中性粒细胞弹性蛋白酶抑制剂对脑出血患者术后氧化应激、炎性介质的影响

Effects of neutrophil elastase inhibitor on oxidative stress and inflammatory mediators in patients with intracerebral hemorrhage

目的观察中性粒细胞弹性蛋白酶(NE)抑制剂对高血压性脑出血(HICH)患者实施穿刺引流术后氧化应激和炎性介质的影响及对神经功能的保护作用。方法选择2016年1月至2017年6月收治的146例HICH患者为研究对象,根据随机数字分为观察组(75例)和对照组(71例)。对照组患者行软通道穿刺引流术后予常规临床治疗;观察组患者通过微量泵静脉注射NE抑制剂西维来司钠注射液0.20 mg/(kg·h),连续用药7 d。术前与术后3 d、7 d,检测两组患者的氧化应激指标与血清炎性因子指标;术后7 d评估神经功能缺损评分。结果术后3 d、7 d,观察组的血清丙二醛水平显著低于对照组,超氧化物歧化酶和谷胱甘肽过氧化物酶水平均显著高于对照组。术后3 d、7 d,观察组多形核白细胞比例、肿瘤坏死因子、白介素(IL)-6、IL-8、超敏C反应蛋白均显著低于对照组(均P<0.05)。术后7 d,观察组的NIHSS评分低于对照组(8.3±2.2 vs 9.2±1.9),差异有统计学意义(P<0.05);总有效率高于对照组(88.0%vs 78.9%),但差异无统计学意义(P>0.05)。结论 HICH术后加用NE抑制剂能明显抑制机体氧化应激反应和炎性反应,有助于患者术后神经功能的改善。

Objective To observe the effects of neutrophil elastase（ NE） inhibitor sivelestat on variations of oxidative stress and inflammatory mediators of hypertensive cerebral hemorrhage（ HICH） patients with percutaneous drainage. Methods 146 HICH patients from January 2016 to June 2017 enrolled in the study and randomly divided into observation group（ 75 cases） and control group（ 71 cases）,all cases group underwent soft channel puncture drainage,the control group with conventional therapy postoperatively,and the observation group added with sivelestat injection intravenously,0. 20 mg/kg/h,continued for 7 days,variations on oxidative stress and serum inflammatory indexes preoperatively and postoperatively for 3 days and 7 days were noted,and neurological function were evaluated postoperatively for 7 days. Results For oxidative stress indexes： the patients in observation group with 3 days and 7 days postoperative MDA levels were significantly lower than the control group,while SOD and GSH-PX were significantly higher than the control group. For inflammatory reaction indexes ： the observation group with 3 days and 7 days postoperative levels on PMN%,TNF-α,IL-6,IL-8,Hs-CRP were all significantly lower than the control group（ all P 〈0. 05）. The 7 days postoperative NIHSS score of the observation group was lower than the control group（ 8. 3 ± 2. 2 vs 9. 2 ± 1. 9）（ P〈0. 05）,and the total effective rate was higher than the control group（ 88. 0% vs 78. 9%）,with no statistical significance（ P〉 0. 05）.Conclusion HICH patients added with sivelestat postoperatively could obviously inhibit oxidative stress reaction and inflammatory reaction,contribute to neurological protection.