Medical Recapitulate

摘要

目的：探讨醒脑静对老年脑梗死患者神经细胞修复相关细胞因子[可溶性血管细胞黏附分子（sVCAM）1、肿瘤坏死因子（TNF）α、白细胞介素（IL）18和高迁移率族蛋白（HMG）B1]表达水平的影响。方法选择2011年10月至2014年6月天门市第一人民医院神经内科收治的老年急性脑梗死患者236例为研究对象，采用随机数字表法将患者分为常规治疗组（118例）和醒脑静组（118例）。常规治疗组给予卧床休息、吸氧、抗血小板聚集、改善脑循环、控制血压、调整血糖等常规治疗；醒脑静组在此基础上加用醒脑静注射液静脉滴注治疗，每日1次，每次20 mL。比较1个疗程后两组患者的疗效、治疗前后梗死灶体积、神经功能缺损评分（ NIHSS ）及血清中 sVCAM－1、TNF－α、IL－18、HMGB1的水平。结果醒脑静组的总有效率显著高于常规治疗组[74．6％（88／118）比41．5％（49／118）]（P＜0．01）。治疗1个疗程后，醒脑静组梗死灶体积和 NIHSS 显著低于常规治疗组[（3．8±0．7） cm3比（5．4±1．2） cm3，（5．2±1．1）分比（7．5±2．0）分]（P ＜0．05）；两组患者的sVCAM－1、TNF－α、IL－18、HMGB1的水平均较治疗前降低，且醒脑静组的水平显著低于常规治疗组[（773．2±74．7）μg／L比（993．5±70．4）μg／L，（40．2±6．5） ng／L比（55．3±10．0） ng／L，（70．3±17．6） ng／L比（90．0±18．5） ng／L，（8．1±1．2） ng／L 比（10．3±1．4） ng／L]，差异有统计学意义（P＜0．05）。结论醒脑静注射液能降低脑梗死患者血清中 sVCAM－1、TNF－α、IL－18、HMGB1的水平，有效提高脑梗死的治疗效果，减少梗死面积，提高患者生活质量。%Objective To investigate the effect of Xingnaojing injection on neurocyte reparative factors [soluble vascular cell adhesion (sVCAM)-1,tumor necrosis factor(TNF)-α,interleukin(IL)-18,high mob-ility group box 1 protein(HMGB1)] of elderly patients with cerebral infarction.Method Total of 236 elderly patients with acute cerebral infarction admitted to Tianmen First People′s Hospital from Oct.2011 to Jun. 2014 were included in the study and divided into a conventional treatment group (118 cases) and a Xingnao-jing group(118 cases) according to the random number table method.The conventional treatment group was given bed rest,oxygen,anti-platelet aggregation,improve cerebral circulation,control of blood pressure,blood sugar and other conventional treatments.The xingnaojing group was given xinnaojing intravenous guttae on the basis of the conventional treatment group′s regimen,once daily,20 mL every time.The efficacy after a course of treatment,and infarct volume before and after treatment,NIHSS score and the levels of sVCAM-1,TNF-α, IL-18,HMGB1 of the two groups were compared.Results The total effective rate of the xingnaojing group was higher than the conventional treatment group[74.6%(88/118) vs 41.5%(49/118)],the difference was statistically significant(P<0.01).After a course of treatment,the infarct volume and NIHSS of the xing-naojing group were lower than the conventional treatment group [(3.8 ±0.7) cm3 vs (5.4 ±1.2) cm3, (5.2 ±1.1) scores vs (7.5 ±2.0) scores],the differences were statistically significant(P <0.05).The sVCAM-1,TNF-α,IL-18,HMGB1 levels of the two groups after treatment were lower than before treatment ,and the xingnaojing group was lower than the conventional treatment group [ ( 773.2 ±74.7 ) μg/L vs ( 993.5 ± 70.4) μg/L,(40.2 ±6.5) ng/L vs (55.3 ±10.0) ng/L,(70.3 ±17.6) ng/L vs (90.0 ±18.5) ng/L,(8.1 ± 1.2) ng/L vs (10.3 ±1.4) ng/L],the differences were statistically significant(P<0.05).Conclusion Xingnaojing injection can reduce the levels of sVCAM-1,TNF-α,IL-18 and HMGB1,reduce the infarct vol-ume and improve the clinical effect and life quality of the patients with cerebral infarction .