β受体阻滞剂对急性脑卒中后感染的影响  

Impact ofβ-blockers on infection occurrence after acute stroke

作　　者：陈丽娜[1] 沈定国[2] 贾颐 刘建军[2] 樊同 

机构地区：[1]西安交通大学第一附属医院,710075 [2]西安高新医院神经内科,710075

出　　处：《中国神经免疫学和神经病学杂志》2015年第1期49-53,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家临床重点专科建设项目经费资助项目(201105)

摘　　要：目的探讨β受体阻滞剂干预治疗对急性脑卒中后感染的影响。方法选取2011-10-2014-01期间的急性脑卒中患者60例,随机分为普萘洛尔干预组和对照组,每组30例,对比两组患者在发病2周内感染的发生情况及血浆总儿茶酚胺、促炎细胞因子及抑炎细胞因子水平。结果普萘洛尔干预组发生感染8例（26.7%）,对照组发生感染14例（46.7%）,两组患者感染率比较有统计学差异（P〈0.05）,干预组感染发生时间与对照组比较差异无统计学意义（P〉0.05）。普萘洛尔干预组患者血浆总儿茶酚胺水平在入院后第2-14天均显著低于对照组（P〈0.05）;IL-6水平在第3天、第5天、第7天均显著高于对照组（P〈0.05）,IL-17在第3-14天显著高于对照组（P〈0.05）,且二者均与血浆儿茶酚胺水平呈负相关（P〈0.05）;IL-10水平在入院后第2-14天均显著低于对照组（P〈0.05）,且IL-10水平均与儿茶酚胺水平呈正相关（P〈0.05）。结论β-受体阻滞剂普萘洛尔可减少急性脑卒中患者血浆儿茶酚胺及抑炎细胞因子水平,增加促炎细胞因子水平,从而改善脑卒中诱导的免疫抑制综合征,降低卒中后感染的发生率,为临床急性脑卒中后感染的防治和改善卒中预后提供理论依据。Objective To investigate the impact ofβ-blockers treatment on infection occurrence after acute stroke.Methods Sixty consecutive patients admitted to our hospital from Oct.2011 to Jan.2014 were included and were randomized into two groups（both with 30patients）：β-blocker treatment group and control group in which patients were treated as same as the former group except forβ-blocker.Comparison analysis was performed between the two groups to compare rate of infection after acute stroke and the plasma levels of catecholamine and cytokines tested by enzyme linked immunosorbent assay（ELISA）at admission（d0）and 2（d2）,3（d3）,5（d5）,7（d7）and 14（d14）days after the admission.Correlation analysis was also performed between catecholamine and cytokines.Results Infection rate in theβ-blocker treatment group was significantly lower than that in the control group [8（26.7%）vs.14（46.7%）,P〈0.05],but the difference in time of infection occurrence between two groups was not significant（P〉0.05）.The concentrations of plasma catecholamine in patients withβ-blocker treatment were lower than that of patients in the control group on d2,d3,d5,d7 and d14（P〈0.05）,while the levels of IL-6were higher in patients withβ-blocker treatment on d3,d5 and d7（P〈0.05）,with IL-17 being higher on d3-d14（P〈0.05）.Both the levels of IL-6and IL-17 were negatively correlated with concentrations of catecholamine（P〈0.05）.Levels of IL-10 were significantly decreased in patients withβ-blocker treatment than in controls（P〈0.05）and were positively correlated with concentrations of catecholamine on d2,d3,d5,d7 and d14（P〈0.05）.Conclusions In patients with acute stroke,intervention withβ-blocker improves stroke-induced immunodepression syndrome（SIDS）and reduces risk of post stroke infection by reducing expression of plasma catecholamine and anti-inflammatory cytokines,and enhancing the concentration of pro-inflammatory cytokine IL-6 and IL-17.The observed effect warranted eval

关 键 词：卒中 感染 免疫抑制 交感神经 Β受体阻滞剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]