高压氧干预下急性脑梗死患者细胞黏附分子变化及对预后的影响  

Changes in intercellular adhesion molecules and effect on prognosis following hyperbaric intervention in patients with acute cerebral infarction

作　　者：李雁[1] 黄烽[1] 韩涛[1] 蔡鹏威[2] 陈发林[2] 周宝英[1] 林侃[1] 张天强[1] 

机构地区：[1]福建省立医院心血管病研究所高压氧室,福州350001 [2]福建省立医院检验科

出　　处：《中华航海医学与高气压医学杂志》2011年第5期296-300,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：福建省科技开发计划项目（2005D0458）;福建省卫生厅青年科研基金资助项目（2009-2-5）

摘　　要：目的对急性脑梗死（acute cerebral infarction，ACI）患者CD11b、CD11c和CD54作动态观察，找出其变化规律及高压氧（hyperbaric oxygen，HBO）对该规律的影响，并进一步阐明HBO对ACI患者脑血管的保护作用；同时对ACI患者治疗前CD11b、CD11e和CD54与近、远期神经功能恢复程度相关性进行探讨。方法64例ACI患者分2组：HBO组31例，常规治疗联合HBO治疗；治疗对照组33例，仅行常规治疗。2组分别在治疗前（发病≤72h）及治疗第7、10、12、20天晨抽取外周静脉血测定CD11b、CD11c和CD54，并在相同治疗时间进行神经功能缺损程度评分（neuralfunctional damagescores，NDS）。另外选取正常对照组25人，仅抽取周围静脉血测定CD11b、CD11c和CD54。结果HBO组和治疗对照组治疗前CD11b、CD11C和CD54表达明显升高，达到高峰，2组各指标差异无统计学意义（P〉0．05），第7天均开始下降。HBO组CD11b、CD11C高峰持续时间为7d，治疗对照组持续10d；HBO组CD54高峰持续时间为10d，治疗对照组持续12d。经相关性和线性回归分析发现，发病第20天时NDS水平（近期疗效）和发病半年、1年时NDS的水平（远期疗效）分别为97．2％、96．7％及97．6％，可用CD11b和／或CD11c和／或CD54的上调水平以及其他相关因素解释。结论HBO治疗后可缩短ACI患者CD11b、CD11c和CD54高峰持续时间。说明HBO可干预细胞黏附分子的变化过程，缩短其异常时限，减少它们的表达，对ACI患者有保护作用，并减少白细胞的黏附。同时治疗前CD11b、CD11C和CD54的表达可预测病情的轻重，影响近、远期疗效，为研究如何调控或抑制CD11b、CD11c和CD54的表达、减少对血管的损伤及早期制定更全面的治疗方案提供依据。Objective To observe dynamically the CDllb, CD1 l c and CD54 in patients with acute cerebral infarction （ACI） , to find out the change pattern and the effect of HBO on the change pattern, to illustrate the protective effects of HBO on cerebrovascular lesion in patients with ACI, and to explore the correlation between the CD1 l b, CD11 c and CD54 before therapy and near and long-term effects on neurological recovery. Methods Sixty-four cases of ACI were divided into the HBO ＋ routine therapy group （31 eases） and the therapy control group with only routine therapy （33 cases）. CDllb, CDllc and CD54 in the subjects of both groups were measured in 72 hours, and on the 7th, 10th, 12th and 20th days respectively following acute infarction, and neural functional damage scores （NDS） were also evaluated at the same time. CDllb, CDllc and CD54 of the subjects in the normal control group （25 cases） were also measured by taking blood samples from peripheral veins. Results The expression of CD11 b, CD11 c and CD54 in the HBO group and the control group increased obviously within 72 hours of onset, and reached peak value within 72 hours. No significant differences could be seen between the two groups （ P 〉 0. 05 ）. Then, the above data declined on the 7th day. CD1 l b, CD11 c in the HBO group maintained at peak level for 7 days, while those in the control group maintained for 10 days. CD54 peak value kept for 10 days in the HBO group, while peak value maintained for 12 days in the therapy control group. Correlation analysis and linear regression analysis indicated that NDS on the 20th day （short-term curative effect） and NDS within half a year and a year （long-term effect） were 97.2% ,96. 7% ,97.6% respectively, which could be explained with the up-regulation of CD11 b and/or CD11 c and/or CD54 and other related factors. Conclusions The duration of peak levels of CD11 b, CDI 1 c and CD54 in ACI patients could be shortened, following hyperbaric oxygen therapy. HBO might intervene in the changi

关 键 词：高压氧 细胞黏附分子 急性脑梗死 神经功能 

分 类 号：R74[医药卫生—神经病学与精神病学]