通窍化瘀醒神汤联合奥拉西坦对重度颅脑损伤患者血清NSE、microRNA-210的影响分析

Effect of Tongqiao Huayu Xingshen Decoction Combined with Oxiracetam on Serum Neuron-specific Enolase and microRNA-210 in Patients with Severe Traumatic Brain Injury

【目的】分析通窍化瘀醒神汤联合奥拉西坦对重度颅脑损伤(severe traumatic brain injury,sTBI)患者疗效及血清神经元特异性烯醇化酶(NSE)、microRNA-210(miRNA-210)水平的影响。【方法】回顾性收集2020年1月至2022年1月在河南省南阳南石医院住院的78例sTBI患者,根据治疗方法的不同将患者分为观察组和对照组,每组各39例。2组患者均给予西医基础治疗,对照组同时给予奥拉西坦治疗,观察组在对照组的基础上联合通窍化瘀醒神汤治疗,疗程为2周。观察2组患者治疗前和治疗3 d、7 d、14 d后美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷指数(GCS)评分、血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、NSE、miRNA-210水平的变化情况,并比较2组患者的临床疗效、并发症总发生率和不良反应总发生率。【结果】(1)治疗2周后,观察组的总有效率为92.31%(36/39),对照组为69.23%(27/39),组间比较,观察组的疗效明显优于对照组(P<0.05)。(2)治疗3 d后,2组患者的NIHSS评分和GCS评分均无明显变化(P>0.05);治疗7 d和14 d后,2组患者的NIHSS评分均较治疗前明显降低(P<0.05),GCS评分均较治疗前明显升高(P<0.05),且观察组在治疗7 d、14 d后对NIHSS评分的降低作用及对GCS评分的升高作用均明显优于对照组(P<0.01)。(3)观察组治疗3 d、7 d、14 d后和对照组治疗7 d、14 d后的血清TNF-α、IL-6、NSE水平均较治疗前明显降低(P<0.05),血清miRNA-210水平均较治疗前明显升高(P<0.05),且观察组在治疗3 d、7 d、14 d后对血清TNF-α、IL-6、NSE水平的降低作用及对血清miRNA-210水平的升高作用均明显优于对照组(P<0.05或P<0.01)。(4)观察组的并发症总发生率为2.56%(1/39),明显低于对照组的17.95%(7/39),差异有统计学意义(P<0.05)。(5)观察组的不良反应总发生率为7.69%(3/39),对照组为10.26%(4/39),组间比较,差异无统计学意义(P>0.05)。【结论】通窍化瘀醒神汤联合奥拉西坦可有效减轻sTBI患者神经功能受损程度和昏迷程度,降低并发症发生率,并且中西医结合治疗并未增加不良反应,具有一定的安全性。

Objective To investigate the efficacy of Tongqiao Huayu Xingshen Decoction combined with Oxiracetam for the treatment of patients with severe traumatic brain injury(sTBI)and to observe its effect on serum levels of neuron-specific enolase(NSE)and microRNA-210(miRNA-210)of the patients.Methods Seventyeight patients with sTBI who were hospitalized in Nanshi Hospital of Nanyang in Henan Province from January 2020 to January 2022 were retrospectively analyzed,and the patients were divided into observation group and control group according to the treatment method,with 39 patients in each group.Both groups of patients were given basic western medical treatment,and additionally the control group was given oral use of Oxiracetam,and the observation group was treated with Tongqiao Huayu Xingshen Decoction based on the treatment of the control group.The treatment for the two groups lasted for 2 weeks.The changes in the National Institute of Health Stroke Scale(NIHSS)score,Glasgow Coma Scale(GCS)score,and serum tumour necrosis factorα(TNF-α),interleukin 6(IL-6),NSE and microRNA-210 levels in the two groups before treatment and after 3,7 and 14 days of treatment were observed.At the end of trial,the clinical efficacy,the total incidence of complications and the total incidence of adverse effects between the two groups were compared.Results(1)After 2 weeks of treatment,the total effective rate of the observation group was 92.31%(36/39)and that of the control group was 69.23%(27/39),and the intergroup comparison showed that the efficacy of the observation group was significantly superior to that of the control group(P<0.05).(2)After 3 days of treatment,there was no significant change in the NIHSS scores and GCS scores of patients in both groups(P>0.05);after 7 days and 14 days of treatment,the NIHSS scores of patients in both groups were significantly decreased compared with those before treatment(P<0.05),and the GCS scores were significantly increased compared with those before treatment(P<0.05).The intergroup comparison showed that the effects of the observation group on decreasing NIHSS scores and increasing GCS scores after 7 and 14 days of treatment were significantly superior to those of the control group(P<0.01).(3)The serum levels of TNF-α,IL-6 and NSE in the observation group after 3,7 and 14 days of treatment and in the control group after 7 and 14 days of treatment were all significantly decreased compared with those before treatment(P<0.05),and the serum miRNA-210 level in the two groups was significantly increased compared with that before treatment(P<0.05).The intergroup comparison showed that the effects of the observation group on decreasing serum TNF-α,IL-6 and NSE levels and on increasing serum miRNA-210 level after 3,7 and 14 days of treatment were significantly superior to those of the control group(P<0.05 or P<0.01).(4)The overall incidence of complications in the observation group was 2.56%(1/39),which was significantly lower than that of the control group[17.95%(7/39)],and the difference was statistically significant(P<0.05).(5)The total incidence of adverse reactions in the observation group was 7.69%(3/39)and that in the control group was 10.26%(4/39),and the intergroup comparison showed that the difference was not statistically significant(P>0.05).Conclusion Tongqiao Huayu Xingshen Decoction combined with Oxiracetam can effectively reduce the degree of neurological impairment and coma in patients with sTBI,and decrease the incidence of complications.The combined therapy of Chinese and western medicine avoids increasing the adverse effects and exerts certain safety.