经颅磁刺激联合普罗布考对急性脑梗死后血管性认知功能障碍患者血管内皮功能和炎性因子的影响

Effects of transcranial magnetic stimulation combined with probucol in treatment of vascular cognitive dysfunction on vascular endothelial function and inflammatory factors of patients with vascular cognitive impairment after acute cerebral infarction

目的探讨经颅磁刺激联合普罗布考对急性脑梗死后血管性认知功能障碍患者血管内皮功能和炎性因子的影响。方法选择2017年6月至2018年6月神经内科收治的急性脑梗死后血管性认知功能障碍患者120例,随机分为联合治疗组和对照组,每组60例。对照组给予常规治疗脑梗死药物,联合治疗组在常规治疗脑梗死药物基础上加用经颅磁刺激联合普罗布考500 mg,口服,3次/d,治疗4周。治疗前后应用洛文斯顿认知评价箱(LOTCA)和简易精神状态检查表(MMSE)评估患者认知功能,观察患者血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、内皮素(ET)-1、一氧化氮(NO)、超敏-C反应蛋白(hs-CRP)变化及炎性因子白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果与治疗前比较,2组患者治疗后,LOTCA和MMSE评分均改善,且联合治疗组LOTCA评分和MMSE评分均高于对照组,差异有统计学意义(均P<0.05)。与对照组相比,联合治疗组TC、TG、LDL-C、ET-1、NO、hs-CRP、IL-1β、IL-6、和TNF-α含量均有明显改善,差异有统计学意义(均P<0.05)。结论经颅磁刺激联合普罗布考治疗可有效降低急性脑梗死后血管性认知功能障碍患者的炎性水平,改善血管内皮功能,提高其认知功能。

Objective To investigate the effects of transcranial magnetic stimulation(TMS) combined with probucol in treatment of vascular cognitive dysfunction on vascular endothelial function and inflammatory factors of patients with vascular cognitive impairment(VCI) after acute cerebral infarction.Methods A total of 120 patients with VCI after acute cerebral infarction who were treated in department of neurology of our hospital from June 2017 to June 2018 were randomly divided into combination treatment group(n=60) and control group(n=60).The patients in control group were treated by conventional treatment for cerebral infarction,however,the aptients in combination treatment group,on the basis of control group, were treated by transcranial magnetic stimulation combined with oral probucol,500 mg once, three times a day,for 4 weeks.The patient’s cognitive function was evaluated by the Loewenstein occupationaltherapy cognitive assessment(LOTCA) and Mini-mental state examination(MMSE) before and after treatment.Moreover the serum levels of TC, TG, LDL-C,HDL-C,ET-1,NO,hs-CRP,IL-1β,IL-6 and TNF-α were observed and compared between the two groups.Results As compared with those before treatment,the LOTCA scores and MMSE scores were improved after treatment in both groups,moreover,which in combination treatment group were significantly higher than those in control group(P <0.05).As compared with those in control group,the levels of TC,TG,LDL-C,ET-1,hs-CRP,IL-1β,IL-6 and TNF-α in combination treatment group were significantly improved(P<0.05).Conclusion The transcranial magnetic stimulation combined with probucol can effectively reduce the inflammatory level of patients with vascular cognitive dysfunction after acute cerebral infarction,which can improve vascular endothelial function and improve patient’s cognitive function.