肢体缺血预适应训练辅助二级预防药物治疗高度狭窄或闭塞性脑血管病临床干预的短期效果分析  

The Combinated Treatment of Limb Ischemic Precondi-tioning and Secondary Prevention of Strokethe Short-term Outcomes of Servere Cerebral Vascular Stenosis and Occlusion

作　　者：马春[1] 李淑婷[1] 吉训明[2] 罗玉敏[1] 

机构地区：[1]首都医科大学宣武医院脑血管病实验室神经变性病教育部重点实验室 [2]首都医科大学宣武医院神经外科,北京100053

出　　处：《罕少疾病杂志》2011年第6期1-5,共5页Journal of Rare and Uncommon Diseases

基　　金：国家自然科学基金项目(编号:30500166);北京市自然科学基金项目(编号:7050001);首都医学发展科研基金项目(编号:2005-2050)

摘　　要：目的观察肢体缺血预适应训练对脑血管高度狭窄或闭塞患者的短期疗效。方法共纳入16例脑动脉高度狭窄或闭塞的患者,随机纳入到预适应组和药物组,每组各8例。两组患者均接受规范卒中二级预防治疗;预适应组同时辅助短暂肢体缺血预适应训练治疗,疗程半年。观察两组患者脑缺血事件发生率、症状改善率、mRS评分以及颈动脉超声和TCD的结果,并检测血清cAMP、HIF-1α和VEGF。结果两组患者均未出现脑缺血事件;预适应组症状改善率87.5%,药物组62.5%,无统计学差异(P>0.05);比较治疗前后两组血管狭窄程度,无统计学差异(P>0.05)。预适应组治疗后血清cAMP的水平较治疗前有显著升高(5.8±2.2 vs 8.9±2.7nmol/L,P<0.01),差异有统计学意义;药物组治疗前后血清cAMP的水平没有统计学差异;两组血清?HIF-1α和VEGF水平在治疗前后均无统计学差异。结论肢体缺血预适应训练可改善缺血性脑血管病患者的症状,其作用可能与血清cAMP增高有关。Objective limb ischemic preconditioning has been proved as an effective neuroprotective modality in stroke animal models. We use the method to treat patients with severe stenotic or occlusion lesions in cerebral arteries to investigate the safety and short-term outcomes. Methods 16 patients with proved severe stenotic or occlusion cerebral artery lesions were enrolled and randomized into preconditioning group （n=8） and control group （n=8）. All patients in both groups received standard secondary prevention therapy of stroke. Patients in the preconditioning group received limb ischemic preconditioning for 6 months. Incidence of cerebrovascular accidents, improvement rate of symptoms, mRS score and severity of stenotic cerebral vessel at 6 months were recorded. Serum cAMP, HIF- 1 and VEGF were measured at baseline and 6 months. Resu/ts No cerebrovascular accident happened in both groups, the improvement rate of symptoms in preconditioning group and control group were 87.5%, and 62.5% respectively （P〉0.05）. The severity of stenotic cerebral vessel wasn＇ t significantly different with baseline tiaras in both groups （p〉0.05）. In preconditioning group serum cAMP at 6 months was significant higher than baseline （5.8 ± 2.2 vs 8.9 ±2.7nmol/L, P〈0.01）, HIF-1 and VEGF showed no significant changes, cAMP, HIF-1 and VEGF weren＇t changed significantly before and after treatment in control group. ConcIusion remote limb ischemic preconditioning can improve the symptom of patients with severe stenotic or occlusion cerebral artery lesions. The mechanism of the method may be correlated with the increase of serum cAMP.

关 键 词：肢体缺血预适应 卒中二级预防治疗 脑血管狭窄 

分 类 号：R743[医药卫生—神经病学与精神病学]