单唾液酸四己糖神经节苷脂联合舒血宁对急性脑梗死患者神经功能的影响及机制研究

A study on effect and mechanism of monosialotetrahexosyl ganglioside combined with Shuxuening injection on nerve function for treatment of patients with acute cerebral infarction

目的探讨单唾液酸四己糖神经节苷脂（GMl）联合舒血宁对急性脑梗死（ACI）患者神经功能的影响及机制。方法选择2013年1月至2016年6月湖北医药学院附属襄阳市第一人民医院神经内科收治的94例ACI患者，按随机数字表法分为两组，每组47例。两组均给予西医常规治疗；一组给予GM1静脉滴注（静滴），每次100mg，每日1次（单用组）；另一组联用GM1和舒血宁肌肉注射，每次2mL，每日2次（联用组）；两组治疗时间均为14d。观察两组患者治疗前后中国脑卒中临床神经功能缺损程度评分（CSS）和格拉斯哥昏迷评分（GCS）、神经因子、氧化应激指标和血流动力学指标的变化。结果与治疗前比较，治疗后联用组CSS评分、神经元特异性烯醇化酶（NSE）、丙二醛（MDA）均显著降低，GCS评分、神经生长因子（NGF）、神经营养因子（NTF）、最大血流速度（Vmax）、最小血流速度（Vmin）、平均血流速度（Vmean）、平均血流量（Qmean）、谷胱甘肽过氧化物酶（GSH—Px）、过氧化氢酶（CAT）、超氧化物岐化酶（SOD）均显著升高（均P〈0．05）。治疗后联用组CSS、NSE、MDA显著低于单用组[CSS评分（分）：11．20±1．78比16．24±1．95，NSE（μg／L）：13．17±1．00比17．68±1．84，MDA（μmol／L）：4．14±0．49比5．61±0．50，均P〈0．05j，GCS、NGF、NTF、GSH—Px、CAT、SOD、Vmax、Vmin、Vmean和Qmean均显著高于单用组[GCS评分（分）：13．68±1．85比12．01±1．76，NGF（ng／L）：88．10±8．83比68．13±7．16，NTF（μg/L）：5．13±0．38比3．71±0．30，GSH—Px（U／L）：128．13±8．07比103．90±6．58，CAT（U／L）：25．74±2．15比19．43±1．84，SOD（μU／L）：94．36±8．00比77．29±7．34，Vmax（cm／min）：48．23±3．36比43．17±2_88，Vmin（cm／min）：8．11±0．76比6．85±0．64，Vmean（cm／min）：18．69±1．37比15．60±1．24，Qmean（mL／min）：9．10±0．74比7．79±0．66，均P〈0．05]。结论GM1与舒血宁联合治疗可通过提高ACI患者脑部血液流动学水平及神经营养相关因子分泌，抑制氧化应激反应，从而改善患者神经功能，对修复受损神经功能有重要临床意义。

Objective To observe the effect of monosialoteterahexosyl ganglioside （GM1） combined with Shuxuening injection on nerve function in patients with acute cerebral infarction （ACI） and its mechanism. Methods A total of 94 patients with ACI admitted to the Department of Neurology in Xiangyang First Peoples＇ Hospital Affiliated to Hubei Medical College from January 2013 to June 2016 were enrolled, and they were divided into two groups by random number table, each group 47 cases. The patients in two groups were all given conventional western medicine treatment; The patients in one group （single group） were treated by intravenous （IV） drip of GM1, 100 mg once a day; and the patients in another group （combined group）, by above GM1 IV drip combined with Shuxuening intramuscular injection, once 2 mL, twice a day; the therapeutic course in two groups was 14 days. Before and after treatment, the changes of China stroke clinical neurological impairment score （CSS score）, glasgow coma score （GCS）, nerve factor, oxidative stress index and hemodynamics index of two groups were observed. Results Compared with those before treatment, after treatment the CSS score, the levels of neuron specific enolase （NSE）, and malondialdehyde （MDA） were significantly lower, while the GCS score, the levels of nerve growth factor （NGF）, neurotrophic factor （NTF）, maximum blood flow velocity （Vmax）, minimum blood flow velocity （Vmin）, mean blood flow velocity （Vmean）, mean blood flow quantity （Qmean）, glutathione peroxidase （GSH-Px）, catalase （CAT） and superoxide dismutase （SOD） were all significantly higher in the combined group （all P 〈 0.05）. After treatment, the CSS score, levels of NSE and MDA in the combined group were significantly lower than those of the single group [CSS： 11.20 ± 1.78 vs. 16.24± 1.95, NSE （μg/L）： 13.17 ± 1.00 vs. 17.68 ± 1.84, MDA （μmol/L）： 4.14 ± 0.49 vs. 5.61 ± 0.50, all P 〈 0.05], GCS score, NGF, NTF, GSH-Px, CAT, SOD, Vmax, Vmin, Vmean and Qmean of the combined group were all significantly higher than those of the single group [GCS： 13.68±1.85 vs. 12.01±1.76, NGF （ng/L）： 88.10±8.83 vs. 68.13±7.16, NTF （μg/L）： 5.13±0.38 vs. 3.71 ± 0.30, GSH-Px （U/L）： 128.13 ± 8.07 vs. 103.90 ± 6.58, CAT （U/L）： 25.74± 2.15 vs. 19.43 ± 1.84, SOD （μU/L）： 94.36±8.00 vs. 77.29±7.34, Vmax （em/min）： 48.23±3.36 vs. 43.17±2.88, Vmin （em/min）： 8.11±0.76 vs.6.85 ± 0.64, Vmean （cm/min）： 18.69 ±1.37 vs. 15.60 ±1.24, Qmean （mL/min）： 9.10 ± 0.74 vs. 7.79 ± 0.66 ,all P 〈 0.05]. Conclusions GM 1 combined with Shuxuening injection can improve nerve function in patients with ACI by improving brain blood flow, secreting neurotrophie related factors and inhibiting oxidative stress reaction, thus it has important clinical significance for repairing the damaged nerve function.