远程缺血预适应对TIA的保护作用及机制研究

Study on the protective effect and mechanism of remote ischemic preconditioning on TIA

目的观察远程缺血预适应(remote ischemic preconditioning,RIPC)对短暂性脑缺血发作(transient ischemia attack,TIA)患者脑血流指标及血管功能的影响,探讨RIPC训练对TIA的保护作用及作用机制。方法将200例患者随机分为治疗组和对照组各100例。对照组单纯按照2011年美国脑卒中和短暂性脑缺血发作二级预防指南用药。治疗组在对照组基础上加用RIPC训练。应用经颅多普勒检查仪检测2组治疗前后颈总动脉及大脑中动脉脑血流指标,采用酶联免疫吸附法测定2组血清缺氧诱导因子1α(hypoxia-inducible factor-1α,HIF-1α)及血管内皮生长因子(vascular endothelial growth factor,VEGF)水平。结果 RIPC训练的患者较未经RIPC训练的患者脑血流量增加,HIF-1α、VEGF水平明显下降,差异均有统计学意义(P<0.05)。结论RIPC训练可以增加TIA患者脑血流量,调节血清HIF-1α及VEGF水平,对TIA患者具有良好的防治效果。

Objective To observe the effect of remote ischemic preconditioning(RIPC)on the transient cerebral index and vascular function in patients with transient ischemic attack(TIA),and to investigate the protective effect and mechanism of RIPC on TIA.Methods Two hundred patients were randomly divided into treatment group and control group,with 100 patients of each group.The control group received only secondary prevention guidelines of stroke and transient ischemic attack in 2011.The treatment group was trained with RIPC on the basis of the control group.The cerebral blood flow indexes of the common carotid artery and middle cerebral artery were measured by TCD before and after treatment.Serum hypoxia-inducible factor-1α(HIF-1α)and vascular endothelial growth factor(VEGF)levels were measured by enzyme linked immunosorbent assay.Results Cerebral blood flow was increased in patients with RIPC training than that without training.HIF-1αand VEGF levels were significantly decreased in patients with RIPC training than that without training,and the difference was statistically significant(P<0.05).Conclusion RIPC can increase cerebral blood flow and regulate serum HIF-1αand VEGF levels of patients with TIA.It has good effect on prevention and treatment of TIA.