丹参注射液联合神经节苷脂辅助治疗康复期脊髓损伤患者的临床疗效及机制

Clinical efficacy and mechanism of Danshen Injection combined with ganglioside in the treatment of patients with spinal cord injury in rehabilitation stage

目的:探讨丹参注射液联合神经节苷脂辅助治疗康复期脊髓损伤(SCI)患者的临床疗效,挖掘其作用机制。方法:将新疆石河子大学第一附属医院收治的113例脊髓损伤患者随机分为对照组(n=25)、丹参注射液组(n=28)、神经节苷脂组(n=30)和联合组(n=30),对照组患者给予正常康复训练,神经节苷脂组在对照组基础上,给予静脉滴注神经节苷脂治疗60mg,每日1次,丹参注射液组在对照组基础上给予静脉滴注丹参注射液治疗10 m L,每日1次,联合组在对照组治疗基础上给予神经节苷脂联合丹参注射液治疗,连续治疗20 d,停药10 d。比较两组患者的治疗总有效率和不良反应发生率,同时于治疗前后,比较各炎症因子水平和运动、痛觉及触觉等神经功能康复指标评分;采用ELISA法检测各组患者治疗前后血清中炎症相关因子TNF-α、IL-8、IL-1β及氧化应激相关因子SOD、MDA、VE的表达。结果:联合组疗效最佳,总有效率为83.33%,高于对照组(60%)、丹参注射液组(75%)及神经节苷脂(66.67%);联合组患者运动、痛觉及触觉的ASIA评分均明显高于对照组、丹参注射液组及神经节苷脂组(P<0.05),且联合组肌力恢复正常时间、住院时间及可下地行走时间均明显低于其他组(P<0.05);所有入组患者治疗后血清炎症相关因子TNF-α、IL-8、IL-1β均低于治疗前,但联合组表达最低(P<0.05);丹参注射液组及联合组患者治疗后血清SOD、VE表达升高,MDA降低(P<0.05)。结论:丹参注射液与神经节苷脂联合应用有助于康复期SCI患者恢复,预防脊髓继发性损害,其作用机制可能与抗炎、抗氧化有关。

OBJECTIVE To explore the clinical effect of Danshen Injection combined with ganglioside adjuvant therapy in patients with spinal cord injury（ SCI） during rehabilitation,and explore its mechanism. METHODS Totally 113 patients with spinal cord injury in the first affiliated hospital of Shihezi university medical college were randomly divided into control group（ n = 25）,Danshen Injection group（ n = 28）,ganglioside group（ n = 30） and combination group（ n = 30）. The patients were given normal rehabilitation training in the control group,treated with intravenous infusion of ganglioside 60 mg qd in ganglioside group. Based on the therapy of the control group,patients were given intravenous infusion of Danshen Injection of 10 m L qd in Danshen Injection group,and ganglioside combined with Danshen Injection in combination group. The treatment was lasted for 20 days,and stopped for 10 days. Then total effective rates and the incidences of adverse reactions were compared between the two groups. At the same time,the levels of neurological rehabilitation were compared with the levels of inflammatory factors and exercise,pain and touch. The levels of TNF-α,IL-8,IL-1 β and oxidative stress-related factors SOD,MDA and VE in serum were measured by ELISA. RESULTS The total effective rate was 8 3. 3 3 % in com bination group, significantly higher than those of the control group（ 6 0 %）, Danshen Injection group（ 75%） and ganglioside（ 66. 67%）. The ASIA score of exercise,pain and touch was significantly higher in the combination group than in the control group,Danshen Injection group and ganglioside group（ P〈0. 0 5）,and the com bination group had significantly reduced tim e to return norm al,the hospitalization tim e and the running tim e than those in other groups（ P〈0. 0 5）.The levels of TNF-α,IL-8 and IL-1 β were lower in all the patients after treatm ent than those before treatm ent,but m ost significant in the com bination group（ P〈0. 0 5）. In patients in Danshen Injection group and com bination group after treatm ent,serum SOD and VE expressionsincreased,M DA decreased（ P〈0. 0 5）. CONCLUSION Danshen Injection combined with ganglioside can help recover the SCI patients in the rehabilitation period and prevent the secondary damage of the spinal cord. The mechanism may be related to anti-inflammation and anti-oxidation.