缺血预适应在急性缺血性脑卒中颅内动脉狭窄中的应用

Ischemic preconditioning in intracranial artery stenosis of acute ischemic stroke

目的分析缺血预适应(IP)治疗急性缺血性脑卒中(AIS)颅内动脉狭窄患者的疗效,为临床治疗提供指导依据。方法选取2020年2月至2021年8月聊城市第三人民医院收治的105例AIS颅内动脉狭窄患者为研究对象,随机数字表法分为对照组52例[男33例、女19例,年龄50~70(63.28±2.06)岁]、观察组53例[男30例、女23例,年龄50~71(63.30±2.09)岁]。对照组口服阿托伐他汀钙片、阿司匹林肠溶片,观察组在对照组基础上给予IP治疗。统计对比两组疗效及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分、血管弹性指标[血管压力-应变弹性系数(Ep)、顺应性(AC)、增大指数(AI)、脉搏波传导速度(PWVβ)]、内皮功能指标[假血友病因子(vWF)、内皮素1(ET-1)、一氧化氮(NO)]、低密度脂蛋白受体相关蛋白6(LRP6)、超敏C-反应蛋白(hs-CRP)、颈动脉内膜中层厚度(IMT)。随访6个月后,采用格拉斯哥预后量表(GOS)评估预后情况。采用统计学软件SPSS 22.0对数据进行分析,计量资料采用t检验,计数资料采用χ^(2)检验。结果观察组总有效率94.34%(50/53)高于对照组80.77%(42/52)(P<0.05)。治疗后观察组NIHSS评分、mRS评分、Ep、AI、PWVβ均低于对照组,AC高于对照组(均P<0.05);治疗后观察组vWF、ET-1、hs-CRP、IMT低于对照组,NO、LRP6水平高于对照组(均P<0.05)。随访6个月后,对照组失访3例,观察组失访4例;观察组预后良好率95.92%(47/49)高于对照组77.55%(38/49)(P<0.05)。结论IP治疗AIS颅内动脉狭窄患者疗效确切,可减轻神经功能、内皮功能损伤,改善血管弹性,抑制炎性反应,提升生活能力,改善患者预后。

Objective To analyze the efficacy of ischemic preconditioning(IP)in treating patients with acute ischemic stroke(AIS)and intracranial artery stenosis and to provide guiding basis for clinical treatment.Methods A total of 105 patients with AIS and intracranial artery stenosis admitted to Liaocheng Third People's Hospital from February 2020 to August 2021 were selected for the study,and were divided into 52 cases in the control group[33 males and 19 females,aged 50-70(63.28±2.06)years]and 53 cases in the observation group[30 males and 23 females,aged 50-71(63.30±2.09)years]by the random number table method.The control group received oral atorvastatin calcium tablets and aspirin enteric tablets,and the observation group was given IP treatment on the basis of the control group.The efficacy of the two groups and the scores of National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS),vascular elasticity indexes[vascular pressure-strain elasticity coefficient(Ep),compliance(AC),augmentation index(AI),and pulse wave velocity(PWVβ)],endothelial function indexes[von Willebrand factor(vWF),endothelin 1(ET-1),and nitric oxide(NO)],low-density lipoprotein receptor-related protein 6(LRP6),high-sensitivity C-reactive protein(hs-CRP),and carotid intima-media thickness(IMT)before and after treatment were recorded.After 6 months of follow-up,the prognosis was assessed by the Glasgow Outcome Scale(GOS).Statistical software SPSS 22.0 was used to analyze the data,t test was used for the measurement data,andχ^(2) test was used for the count data.Results The total effective rate in the observation group[94.34%(50/53)]was higher than that in the control group[80.77%(42/52)](P<0.05).After treatment,the NIHSS score,mRS score,Ep,AI,and PWVβin the observation group were lower than those in the control group,and the AC was higher than that in the control group(all P<0.05).After treatment,the levels of vWF,ET-1,and hs-CRP and IMT in the observation group were lower than those in the control group,while the levels of NO and LRP6 were higher than those in the control group(all P<0.05).After 6 months of follow-up,3 cases in the control group and 4 cases in the observation group were lost to follow-up;the good prognosis rate of the observation group was 95.92%(47/49),which was higher than that of the control group[77.55%(38/49)](P<0.05).Conclusion IP treatment has definite efficacy for patients with intracranial artery stenosis of AIS and can reduce the neurological and endothelial function damage,improve the vascular elasticity,inhibit the inflammatory response,enhance the living ability,and improve the patients'prognosis.