肢体远端缺血预处理联合高压氧治疗皮层下缺血性血管性痴呆疗效观察

Clinical observation of remote ischemic conditioning combined with hyperbaric oxygen in the treatment of subcortical ischemic vascular dementia

目的观察肢体远端缺血预处理(remote ischemic conditioning,RIC)联合高压氧治疗(hyperbaric oxygen,HBO)对皮层下缺血性血管性痴呆(subcortical ischemic vascular dementia,SIVD)患者认知功能及炎症因子IL-6、hs-CRP、TNF-α表达的影响。方法纳入河北北方学院附属第一医院2019-06—2020-06神经内科门诊SIVD患者40例,联合组及HBO组各20例,2组均接受基础治疗。HBO组在基础治疗方案上给予高压氧治疗,使用多人空气加压舱,压强设为0.2 MPa,面罩吸氧1 h,1次/d。联合组患者在HBO组方案上给予肢体远端缺血预处理,使用远程缺血预适应训练仪,严格按照说明书操作:将患者双侧上肢收缩压迅速加压到200 mmHg,持续5 min(缺血期),然后进行5 min放气(再灌注期),形成一个循环,每次接受5个循环训练,2次/d。2组疗程共12周,结束后行疗效评定,并在治疗前及疗程结束时抽取患者清晨空腹肘静脉血,使用酶联免疫吸附试验法检测IL-6、TNF-α水平,比浊免疫测定法测定hs-CRP;使用神经心理学评估比较2组治疗前后认知功能。结果2组性别、年龄、学历、体重指数、高血压、糖尿病、同型半胱氨酸、甘油三酯、胆固醇、低密度脂蛋白、IL-6、TNF-α、hs-CRP水平比较差异无统计学意义(P>0.05),2组治疗前汉密尔顿抑郁量表、简易精神状态量表、蒙特利尔认知评估、临床痴呆评定量表、霍普金斯言语学习测验(修订版)、口语流畅性测验、连线测验A、连线测验B、符号数字转换测验、线方向判断、日常生活活动能力量表、神经精神量表评分无显著差异(P>0.05)。治疗12周后联合组霍普金斯言语学习测验修订版、口语流畅性测验、连线测验A、连线测验B、线方向判断评分差异有统计学意义(P<0.05),HBO组霍普金斯言语学习测验(修订版)、连线测验B评分差异有统计学意义(P<0.05)。2组疗效的协方差分析表明,联合组患者在线方向判断上的表现优于HBO组。2组IL-6、TNF-α水平治疗前后比较差异无统计学意义(P>0.05),HBO组炎症因子hs-CRP水平治疗前后比较差异无统计学意义(P>0.05),联合组治疗后hs-CRP水平较治疗前差异有统计学意义(P<0.05)。结论RIC联合HBO可改善SIVD患者认知功能,降低炎症因子表达,安全有效,较单纯HBO治疗更有优势。

Objective To observe the effects of remote ischemic conditioning(RIC)combined with hyperbaric oxygen(HBO)on cognitive function and expression of inflammatory cytokines IL-6,hs-CRP and TNF-αin patients with subcortical ischemic vascular dementia(SIVD).MethodsA total of 40 SIVD patients from the Department of Neurology of the First Affiliated Hospital of Hebei North University from June 2019 to June 2020 were selected,and divided into combined group and HBO group,with 20 cases in each group.Both groups received basic treatment.HBO group was given hyperbaric oxygen therapy in addition to the basic treatment plan.Multi-person air pressurized chamber was used,the pressure was set at 0.2 MPa,and oxygen was inhaled by mask for 1 hour,once a day.Patients in the combined group received remote ischemic conditioning on the HBO regimen.The remote ischemia-preconditioning machine was used and the procedure was strictly followed:the patient’s bilateral upper limb systolic pressure was rapidly increased to 200 mmHg for 5 minutes(ischemia period),followed by 5 minutes of air release(reperfusion period),forming a cycle of 5 cycles each time,twice a day.The course of treatment was 12 weeks.Efficacy was evaluated at the end of the course of treatment.Fastening elbow venous blood was extracted from the patients in the morning before and at the end of the course of treatment.IL-6 and TNF-αlevels were detected by enzyme-linked immunosorbent assay,and hs-CRP was determined by turbidimetric immunoassay.Neuropsychological assessment was used to compare cognitive function between the two groups before and after treatment.ResultsThere were no significant differences in gender,age,education background,body mass index,hypertension,diabetes,homocysteine,triglyceride,cholesterol,low density lipoprotein,IL-6,TNF-αand hs-CRP between the two groups(P>0.05).There were no significant differences between the two groups in Hamilton depression scale,simple mental state scale,the Montreal cognitive assessment,clinical dementia rating scale,Hopkins verbal learning test-revised,controlled oral word association test,trail making test-A,trail making test-B,symbol digit modalities test,judgment of line orientation,daily life activities ability scale,neuropsychological scale score before treatment(P>0.05).After 12 weeks of treatment,there were statistically significant differences in Hopkins verbal learning test-revised,controlled oral word association test,trail making test-A,trail making test-B and judgment of line orientation in the combined group(P<0.05),there were statistically significant differences between HBO group’s Hopkins verbal learning test-revised and trail making test-B(P<0.05).Covariance analysis of outcomes between the two groups showed that patients in the combination group performed better in judgment of line orientationt than those in the HBO group.There was no statistically significant difference in IL-6 and TNF-αbetween the two groups before and after treatment(P>0.05),and no statistically significant difference in hs-CRP between the HBO group(P>0.05).The difference of hs-CRP in the combined group after treatment was statistically significant(P<0.05).Conclusion tients and reduce the expression of inflammatory factors,which is safe and effective,and has more advantages than HBO alone.