远端缺血后适应处理对急性脑梗死患者血清促炎因子和抗炎因子的影响及其临床意义

The impacts of remote ischemia post-conditioning on serum pro-inflammatory factors and anti-inflammatory factors and its clinical significance in patients with acute cerebral infarction

目的探讨远端缺血后适应处理(RIPC)对急性脑梗死患者血清促炎因子和抗炎因子的影响及其临床意义。方法连续纳入2012年1月—2015年6月江汉大学附属医院/武汉市第六医院神经内科急性脑梗死患者100例,采用随机数字表法分为对照组和观察组,每组各50例,对照组给予常规治疗,观察组加用RIPC。分析治疗前、治疗后2周血清促炎因子(INFγ、TNF-α、IL-18以及IL-8)和抗炎因子(IL-13、TGFβ以及IL-4)水平变化。结果对照组血清促炎因子与抗炎因子治疗前后差异均无统计学意义(P>0.05)。观察组患者治疗后血清TNF-α[(102.7±22.8)pg/ml vs.(61.3±12.1)pg/ml,t=2.335,P=0.013]和IL-18[(37.7±5.4)pg/ml vs.(14.3±3.7)pg/ml,t=2.247,P=0.016]水平明显下降(P<0.05),血清IL-13水平[(15.9±3.6)pg/ml vs.(52.2±4.1)pg/ml,t=2.300,P=0.014]上升,且改善情况优于对照组(P<0.05)。RIPC与△TNF-α(r=0.641,P<0.05)、△IL-18(r=0.687,P<0.05)以及△IL-13(r=0.732,P<0.05)呈正相关。结论 RIPC治疗有助于改善急性脑梗死患者抗炎/促炎系统,可能是潜在的急性脑梗死治疗方法。

Objective To evaluate the impacts of remote ischemia post-conditioning（RIPC） on serum pro-inflammatory factors and anti-inflammatory factors and its clinical significance in patients with acute cerebral infarction.Methods A total of 100 consecutive patients with acute cerebral infarction in Department of Neurology of Wuhan Sixth Hospital Affiliated to Jianghan University from January 2012 to June 2015 were included in this study and were randomly divided into RIPC group and control group,50 cases for each group.The control group was given conventional treatment,and the observation group received additional RIPC treatment.The changes of serum pro-inflammatory factors（INFγ,TNF-α,IL-18 and IL-8） and antiinflammatory factors（IL-13,TGFβ and IL-4） were compared before treatment and 2 weeks after treatment.Results There were no significant differences in pro-inflammatory factors and anti-inflammatory factors before and after treatment in the control group（P〉0.05）.The levels of serum TNF-α[（102.7 ± 22.8） pg/ml vs.（61.3 ± 12.1） pg/ml,t = 2.335,P =0.013]and IL-18.（37.7 ±5.4） pg/ml vs.（14.3 ±3.7） pg/ml,t =2.247,P =0.016]were significantly reduced after treatment,while Levels of serum IL-13[（15.9 ±3.6） pg/ml vs.（52.2 ±4.1） pg/ml,t =2.300,P =0.014]were significantly increased in the observation group,and improvements was superior to that in control group,there were significant differences（P〈0.05）.Correlation Analysis showed that RIPC was positively associated with △TNF-α（r =0.641.P〈0.05）,△IL-18（r =0.687.P〈0.05） and △IL-13（r =0.732,P〈0.05）.Conclusion RIPC may improve the pro-inflammatory/anti-inflammatory system in patients with acute cerebral infarction,which may be a potential treatment method of acute cerebral infarction.