缺血预适应在缺血性脑卒中患者神经功能中的保护作用

Effect of ischemic preconditioning in protection of neurological function in patients with ischemic stroke

目的研究缺血预适应在缺血性脑卒中患者神经功能中的保护作用及疗效。方法选取2019年6月至2021年6月聊城市第三人民医院收治的110例缺血性脑卒中患者,进行前瞻性随机平行对照研究,采用随机数字表法将患者分为A组和B组,每组55例。A组男23例,女32例;年龄52~74(62.78±4.77)岁;B组男27例,女28例;年龄51~73(61.48±4.59)岁。B组采用常规药物治疗,A组在B组的基础上采用远隔缺血后适应治疗。比较两组临床疗效,治疗前、治疗3个月后美国国立卫生研究院卒中量表(NIHSS)、日常生活能力Barthel指数(BI)评分及梗死灶体积、血清S100蛋白(S100β)、神经元特异性烯醇化酶(NSE)、新喋呤(Npt)、半乳糖凝集素3(GAL3)、血液流变学指标(血浆黏度、全血高切黏度、全血低切黏度、纤维蛋白原)水平。计数资料采用χ^(2)检验,计量资料采用t检验。结果治疗3个月后,A组临床总有效率为94.55%(52/55),高于B组的81.82%(45/55),两组比较,差异有统计学意义(χ^(2)=4.274,P=0.039);治疗3个月后,A组NIHSS评分为(9.74±1.83)分,低于B组的(12.25±2.82)分,BI评分为(75.26±5.38)分,高于B组的(62.47±6.02)分,两组比较,差异均有统计学意义(t=5.496、11.748,均P<0.001);治疗3个月后,A组梗死灶体积为(3.35±1.02)cm^(3),缩小幅度优于B组[(3.79±1.11)cm^(3)],差异有统计学意义(P<0.05);治疗3个月后,A组全血低切黏度为(5.08±0.79)mPa·s、全血高切黏度为(4.22±0.51)mPa·s、血浆黏度为(1.17±0.34)mPa·s、纤维蛋白原为(2.86±0.34)g/L,均低于B组的(6.63±1.02)mPa·s、(4.85±0.62)mPa·s、(1.36±0.40)mPa·s、(3.53±0.42)g/L,两组比较,差异均有统计学意义(均P<0.05);治疗3个月后,A组血清S100β为(1.37±0.38)μg/L、NSE为(15.28±3.37)μg/L、Npt为(6.95±1.78)nmol/L、GAL3为(9.68±2.27)g/L,均低于B组的(1.74±0.46)μg/L、(19.72±4.73)μg/L、(9.07±2.24)nmol/L、(11.94±3.04)g/L,两组比较,差异均有统计学意义(均P<0.05)。结论缺血预适应辅助治疗缺血性脑卒中患者可进一步提升疗效,可有效改善患者日常生活能力及神经功能,缩小梗死灶体积,调节血液流变学状态,促进病情恢复。

Objective To study the effect of ischemic preconditioning in the protection of neurological function in patients with ischemic stroke.Methods A prospective randomized parallel controlled study was conducted on 110 ischemic stroke patients admitted to Liaocheng Third People's Hospital from June 2019 to June 2021,and the patients were divided into group A and group B by the random number table method,with 55 cases in each group.There were 23 males and 32 females in group A,and they were 52-74(62.78±4.77)years old.There were 27 males and 28 females in group B,and they were 51-73(61.48±4.59)years old.Group B were treated with conventional drugs,and group A with post-adaptation therapy for distal ischemia on the basis of group B.The clinical efficacies and the scores of National Institutes of Health Stroke Scale(NIHSS)and Barthel Index of Activities of Daily Living(BI),infarct volumes,serum levels of S100 protein(S100β),neuron-specific enolase(NSE),neopterin(Npt),and galactose lectin 3(GAL3),and blood rheology indicators(plasma viscosity,whole blood high cut viscosity,whole blood low cut viscosity,fibrinogen)before and after 3 months'treatment were compared between the two groups.χ^(2)test was used for the enumeration data,and t test for the measurement data.Results After 3 months'treatment,the total clinical effective rate of groupAwas higher than that of groupB[94.55%(52/55)vs.81.82%(45/55)],with a statistical difference(χ^(2)=4.274,P=0.039);the NIHSS score was lower and the BI score was higher in group A than in group B[(9.74±1.83)vs.(12.25±2.82)and(75.26±5.38)vs.(62.47±6.02)],with statistical differences(t=5.496 and 11.748;both P<0.001);the infarct volume of group A decreased more than that of group B[(3.35±1.02)cm^(3)vs.(3.79±1.11)cm^(3);P<0.05];the whole blood low cut viscosity,whole blood high cut viscosity,plasma viscosity,and fibrinogen level in group A were lower than those in group B[(5.08±0.79)mPa·s vs.(6.63±1.02)mPa·s,(4.22±0.51)mPa·s vs.(4.85±0.62)mPa·s,(1.17±0.34)mPa·s vs.(1.36±0.40)mPa·s,and(2.86±0.34)g/L vs.(3.53±0.42)g/L;all P<0.05];the levels of S100β,NSE,Npt,and GAL3 in group A were lower than those in group B[(1.37±0.38)μg/L vs.(1.74±0.46)μg/L,(15.28±3.37)μg/L vs.(19.72±4.73)μg/L,(6.95±1.78)nmol/L vs.(9.07±2.24)nmol/L,and(9.68±2.27)g/L vs.(11.94±3.04)g/L;all P<0.0].Conclusion Ischemic preconditioning adjuvant therapy for ischemic stroke patients can improve the curative effect and their daily living ability,neurological function,and recovery,reduce the infarct volume,and regulate their hemorheological state.