重组人促红细胞生成素对急性脑梗塞患者认知障碍的改善作用

Improvement effect of recombinant human erythropoietin on cognition disorders in acute brain infarction patients

目的探讨重组人促红细胞生成素(rHu-EPO)对急性脑梗塞患者的认知障碍是否具有改善作用。方法将急性脑梗塞合并认知障碍患者分为对照组(16例)和治疗组(18例),其中两组中各有两例治疗期间因主动要求出院中途退出。对照组进行急性脑梗塞的常规治疗,治疗组在常规治疗的基础上给予30 IU/kg的rHu-EPO皮下注射,每周3次,疗程4周。采用蒙特利尔认知评估量表(MoCA)评估患者治疗前后神经认知功能的变化,采用美国国立卫生研究院神经功能缺损评分标准(NIHSS)进行神经功能缺损评分,并通过磁共振扫描计算梗死灶的体积。结果与治疗前相比,对照组与治疗组患者治疗后的MoCA总分(t=1.684,P=0.035;t=3.622,P=0.011)、语言(t=2.258,P=0.025;t=3.472,P=0.019)、延迟记忆能力评分(t=2.665,P=0.018;t=4.826,P=0.026)较治疗前均有较大程度的提高,且治疗组治疗后的MoCA总分[(20.21±2.63)分vs.(16.99±2.28)分;t=4.183,P=0.011]、语言[(2.76±0.83)分vs.(1.66±0.71)分;t=4.865,P=0.008]、延迟回忆[(4.66±1.38)分vs.(3.12±1.02)分;t=2.643,P=0.025]评分均显著高于对照组。对照组与治疗组治疗后的NIHSS均显著低于治疗前(t=3.506、8.126,P=0.018、0.002),且治疗组患者较对照组更低(t=2.508,P=0.026)。与治疗前相比,治疗组患者治疗后脑梗塞灶体积有所减小[(12.8±3.5)cm3 vs.(8.2±2.3)cm3;t=6.204,P=0.001],且治疗组患者脑梗塞灶体积较对照组明显减小(t=3.268,P=0.022)。结论在常规治疗的基础上加用rHu-EPO对急性脑梗塞患者认知功能具有显著的改善作用,尤其是在语言功能和延迟回忆能力方面改善明显。

Objective To study the improvement effect of recombinant human erythropoietin （rHu-EPO） on cognition disorders in acute brain infarction patients. Methods Acute brain infarction patients with cognition disorders were randomly divided into the control group （16 cases） and rHu-EPO group （18 cases）, and two cases in each group were initiatively dropped out during the therapy. Patients in the control group received conventional treatment, and patients in the rHu-EPO group were given subcutaneous injection of 30 IU/kg rHu-EPO 3 times per week, and lasted for 4 weeks additionally. Montreal cognitive assessment scales （MoCA） were used to evaluate cognitive function, neural function defect were scaled according to the national institutes of health neurological deficit score （NIHSS） and infarction sizes were determined by magnetic resonance imaging before and after the therapy. Results Compared with before the therapy, the MOCA score （t = 1.684, P= 0.035; t = 3.622, P= 0.011）, language function scores （t = 2.258, P=0.025; t=3.472, P=0.019） and delayed memory function scores （t=2.665, P-0.018; t=4.826, P= 0.026） in the control group and rHu-EPO group all increased markedly, and the MoCA score [（20.21±2.63） vs. （16.99±2.28）; t =4.183, P=0.011], language function scores [（2.76±0.83） vs. （1.66±0.71）; t =4.865, P=0.008] and delayed memory function scores [（4.66±1.38） vs. （3.12±1.02）; t = 2.643, P = 0.025] in the rHu-EPO group were much higher than those in the control group. After the therapy, the NIHSS in the control group and rHu-EPO group were also lower than those before the therapy （t = 3.506, 8.126; P = 0.018, 0.002）, and in the rHu-EPO group reduced obviously as compared with that in the control group （t = 2.508, P= 0.026）. Meanwhile, the infarction sizes after the therapy only in the rHu-EPO group decreased as compared with before the therapy [（12.8±3.5）cm^3 vs. （8.2±2.3）cm^3; t = 6.204, P= 0.001], and in the rHu-EPO group were much smaller than those in the control group （t = 3.268, P = 0.022）. Conclusion Based on conventional therapy, rHu-EPO may effectively improve cognition disorders in acute brain infarction patients, especially language and delayed memory function.