高压氧综合治疗对脊髓损伤患者神经功能恢复的影响及其作用机制

Effects of comprehensive hyperbaric oxygen therapy on the recovery of neurological function in the patients with spinal cord injury and possible mechanism involved

目的探讨高压氧(HBO)综合治疗对脊髓损伤(SCI)患者神经功能恢复的影响及其作用机制。方法选取2016年3月至2019年3月禹城市人民医院骨科收治的132例SCI患者作为研究对象,按照随机数字表法将患者分成观察组和对照组,每组66例。对照组患者采用常规治疗,观察组在常规治疗的基础上给予HBO治疗。比较2组患者治疗前后日常生活能力评分、神经功能评分及临床疗效,酶联免疫吸附法测定2组患者治疗前后血清HSP70和MCP-1表达水平。结果治疗3个疗程后,观察组患者总有效率(87.88%)明显高于对照组(68.18%),差异有统计学意义(P<0.05);2组患者Barthel评分明显提高,且观察组患者Barthel指数显著高于对照组,差异有统计学意义(P<0.01);2组患者轻触觉、针刺觉及运动评分明显提高,且观察组患者轻触觉、针刺觉及运动评分显著高于对照组,差异有统计学意义(P<0.05或P<0.01)。2组患者血清HSP70水平明显升高,血清MCP-1水平明显降低,且观察组患者血清HSP70水平显著高于对照组,MCP-1水平明显低于对照组,差异有统计学意义(P<0.05或P<0.01)。结论HBO综合治疗SCI患者可有效增强患者日常生活活动能力,恢复神经功能,提高临床疗效,并可能通过下调血清MCP-1和上调HSP70水平来改善患者临床症状。

Objective To explore the effects of comprehensive hyperbaric oxygen(HBO)therapy on the recovery of neurological function in the patients with spinal cord injury and possible mechanism involved.Methods One hundred and thirty-two patients with spinal cord injury who were admitted into the hospital from March 2016 to March 2019 were selected as research subjects,and were randomly divided into the observation group and the control group,each consisting of 66 patients.The patients in the control group were treated with routine therapy,while the patients in the observation group received hyperbaric oxygen(HBO)on the basis of routine therapy.Then,daily life scores,neurological function scores and clinical efficacy were compared between the patients of the 2 groups,both before and after treatment.The expression levels of heat shock protein 70(HSP70)and MCP-1 were detected by ELISA.Results After 3 courses of treatment,the total efficacy rate of the observation group(87.88%)was obviously higher than that of the control group(68.18%),with statistical significance(P<0.05).The Barthel scores in the patients of both groups all obviously increased,with those of the observation group being significantly higher than those of the control group,also with statistical significance(P<0.01).The scores of light touch,acupuncture and movement in the patients of both groups also significantly increased,with those of the observation group being obviously higher than those of the control group,also with statistical significance(P<0.05 or P<0.01).The serum HSP70 levels of the patients in both groups all significantly increased and the serum MCP-1 levels significantly decreased,with the HSP70 level of the observation being obviously higher than that of the control group,and serum MCP-1 level in the observation group being significantly lower than that in the control group,with statistical significance(P<0.05 or P<0.01).Conclusion Comprehensive HBO therapy in the treatment of patients with SCI could effectively promote their daily life activity,help to restore nerve function,enhance clinical efficacy,and furthermore alleviate clinical symptoms through the access of down-regulating MCP-1 level and up-regulating HSP70 level with good safety.