奥扎格雷钠和长春西汀联合高压氧治疗急性脑梗死患者的临床疗效及其作用机制

Clinical effect and mechanism of ozagrel sodium and vinpocetine combined with hyperbaric oxygen on acute cerebral infarction

目的探讨奥扎格雷钠和长春西汀联合高压氧(HBO)治疗急性脑梗死(ACI)患者的临床疗效及其作用机制。方法选取2016年12月至2019年6月上海交通大学医学院附属新华医院崇明分院神经内科收治的172例ACI患者作为研究对象,采用1∶1∶1∶1抽签法分为A、B、C、D组,每组43例;A组采用奥扎格雷钠治疗,B组采用长春西汀治疗,C组采用长春西汀和奥扎格雷钠治疗,D组采用长春西汀和奥扎格雷钠联合HBO治疗。观察4组患者的临床疗效,比较4组患者美国国立卫生研究院卒中量表(NIHSS)、蒙特利尔认知评估量表(MoCA)评分;采用酶联免疫吸附法检测各组患者血清氧化应激因子如丙二醛(MDA)、超氧化物歧化酶(SOD),脑损伤反应因子如巨噬细胞集落刺激因子(M-CSF)、可溶性细胞间黏附分子-1(sICAM-1),神经血管生长因子如脑源性神经营养因子(BDNF)、血管内皮生长因子(VEGF)的水平。结果治疗4个疗程后,D组总有效率(93.0%)明显高于C组(83.7%),C组总有效率(83.7%)明显高于B组(74.4%)和A组(72.1%),差异均有统计学意义(P<0.05)。D组NIHSS评分明显低于C组,MoCA评分高于C组;C组NIHSS评分明显低于A、B组,MoCA评分高于A、B组,差异均有统计学意义(P<0.05)。D组患者血清MDA水平明显低于C组,SOD水平高于C组;C组患者血清MDA水平明显低于A、B组,SOD水平高于A、B组,差异均有统计学意义(P<0.05)。D组患者血清sICAM-1和M-CSF水平明显低于C组,C组患者血清sICAM-1和M-CSF水平明显低于A、B组,差异均有统计学意义(P<0.05)。D组患者血清BDNF、VEGF水平明显高于C组,C组患者血清BDNF、VEGF水平明显高于A、B组,差异均有统计学意义(P<0.05)。结论奥扎格雷和长春西汀联合HBO能明显提高ACI患者的临床疗效,其机制主要是通过调节机体脑损伤反应因子、氧化应激因子及促神经血管生长因子的水平而实现的。

Objective To investigate the clinical efficacy and mechanism of ozagrel sodium and vinpocetine combined with hyperbaric oxygen(HBO)in the treatment of acute cerebral infarction(ACI).Methods A total of 172 patients with ACI,admitted to the Department of Neurology,Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2016 to June 2019,were selected and divided into groups A,B,C,and D by lottery with the ratio of 1∶1∶1∶1,i.e.43 cases in each group.The group A was treated with ozagrel sodium,the group B was treated with vinpocetine,the group C was treated with vinpocetine and ozagrel sodium,and the group D was treated with vinpocetine,ozagrel sodium,and HBO.The clinical effects of the four groups were observed,and the National Institutes of Health Stroke Scale(NIHSS)and the Montreal Cognitive Assessment(MoCA)scores were compared.The levels of serum oxidative stress factors,i.e.malondialdehyde(MDA)and superoxide dismutase(SOD),the levels of brain injury response factors,i.e.macrophage colony stimulatory factor(M-CSF)and soluble intercellular adhesion molecule-1(sICAM-1),and the level of vascular endothelial growth factor were measured by enzyme linked immunosorbent assay.Results After 4 courses of treatment,the total effective rate of the group D(93.0%)was significantly higher than that of the group C(83.7%),and the total effective rate of the group C(83.7%)was significantly higher than those of the group B(74.4%)and the group A(72.1%)(P<0.05).The NIHSS score of the group D was significantly lower than that of the group C,and the MoCA score of the group D was higher than that of the group C;the NIHSS score of the group C was significantly lower than those of the group A and the group B,and the MoCA score of the group C was higher than those of the group A and the group B,the differences were statistically significant(P<0.05).The serum MDA level of the group D was significantly lower than that of the group C,and the SOD level of the group D was higher than that of the group C;the serum MDA level of the group C was significantly lower than those of the group A and the group B,and the SOD level of the group C was higher than those of the group A and the group B,the differences were statistically significant(P<0.05).The serum levels of sICAM-1 and M-CSF in the group D were significantly lower than those in the group C,and the serum levels of sICAM-1 and M-CSF in the group C were significantly lower than those in the group A and the group B,with statistically significant differences(P<0.05).The serum levels of BDNF and VEGF in the group D were significantly higher than those in the group C,and the serum levels of BDNF and VEGF in the group C were significantly higher than that in group A and the group B,with statistically significant differences(P<0.05).Conclusion Ozagrel sodium and vinpocetine combined with HBO can significantly improve the curative effect on ACI mainly by regulating the levels of brain injury response factors,oxidative stress factors,and neurovascular growth factor after ACI.