SII和MHR在经颅直流电刺激治疗一氧化碳中毒迟发性脑病患者疗效评价中的应用

Systemic immune-inflammation index and monocyte to high-density lipoprotein cholesterol ratio in clinical efficacy evaluation of transcranial direct current stimulation in patients with delayed encephalopathy due to carbon monoxide poisoning

目的通过观察经颅直流电刺激(tDCS)治疗的一氧化碳中毒迟发性脑病(DEACMP)患者血系统性免疫炎症指数(SII)和单核细胞与高密度脂蛋白胆固醇比值(MHR)的变化,客观地评价tDCS治疗DEACMP的效果。方法选择河北医科大学哈励逊国际和平医院急救医学部自2020年1月至2022年2月收治的80例DEACMP患者进入研究,采用随机数字表法将患者分成观察组(39例)和常规组(41例),2组均给予常规治疗,观察组在常规基础上给予tDCS治疗,以左侧前额叶背外侧为阳极刺激部位,右侧肩部为阴性刺激部位,治疗时间为30 min/次,刺激强度为1.5 mA,1次/d。常规组在基础治疗上辅以tDCS伪刺激(1.5 mA电流刺激10 s),电极片保持30 min,1次/d。2组治疗疗程均为4周。分别在治疗前、治疗后4周和治疗后6月时检测2组患者SII、MHR,脑电图(EEG)资料、蒙特利尔认知评估量表(MoCA)评分、日常生活能力量表(ADL)评分,比较2组患者治疗4周后治疗总有效率[总有效率(%)=(痊愈例数+好转例数)/总例数×100%],同时分析治疗前SII、MHR与ADL评分和EEG异常程度的相关性。结果观察组总有效率为92.3%(痊愈30例,好转6例),常规组总有效率为73.2%(痊愈22例,好转8例),差异有统计学意义(χ^(2)=5.070,P=0.024)。治疗后4周、治疗后6月时,观察组的SII、MHR、EEG异常率和P300潜伏期明显低于常规组,MoCA、ADL评分和P300波幅明显高于常规组,差异均有统计学意义(P<0.05)。相关性分析结果显示,治疗前SII、MHR与ADL评分呈负相关关系(r=-0.805,P<0.001;r=-0.788,P<0.001)。SII、MHR和EEG异常程度呈正相关关系(r=0.803,P<0.001;r=0.719,P<0.001)。结论tDCS治疗能有效降低DEACMP患者炎症水平,改善患者预后评分;SII、MHR可初步评价tDCS治疗效果。

Objective To observe the changes of blood systemic immune-inflammation index(SII)and monocyte to high-density lipoprotein cholesterol ratio(MHR)in patients with delayed encephalopathy after carbon monoxide poisoning(DEACMP)accepted transcranial direct current stimulation(tDCS)treatment,and to objectively evaluate the efficacy of tDCS in DEACMP.Methods A total of 80 DEACMP patients admitted to our hospital from January 2020 to February 2022 were selected and randomly divided into observation group(n=39)and routine group(n=41).Conventional treatment was given to patients of both groups.On this basis,tDCS was given additionally to the observation group:the left dorsolateral prefrontal lobe was used as the positive stimulation site,and the right shoulder was used as the negative stimulation site;the treatment duration was 30 min/time,and the stimulation intensity was 1.5 mA,once per d;and sham stimulation was given to the routine group:the electrodes were stimulated with 1.5 mA current for 10 s and kept for 30 min,once per d.Patients of both groups were treated for 4 weeks.Before,and 4 weeks and 6 months after treatment,SII and MHR were detected;the electroencephalogram(EEG)results,and scores of Montreal Cognitive Assessment(MoCA)and activities of daily living(ADL)were observed.The total effective rate between the 2 groups after 4 weeks of treatment(total effective rate[%]=[number of cured cases+number of improved cases]/total number of cases×100%),and the correlations of SII and MHR before treatment with ADL scores and abnormal degree of EEG were analyzed.Results The total effective rate in the observation group(92.3%,30 were cured and 6 got improvement)was significantly higher than that in the routine group(73.2%,22 were cured and 8 got improvement;χ^(2)=5.070,P=0.024).Four weeks and 6 months after treatment,SII,MHR,abnormal rates of EEG and P300 latency in the observation group were significantly lower than those in the routine group,and the MoCA and ADL scores and P300 amplitude were statistically higher than those in the routine group(P<0.05).Correlation analysis showed that SII and MHR before treatment were negatively correlated with ADL scores(r=-0.805,P<0.001;r=-0.788,P<0.001);SII and MHR were positively correlated with abnormal degree of EEG(r=0.803,P<0.001;r=0.719,P<0.001).Conclusion The tDCS treatment can effectively reduce the inflammation levels and improve prognosis scores in DEACMP patients;SII and MHR can preliminarily evaluate the therapeutic effect of tDCS.