大剂量维生素C和维生素E对急性颅脑损伤病人神经损伤、神经营养及氧化应激的影响

Effects of high-dose vitamin C and vitamin E on nerve injury,neurotrophic and oxidative stress in patients with acute traumatic brain injury

目的探讨大剂量维生素C和维生素E对急性颅脑损伤病人神经损伤、神经营养及氧化应激的影响。方法2018年1月至2018年11月前瞻性收集84例急性颅脑损伤并随机分为对照组(n=42,接受常规治疗)和观察组(n=42,接受大剂量维生素C和维生素E联合常规治疗)。治疗前、治疗后4、7 d,采用酶联免疫吸附法测定血清神经损伤指标包括神经元特异性烯醇化酶(NSE)、S100蛋白、脑红蛋白(NGB)、泛素羧基末端水解酶L1(UCH-L1)、神经营养指标包括神经营养因子-α(NTF-α)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)、胰岛素样生长因子-1(IGF-I),采用放射免疫沉淀法测定氧化应激指标[包括超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GPx)、过氧化氢酶(CAT)、丙二醛(MDA)、晚期氧化蛋白产物(AOPP)]。结果治疗后4、7 d,两组血清NSE、S100B、NGB、UCH-L1、MDA、AOPP含量均显著降低(P<0.05),血清NTF-α、BDNF、NGF、IGF-I、SOD、GPx、CAT含量均显著增高(P<0.05),而且,观察组均明显优于对照组(P<0.05)。结论大剂量维生素C和维生素E治疗能够减轻急性颅脑损伤病人神经损伤程度、氧化应激反应并改善神经营养状态。

Objective To explore the effects of high-dose vitamin C and vitamin E on the nerve injury,neurotrophic and oxidative stress in patients with acute traumatic brain injury(TBI).Methods From January 2018 to November 2018,84 patients with acute TBI were prospectively recruited and randomly divided into control group(n=42,receiving conventional treatment)and observation group(n=42,receiving high-dose vitamin C and vitamin E based on conventional treatment).Before treatment,and 4 and 7 days after treatment,enzyme-linked immunosorbent assay was used to determine serum nerve injury indicators[including neuron-specific enolase(NSE),S100 protein,neuroglobin(NGB),and ubiquitin carboxy-terminal hydrolase L1(UCH-L1)]and neurotrophic indicators[including neurotrophic factor-α(NTF-α),brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF),insulin-like growth factor-1(IGF-I),and radioimmunoprecipitation method was used to measure oxidative stress indicatorsincluding superoxide dismutase(SOD),glutathione peroxidase(GPx),catalase(CAT),malondialdehyde(MDA),advanced oxidized protein products(AOPP).Results At 4 and 7 days after treatment,the levels of serum NSE,S100B,NGB,UCH-L1,MDA,and AOPP were significantly reduced in the two groups(P<0.05),and the levels of serum NTF-α,BDNF,NGF,IGF-I,SOD,GPx and CAT were significantly increased(P<0.05).The improvement of the serum biomarkers in the observation group was significantly better than those in the control group(P<0.05).Conclusion Highdose vitamin C and vitamin E treatment can reduce the degree of nerve damage and oxidative stress and improve neurotrophic status in the patients with acute TBI.