抗氧化药物添加治疗急性脑梗死合并2型糖尿病的疗效观察

Therapeutic effect of antioxidant additive treatment on acute cerebral infarction complicated with type 2 diabetes

目的探索抗氧化剂α-硫辛酸添加治疗对急性期脑梗死合并2型糖尿病临床疗效及对氧化应激水平的影响。方法入组急性脑梗死合并2型糖尿病患者,随机分成常规治疗组(32例)和添加治疗组(32例),添加治疗组是在常规治疗基础上加用α-硫辛酸注射液,共14 d。观察入组患者发病48 h脑卒中患者NIHSS、改良Rankin评分;检测空腹血糖、糖化血红蛋白、血脂、hs-CRP、炎性因子(IL-1、IL-6、TNF-α)和血清8-OHDG、MDA和SOD。治疗14 d后重复上述血液指标和NIHSS评分。发病12 w进行mRS和ADL评分。结果常规治疗组和添加治疗组在治疗14 d时治疗前后NIHSS评分差值及发病12 w时mRS评分差值均提示添加治疗组针对神经功能缺损改善较常规治疗组好,评分差值均有统计学差异;ADL评分在添加治疗组较常规治疗组有明显改善,差值有统计学差异(P值均<0.01)。治疗14 d后,添加治疗组8-OHDG、MDA水平较常规治疗组明显下降,有统计学意义(P值均<0.05)。治疗前后常规治疗组和添加治疗组中8-OHDG、MDA和SOD的差值均有统计学意义(P值均<0.01)。炎性因子(IL-1、IL-6、TNF-α)和hs-CRP差值在两组也均有统计学差异。结论添加α-硫辛酸进行抗氧化治疗对急性脑梗死合并2型糖尿病患者运动症状缺失程度的改善及恢复有较好的效果,能更有效抑制氧化应激反应,对这类患者的临床治疗有一定指导意义。

Objective To research the clinical efficacy and effect on oxidative stress levels of alpha-lipoic acid additive treatment in acute cerebral infarction（ ACI） patients with type 2 diabetes mellitus（ T2 DM）. Methods 64 ACI cases with T2 DM were randomized into 2 groups： control group and additive treatment group. Patients in additive treatment were given alpha-lipoic acid for 14 days except the same treatment of control group. The scores of NIHSS,mRS or ADL were evaluated and the levels of blood glucose,Hb A1 c,blood lipid,hs-CRP,IL-1,IL-6,TNF-α,8-OHDG,MDA,SOD were measured before and after treatment. Results 14 days after one course of treatment,the mean NIHSS scale difference of additive treatement group was significantly larger than that of control group. 12 weeks after treatment,the differences of mRS score were also statistically significant. The level of 8-OHDG and MDA in additive treatment group were significantly lower than that in control group（ P 0. 01）. Before and after treatment,the differences of 8-OHDG,MDA and SOD in control group and additive treatment group were significantly different（ P 0. 01）. Conclusion For ACI patients with T2 DM,alpha-lipoic acid antioxidant treatment have good effect of motor recovery and effectively inhibit the oxidative stress reaction. This can be a guide of clinical treatment for this kind of patients.