尼莫地平治疗对于蛛网膜下腔出血患者脑源性神经营养因子及组织型纤溶酶原激活物水平的影响

Study on the effect of nimodipine on level of brain-derived neurotrophic factor and tissue-type plasminogen activator in patients with subarachnoid hemorrhage

目的观察尼莫地平治疗对于蛛网膜下腔出血(SAH)患者血浆组织型纤溶酶原激活物(t-PA)和脑源性神经营养因子(BDNF)浓度的影响,并分析其与神经功能恢复情况的关系。方法纳入SAH患者共106例,按照是否接受尼莫地平治疗分为尼莫地平组(57例)和对照组(49例)。患者入院后即刻、7 d、14 d、21 d和28 d时检测血浆t-PA和BDNF水平,发病后6个月时应用NIHSS量表和Barthel指数分别评价神经功能缺损和患者生存质量。结果与治疗前相比,治疗后7 d、14 d、21 d,两组t-PA水平均逐渐增加,至21 d达峰值后,28 d明显下降,尼莫地平组各时间点水平均明显高于对照组,差异有显著性(P<0.05);两组BDNF水平均明显增加,且随治疗时间延长逐渐增加,治疗后21 d、28 d尼莫地平组明显高于对照组,差异有显著性(P<0.05)。应用尼莫地平显著改善患者NIHSS和BARTHEL指数,提示预后良好,生活质量较高。结论与未接受莫地平治疗的SAH患者相比,接受尼莫地平治疗患者血浆t-PA和BDNF水平升高,且预后良好,生活质量较高。

Objective To explore the effect of nimodipine on levels of brain - derived neurotrophic factor （BDNF） and tissue - type plas- minogen activator （ t - PA） in patients with suharachnoid hemorrhage （ SAH）, and to analyze its relationship with recovery of neurological func- tion. Methods 106 patients with SAH were included in this study, and they were divided into nimodipine group and control group. Plasma levels of t - PA and BDNF were measured on the day of admission and 7 days, 14 days, 21 days and 28 days afterward. Scores of NIHSS and Barthel in- dexes were calculated in 6 months later. Results In comparison with those before treatment, t - PA levels of patients in 2 groups in 7 d, 14 d and 21 d after treatment were gradually increased to the peak at 21 d, then t - PA level was obviously decreased at 28 d. They in nimodipine group at each time point were significantly higher than those in control group on average, and the difference was significant （ P 〈 0.05 ）. The level of BDNF in these 2 groups was significantly increased, and it gradually increased with the extension of treatment course. The efficacy of nimodipine in 21 and 28 days after treatment was significantly higher than that of control group, and the difference is significant （ P 〈 0.05 ）. NIHSS and BARTHEL indexes after the application of nimodipine were significantly improved in patients with good and high quality of living. Conclusion After the application of nimedipine, plasma levels of t - PA and BDNF are significantly increased in patients with SAH, thus it indicates the better outcome and quality of life in these patients.