银杏二萜内酯葡胺注射液对急性缺血性脑卒中患者血清半乳糖凝集素-3水平的影响

Effect of Ginkgo diterpenoid lactone glucosamine injection on serum galectin-3 level in patients with acute ischemic stroke

目的:探讨银杏二萜内酯葡胺注射液对急性缺血性脑卒中(AIS)患者血清半乳糖凝集素-3(gal-3)水平的影响,并观察血清gal-3水平变化与患者神经功能缺损症状和预后的关系。方法:纳入88例AIS患者,随机分为对照组和试验组,每组各44例。两组患者均给予阿司匹林肠溶片口服,在此基础上,试验组患者给予银杏二萜内酯葡胺注射液静脉滴注,对照组患者给予安慰剂注射液静脉滴注,治疗周期为14 d。于治疗前后检测并比较两组患者的血清gal-3、白介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)水平;于治疗前及治疗第14、28、90天,评估并比较两组患者的美国国立卫生研究院卒中量表(NIHSS)评分;于治疗前及治疗第90天,评估并比较两组患者的改良Rankin量表(mRS)评分。对患者的血清gal-3、IL-1β、IL-6、TNF-α水平变化与患者预后不良(治疗第90天的mRS评分≥3分)之间的相关性进行分析。结果:研究过程中,对照组剔除或脱落8例患者,试验组剔除或脱落8例患者,最终纳入统计分析者对照组36例、试验组36例。①治疗第14、28、90天,两组患者的NIHSS评分较治疗前均明显降低(P<0.05),且试验组患者的评分低于对照组(P<0.05)。②治疗第90天,两组患者的mRS评分较治疗前均明显降低(P<0.05),且试验组患者的评分低于对照组(P<0.05)。③治疗后,试验组患者的血清gal-3水平较治疗前明显降低(P<0.05),对照组患者的血清gal-3水平较治疗前明显升高(P<0.05),且试验组患者的血清gal-3水平显著低于对照组(P<0.05)。④治疗后,试验组患者的血清IL-1β水平较治疗前明显降低(P<0.05),TNF-α水平明显升高(P<0.05)。⑤预后不良与血清gal-3、IL-1β水平升高呈正相关关系(P<0.05),预后不良与血清TNF-α水平升高呈负相关关系(P<0.05)。结论:银杏二萜内酯葡胺注射液可有效改善AIS患者的神经功能缺损症状及预后,其机制可能与降低患者的血清gal-3水平进而达到神经保护作用相关。

Objective:To explore the influence of Ginkgo diterpenoid lactone glucosamine injection on the level of serum galectin-3(gal-3)in patients with acute ischemic stroke(AIS),and observe the relationship between the changes of serum gal-3 level and the neurological deficit symptoms and prognosis of the patients.Methods:A total of 88 patients with AIS were enrolled and randomly divided into the control group and trial group,44 cases in each group.The patients in both groups were orally treated with aspirin enteric-coated tablets.Based on above,the patients in the trial group were treated with intravenous drip of Ginkgo diterpenoid lactone glucosamine injection,and the patients in the control group were treated with intravenous drip of placebo injection.The treatment course was 14 d.Before and after treatment,the levels of serum gal-3,interleukin-1β(IL-1β),IL-6 and tumor necrosis factor-α(TNF-α)in the two groups were detected and compared.Before treatment and on the 14th,28th and 90th day of treatment,the scores of National Institutes of Health Stroke Scale(NIHSS)in the two groups were evaluated and compared.Before treatment and on the 90th day of treatment,the scores of modified Rankin Scale(mRS)in the two groups were evaluated and compared.The correlation between the changes of serum gal-3,IL-1β,IL-6 and TNF-αlevels and the poor prognosis(mRS scores≥3 points on the 90th day of treatment)was analyzed.Results:During the study,8 patients in the control group were excluded or dropped out,and 8 patients in the trial group were excluded or dropped out.Finally,36 cases in the control group and 36 cases in the trial group were included in the statistical analysis.①On the 14th,28th and 90th day of treatment,the scores of NIHSS in the two groups were significantly decreased compared with those before treatment(P<0.05),and the score of the trial group was lower than that of the control group(P<0.05).②On the 90th day of treatment,the scores of mRS in the two groups were significantly decreased compared with those before treatment(P<0.05),and the score of the trial group was lower than that of the control group(P<0.05).③After treatment,the serum gal-3 level of the trial group was significantly decreased compared with that before treatment(P<0.05),the serum gal-3 level of the control group was significantly increased compared with that before treatment(P<0.05),and the serum gal-3 level of the trial group was significantly lower than that of the control group(P<0.05).④After treatment,the serum IL-1βlevel of the trial group was significantly decreased compared with that before treatment(P<0.05),and the TNF-αlevel was significantly increased(P<0.05).⑤Poor prognosis was positively correlated with the increased serum gal-3 and IL-1βlevels(P<0.05),and poor prognosis was negatively correlated with the increased serum TNF-αlevel(P<0.05).Conclusion:Ginkgo diterpenoid lactone glucosamine injection can effectively improve the symptoms and prognosis of neurological deficits in patients with AIS,and its mechanism may be related to the reduction of the serum gal-3 level in patients to achieve neuroprotection.