早期强化降压控制策略对脑出血血肿扩大、vWF、NF-κB及神经功能的影响

Effects of early intensive antihypertensive strategy on hematoma enlargement,vWF,NF-κB and neurological function in patients with intracerebral hemorrhage

目的探讨早期强化降压控制策略对脑出血(intracerebral hemorrhage,ICH)血肿扩大、血管性血友病因子(v WF)、核因子κB(NF-κB)及神经功能的影响。方法选取2013-10至2015-10我院神经外科收治的ICH患者88例(完成82例,脱落6例)作为研究对象,采用随机数字表法分为强化降压组(44例,完成42例,脱落2例)和标准降压组(44例,完成40例,脱落4例)。记录两组降压前及降压1、24 h收缩压,计算降压前和降压24 h血肿量,对比血肿扩大率;降压前和降压5 d测定v WF、NF-κB水平;降压14 d发放美国国立卫生院神经功能缺损(NIHSS)评分评估神经功能损伤程度,90 d发放Rankin量表(mRS)评估患者近期预后。结果强化降压组降压后1 h、24 h收缩压水平均低于标准降压组,差异有统计学意义(P<0.05);强化降压组降压24 h血肿量(12.03±4.16)ml低于标准降压组,差异有统计学意义(P<0.05);强化降压组血肿扩大率为4.76%明显低于标准降压组的22.5%,差异有统计学意义(P<0.05);强化降压组治疗5 d v WF(121.54±26.67)%和外周血NF-κB(20.15±9.85)nmol/ml明显低于标准降压组,差异有统计学意义(P<0.05);两组降压前和14 d NIHSS评分比较,差异无统计学意义;强化降压组近期预后良好率为78.57%明显高于标准降压组的57.5%,差异有统计学意义(P<0.05)。结论早期强化降压控制策略可预防ICH患者血肿扩大发生,降低v WF、外周血NF-κB水平,改善疾病预后,且对神经功能恢复无影响。

Objective To investigate the effect of early intensive antihypertensive strategy on hematoma enlargement, van Willebrand factor （vWF） , nuclear factor kappa B （NF-κB） and neurological function in patients with intracerebral hemorrhage （ICH）. Methods Eighty-eight patients （82 eases completed the treatment, and 6 eases were lost to follow up）with ICH admitted to our hospital between October 2013 and October 2015 were selected as subjects. By the random number table method, the patients were equally divided into intensive antihypertensive group （42 cases completed the treatment, and 2 cases were lost to follow up） and standard antihypertensive group （40 cases completed the treatment, 4 cases were lost to follow up）. The systolic blood pressure of both groups was recorded before lowering blood pressure and 1 h and 24 h after it. The hematoma volume was calculated before lowering blood pressure and 24 h after it. The rate of hematoma enlargement was compared. The levels of vWF and NF-KB were determined before lowering blood pressure and 5 d after it. 14d after lowering blood pressure, the National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the degree of neurological impairment. 90 d after lowering blood pressure, the modified Rankin Scale （mRS） was used to evaluate the short-term prognosis of patients. Results After 1 h and 24h of lowering blood pressure, the systolic blood pressure of the intensive antihypertensive group（ 12.03 ± 4.16） ml was lower than that of the standard antihypertensive group （P 〈 0.05）. The 24 h hematoma volume of the intensive antihypertensive group was less than that of the standard antihypertensive group （ P 〈 0.05 ）. The rate of hematoma enlargement in the intensive antihypertensive group （4.76%） was significantly lower than that in the standard antihypertensive group （ 22.5% ）. After 5d of treatment, vWF（ 121.54 ± 26.67 ） % and peripheral blood NF-κB （ 20.15 ± 9.85 ） nmol/ml in the intensive antihypertensive group were significantly lower than those in the standard antihypertensive group （ P 〈 0. 05 ）. There was no significant change in NIHSS score after 14d of lowering blood pressure. The good and excellent rate of short-term prognosis of the intensive antihypertensive group （78.57%） was significantly higher than that of the standard antihypertensive group （57. 5% ）.Conclusions Early intensive antihypertensive strategy can prevent hematoma enlargement in patients with ICH, reduce the levels of vWF and peripheral blood NF-KB, improve prognosis, and have no effect on the recovery of neurological function.