远程缺血后适应对短暂性脑缺血发作患者的脑氧代谢及血清BDNF、MMP-9的影响

摘要

目的 观察远程缺血后适应对短暂性脑缺血发作(TIA)患者脑氧代谢及血清脑源性神经营养因子(BDNF)、基质金属蛋白酶-9(MMP-9)水平的影响及脑保护机制.方法 选择2015年1月-2016年12月于石家庄市第一医院老年病科诊治TIA患者200例作为研究对象,随机数字表法分为2组,每组100例.对照组单纯按照脑卒中和短暂性脑缺血发作二级预防指南用药.观察组在对照组单纯用药的基础上加用远程缺血后适应训练.治疗前和治疗6个月后,采用脑血氧监测仪检测脑氧代谢指标颈内静脉血氧饱和度(SjvO2)、脑静脉血氧饱和度(CjvO2)、动脉—颈内静脉血氧含量差(Da-jvO2)及动脉血氧含量(CaO2),采用酶联免疫吸附法测定各组患者血清BDNF和MMP-9水平.观察2组患者的不良反应.结果 治疗6个月后,观察组患者SjvO2及CjvO2均高于对照组(t=1.103,P=0.039;t =1.755,P=0.017),而Da-jyO2及CaO2均低于对照组(t=1.096,P=0.042;t =3.302,P=0.019);观察组患者血清BDNF水平明显高于对照组(t=7.472,P=0.003),MMP-9水平明显低于对照组(t=7.894,P=0.001).观察组少数患者出现肢体麻木、疼痛,但均可完全缓解,对治疗无影响.结论 远程缺血后适应训练可以调节TIA患者脑氧代谢及血清BDNF和MMP-9水平,进一步阐述了远程缺血后适应对TIA的脑保护机制.%Objective To observe the effects of remote ischemic postconditioning on cerebral oxygen metabolism and serum levels of brain-derived neurotrophic factor (BDNF) and matrix metalloproteinase-9 (MMP-9) in patients with transient ischemic attack (TIA) and the mechanism of brain protection.Methods Two hundred patients were randomly divided into treatment group and control group,with 100 patients of each group.The control group received only secondary prevention guidelines of stroke and transient ischemic attack in 2011.The treatment group was trained with RIPC on the basis of medication in the control group.Cerebral oxygen metabolism indexes including SjvO2,CjvO2,Da-jvO2 and CaO2 were measured by cerebral blood oxygen monitor.Serum BDNF and MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA).The adverse reactions of the two groups were observed.Results The levels of SjvO2 and CjvO2 in patients with RIPC were higher than the control group (t =1.103,P =0.039;t =1.755,P =0.017),while Da-jvO2 and CaO2 were lower than the control group (t =1.096,P =0.042;t =3.302,P =0.019),the differences were statistically significant.The serum level of BDNF in treatment group was significantly higher than the control group (t =7.472,P =0.003),the expression of MMP-9 was significantly lower than the control group (t =7.894,P =0.001).Compared with the control group,a small number of patients in the treatment group showed numbness and pain in the limbs,but all of them could be relieved completely without any effect on the treatment.Conclusion Remote ischemic postconditioning training can regulate cerebral oxygen metabolism and serum BDNF and MMP-9 levels in patients with transient ischemic attack,further elaborated the cerebral protective mechanism of RIPC on TIA and providing the reliable data support for clinical treatment.