奥拉西坦对大面积脑梗死的治疗效果及机制

The therapeutic effect and mechanism of oxiracetam on large area cerebral infarction

目的探究奥拉西坦对大面积脑梗死的治疗效果及机制。方法将90例大面积脑梗死患者均分为对照组和观察组,对照组采用常规对症治疗,观察组在对照组治疗的基础上加用奥拉西坦,均连续治疗2周;比较2组患者的治疗效果、治疗前和治疗2周时的美国国立卫生院神经功能缺损(NIHSS)评分和Barthel指数水平,治疗前、治疗第3、第7天时检测2组患者血清高敏C反应蛋白(hs-CRP)、溶性细胞间黏附分子-1(sICAM-1)、基质金属蛋白酶-9(MMP-9)、促生长激素释放肽(Ghrelin)水平。结果治疗结束时,观察组患者的总有效率高于对照组,差异有统计学意义(P<0.05);2组患者治疗前的NIHSS评分、Barthel指数及血清hs-CRP、sICAM-1、MMP-9、Ghrelin水平比较差异无统计学意义(P>0.05),2组患者治疗2周时的NIHSS评分低于治疗前、Barthel指数高于治疗前,且观察组治疗2周时Barthel指数高于对照组、NIHSS评分低于对照组,差异有统计学意义(P<0.05);2组患者治疗后第3及第7天时,血清hs-CRP、MMP-9水平均低于治疗前,差异有统计学意义(P<0.05);对照组治疗第3天时血清sICAM-1水平高于治疗前,治疗第3和第7天时血清Ghrelin水平低于治疗前(P<0.05);观察组患者治疗第3天时血清Ghrelin水平低于治疗前,治疗第7天时的血清sICAM-1水平低于治疗前(P<0.05);观察组治疗第3和第7天时的血清Ghrelin水平高于对照组,hs-CRP、sICAM-1、MMP-9低于对照组(P<0.05)。结论奥拉西坦治疗大面积脑梗死疗效显著,其机制可能与调节hs-CRP、sICAM-1、MMP-9、Ghrelin的表达水平有关。

Objective To explore the therapeutic effect and mechanism of oxiracetam on large area cerebral infarction.Methods Ninety patients with large area cerebral infarction were divided into control and observation groups.The control group was given conventional treatment,while the observation group was treated with conventional treatment plus oxiracetam.Both groups were treated for 2 consecutive weeks.The therapeutic effect,the National Institutes of Health Neurological Impairment(NIHSS)score and Barthel index before the treatment and at 2 weeks of treatment were compared.In addition,the levels of serum high-sensitivity C-reactive protein(hs-CRP),soluble intercellular adhesion molecule-1(sICAM-1),and matrix metalloproteinase-9(MMP-9),growth hormone releasing peptide(Ghrelin)were measured before the treatment,on the 3 rd and 7 th day of treatment.Results At the end of treatment,the total therapeutic effect rate of observation group was higher than that of control group(P<0.05).Before treatment,there was no significant differences in NIHSS score,Barthel index,and serum hs-CRP,sICAM-1,MMP,and Ghrelin levels between two groups(P>0.05).After two-week treatment,NIHSS scores of the two groups were lower than before the treatment,while Barthel index was higher than before the treatment.After two-week treatment,observation group had high Barthel index but low NIHSS scores relative to control group(P<0.05).On the 3 rd and 7 th day of the treatment,serum hs-CRP and MMP-9 levels of two groups were lower than those before treatment(P<0.05).Control group had higher serum sICAM-1 level than that before treatment and on the 3 rd day of treatment,but lower serum Ghrelin level on the 3 rd and 7 th day of treatment than that before treatment(P<0.05).Observation group had lower serum Ghrelin level on 3 rd day and lower sICAM-1 level on 7 th day than before the treatment(P<0.05),higher serum Ghrelin level but lower hs-CRP,sICAM-1,and MMP-9 on days 3 rd and 7 th of treatment than control group(P<0.05).Conclusion Oxiracetam is effective in treating large area cerebral infarction,and its mechanism may be related to the regulation of the expression levels of hs-CRP,sICAM-1,MMP-9,and Ghrelin.