基于Nrf2抗氧化通路研究大承气汤促进脑出血手术术后神经功能恢复的作用

Effect of Dachengqi Decoction(大承气汤) on Postoperative Neurological Function Recovery in Patients with Intracerebral Hemorrhage Based on Nrf2 Antioxidant Pathway

目的 探讨大承气汤促进脑出血手术患者术后神经功能恢复的作用及对核因子E2相关因子2(NF-E2-related factor 2,Nrf2)抗氧化通路的影响。方法 2018年1月—2021年1月在医院接受手术治疗的高血压脑出血患者116例,参照随机数表法将入组患者分为对照组、观察组各58例。对照组患者接受高血压脑出血术后常规治疗,观察组患者在对照组基础上口服或者鼻饲大承气汤治疗,以4周为1个疗程,持续治疗2个疗程后评估效果。对比两组患者的治疗后脑出血CT病情、神经功能评分、血清神经功能指标水平、Nrf2抗氧化通路分子表达水平及治疗期间药物相关不良反应发生率的差异。结果 术后8周,观察组患者该时间点的脑血肿、脑水肿体积低于对照组患者,差异均有统计学意义(P<0.05);观察组患者的美国国立卫生研究院卒中量表(NIH stroke scale, NIHSS)评分值低于对照组患者,简式Fugl-Meyer运动量表(Fugl-Meyer motor function assessment, FMA)评分值高于对照组患者,差异均有统计学意义(P<0.05);观察组患者的血清脑源性神经营养因子(brain-derived neurotrophic factor, BDNF)、胰岛素样生长因子-1(insulin-like growth factor 1,IGF-1)、降钙素基因相关肽(calcitonin gene related peptide.CGRP),水平高于对照组患者,差异均有统计学意义(P<0.05)。观察组患者的Nrf2表达水平高于对照组患者,TNF-α、Arg1表达水平低于对照组患者,差异均有统计学意义(P<0.05)。治疗期间,两组患者药物相关不良反应发生率的差异无统计学意义(P>0.05)。结论 大承气汤术后辅助治疗可促进高血压脑出血患者的术后神经功能恢复,可能与该药调节Nrf2抗氧化通路活性的机制相关。

Objective To investigate the effect of Dachengqi Decoction(大承气汤)on the recovery of postoperative nerve function in patients with cerebral hemorrhage and the effect on Nrf2 antioxidant pathway.Methods A total of 116 patients with hypertensive intracerebral hemorrhage who received surgical treatment in the hospital from January 2018 to January 2021 were divided into control group and observation group with 58 patients in each group according to random number table method.Patients in control group received routine treatment after hypertensive intracerebral hemorrhage and those in observation group were treated with Dachengqi Decoction orally or nasally on the basis of control group,with 4 weeks as a course of treatment.After 2 courses of continuous treatment,the effect was evaluated.CT status,neurological function score,serum neurological function index level,Nrf2 antioxidant pathway molecular expression level and incidence of drug-related adverse reactions were compared between two groups after treatment.Results 8 weeks after surgery,the volume of cerebral hematoma and cerebral edema in the observation group was lower than that in control group,and the differences were statistically significant(P<0.05).NIH Stroke Scale(NIHSS)score of the observation group was lower than that of the control group.Fugl-Meyer motor function assessment(FMA)score was higher than that of the control group,and the differences were statistically significant(P<0.05).Serum levels of brain-derived neurotrophic factor(BDNF),insulin-like growth factor 1(IGF-1)and calcitonin gene related peptide(CGRP)in observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The expression level of Nrf2 in observation group was higher than that in the control group,and the expression levels of tumor necrosis factor-α(TNF-α)and arginase 1(Arg1)were lower than those in the control group,and the differences were statistically significant(P<0.05).During treatment,there was no significant difference in the incidence of drug-related adverse reactions between two groups(P>0.05).Conclusion Postoperative adjuvant therapy of Dachengqi Decoction can promote the recovery of postoperative neurological function in patients with hypertensive intracerebral hemorrhage,which may be related to the mechanism of the drug regulating Nrf2 antioxidant pathway activity.