用酶联免疫吸附法(ELISA)测定血清中血管内皮细胞生长因子(VEGF)、碱性成纤维细胞生长因子(b FGF)的水平;均在入院第1天、7天采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评分。结果治疗7 d后,纳洛酮组较对照治疗更能显著降低神经功能缺损评分(P<0.01);纳洛酮组VEGF、b FGF水平均增高,且与对照组比较,差异有统计学意义(P<0.05);而对照组中b FGF水平呈略下降趋势(P>0.05),更能佐证纳洛酮可促进血清b FGF的高表达。结论纳洛酮作为一种新型的脑保护剂可以通过显著增加脑梗死患者血清中VEGF、b FGF的表达来改善神经功能缺损程度和血液供应状态,减轻残疾。

Objective To observe the effects of Naloxone therapy on patients with acute cerebral collateral circulation. Methods Within 72h after acute cerebral infarction admitted to hospital, confirmed by CT or MRI patients met the clinical and radiographic changes accordingly, using completely randomized into control group and naloxone groups. The control group received antiplatelet drugs, lipid, vasodilators, traditional Chinese medicine and the treatment of cerebral protective drugs based on their incidence, concurrent diseases, the treatment group were treated based on the use of naloxone 2.4mg ＋ 5 % glucose 250 ml （diabetic patients with 9% NaCl 250 ml） infusion once / day, continuous application of seven days.Two subjects were drawn on day 1,7 admission supine blood, serum vascular endothelial growth factor （VEGF） using enzyme-linked immunosorbent assay （ELISA）, basic fibroblast growth factor（bFGF） in level;Were 1.7 days after admission by the United States National Institutes of Health Stroke Scale （NIHSS） neurological deficit scores. Results 7 days of treatment, naloxone treatment compared with the control group decreased significantly better neurological deficit scores （P〈0.01）;naloxone group VEGF, bFGF levels were increased, and compared with control group, P 〈0.05 was considered statistically significant significance; bFGF levels in the control group showed a slightly decreasing trend （P〉 0.05）, more evidence of naloxone can promote high expression of serum bFGF. Conclusion Naloxone as a novel neuroprotec-tive agent can be significantly increased by VEGF, bFGF expression in serum of patients with cerebral infarction to improve the degree of neurological impairment and blood supply to the state, reduce disability.