丁苯酞对急性脑梗死患者氧化应激指标及其信号通路相关因子水平的影响

Effect of butylphthalide on oxidative stress indexes and its signaling pathway related factors in patients with acute cerebral infarction

目的研究丁苯酞对急性脑梗死患者氧化应激指标及其信号通路相关因子水平的影响。方法将本院2020年8月至2021年4月收治的100例急性脑梗死患者采用分层区组随机化方法分为对照组和研究组各50例,对照组行常规治疗,研究组在常规治疗上加用丁苯酞注射液(100 mL,iv gtt,bid)治疗14 d。比较2组患者治疗前后神经功能缺损评分和氧化应激指标、相关信号通路因子、神经损伤标志物、C反应蛋白(CRP)、低密度脂蛋白(LDL)水平,以及临床疗效和安全性。结果治疗期间对照组脱落3例,研究组脱落2例,最终分别入组47例和48例。治疗后,研究组丙二醛水平显著低于对照组,超氧化物歧化酶、谷胱甘肽过氧化物酶显著高于对照组(P<0.05);研究组Kelch样ECH相关蛋白1(Keap1)mRNA明显高于对照组,核因子E2相关因子(Nrf2)和抗氧化反应元件(ARE)mRNA明显低于对照组(P<0.05);研究组CRP、LDL水平明显低于对照组(P<0.05);研究组美国国立卫生研究院卒中量表评分以及髓鞘碱性蛋白、神经元特异性烯醇化酶、S100钙结合蛋白B均显著低于对照组(P<0.05)。研究组治疗总有效率显著高于对照组(96%vs.81%,P<0.05),用药期间不良反应发生率与对照组比较无显著差异(6%vs.8%,P>0.05)。结论丁苯酞治疗急性脑梗死患者疗效确切,可能通过影响Keap1-Nrf2/ARE信号通路来抑制机体氧化应激,减轻患者神经功能损伤,且具有调节脂代谢异常、减轻机体炎症的优势。

AIM To study the effect of butylphthalide on oxidative stress indicators and its signaling pathway related factors in patients with acute cerebral infarction.METHODS A total of 100 patients with acute cerebral infarction admitted to the hospital from August 2020 to April 2021 were divided into control group and study group by stratified blocked randomization method,with 50 patients in each group.The control group underwent conventional treatment,and the study group was treated with butylphthalide injection(100 mL,iv gt,bid)for 14 d on the basis of conventional treatment.The two groups were compared in terms of neurological impairment score,oxidative stress indicators,related signaling pathway factors nerve injury markers,C-reactive protein(CRP)and low-density lipoprotein(LDL)levels,as well as clinical efficacy and safety before and after treatment.RESULTS There were 3 cases in the control group and 2 cases in the study group dropped out during treatment.Finally,47 cases in the control group and 48 cases in the study group were included respectively.After treatment,the level of malondialdehyde in the study group was significantly lower than that in the control group,while superoxide dismutase and glutathione peroxidase were significantly higher than those in the control group(P<0.05);the Kelch-like ECH-associated protein 1(Keapl)mRNA in the study group was significantly higher than that in the control group,while nuclear factor E2 related factor(Nrf2)and antioxidant response element(ARE)mRNA were significantly lower than those in the control group(P<0.05).The levels of CRP and LDL in the study group were significantly lower than.those in the control group(P<0.05).The National Institutes of Health Stroke Scale score and the levels of myelin basic protein,neuron-specific enolase,and S100 calcium binding protein B in the study group were significantly lower than those in the control group(P<0.05).The total effective rate of treatment in the study group was significantly higher than that in the control group(96%vs.81%,P<0.05),with no statistically significant difference in the total incidence of adverse reactions between the two groups(6%vs.8%,P>0.05).CONCLUSION Butylphthalide is effective in the treatment of patients with acute cerebral infarction,which may inhibit oxidative stress and relieve neurological damage through affecting the Keapl-Nrf2/ARE signaling pathway,and also has the advantage of regulating lipid metabolism abnormalities and reducing inflammation in the body.