粒细胞集落刺激因子和促红细胞生长素单药或联合治疗急性脑梗死的临床分析  

Clinical Trial of the Combined Treatment of Granulocyte-Colony Stimulating Factor and Erythropoietin in Cerebral Infarction

作　　者：吴成斯[1] 吴仕站 张诚[1] 徐仁伵[1] 黄经纬[1] 徐文苑[1] 

机构地区：[1]南昌大学第一附属医院神经内科,330006 [2]江西省万年县人民医院神经内科,335500

出　　处：《中国临床神经科学》2016年第2期158-165,共8页Chinese Journal of Clinical Neurosciences

基　　金：2010年江西省教育厅科学技术研究项目(编号:GJJ11347)

摘　　要：目的 (1)观察重组人粒细胞集落刺激因子(G-CSF)和重组人促红细胞生长素(EPO)单用或联合应用对大鼠脑缺血再灌注(I/R)后的保护作用。(2)探讨临床应用G-CSF和EPO治疗急性脑梗死的疗效及安全性。方法 (1)大鼠实验:72只大鼠制备局灶性I/R模型,分为G-CSF组(给予G-CSF)、EPO组(给予EPO)和对照组(均n=24),各组又分为1 d、7 d、14 d、28 d,共4个亚组(均n=6)。于再灌注后不同时间点进行神经功能评分及梗死面积检测。(2)临床试验:72例急性脑梗死患者随机分为治疗组(36例)和对照组(36例)。两组均按急性脑梗死常规方法治疗,治疗组在此基础上分别添加G-CSF(GCSF亚组,12例)、EPO(EPO亚组,12例)和G-CSF+EPO联合(G-CSF+EPO亚组,12例)治疗。采用美国国立卫生研究院脑卒中量表(NIHSS)和改良Rankin量表进行评分。结果 (1)大鼠实验:再灌注后14和28 d,两组神经功能评分均高于对照组(P<0.05),梗死面积均明显小于对照组(P<0.05)。(2)临床试验:治疗后1、7和14 d各组NIHSS评分和改良Rankin量表评分比较差异无显著性(P>0.05)。与对照组比较,治疗后28 d、3个月、6个月、1年、2年各治疗亚组NIHSS评分、改良Rankin量表评分均显著好转(P<0.05或P<0.01)。G-CSF+EPO亚组疗效明显优于G-CSF亚组和EPO亚组(P<0.05)。治疗后14d,治疗组与对照组比较脑梗死体积差异无显著性(P>0.05);治疗后28 d各亚组脑梗死体积均明显小于对照组,差异有统计学意义(P<0.05或P<0.01)。G-CSF、EPO治疗期间未出现明显不良反应。结论 G-CSF、EPO能明显改善大鼠的神经功能症状、减小梗死面积,对大鼠I/R损伤有保护作用。G-CSF和EPO单药或联合治疗急性脑梗死患者耐受性良好,可改善临床预后。Aim To observe the protection of therapy of granulocyte-colony stimulating factor（G-CSF） or erythropoietin（EPO） against the cerebral ischemia-reperfusion in rats, and to evaluate the validity oftherapy, and apply it to ischemia patients. To investigate the efficacy of combined treatment of G-CSF and EPO in cerebral infarction. Methods PART ONE： The model of focal cerebral ischemia-reperfusion in rats was established by middle cerebral artery occlusion. Therapy of G-CSF or EPO was administered, after reperfusion for corresponding time, the neurological function score was evaluated, the infarct volume was measured with TTC stain. PART TWO： 72 patients with the acute cerebral infarction were randomly divided into a treatment group and a control group, each group included 36 patients. Both the two groups were treated with conventional therapy of acute cerebral infarction. On this basis, the treatment group were randomly divided into three subgroups, and each subgroup was added with G-CSF only, EPO only and G-CSF combined with EPO respectively. Results PART ONE： The neurological function score of the two treatment groups after reperfusion for 14 d, 28 d obviously exceeded that of the I/R group, and the difference was significant（P≤0.05）. After reperfusion for 14 d and 28 d, the infarct volume of the two treatment groups was significantly reduced compared to the I/R group（P〈0.05）. PART TWO： There is no significant difference, after the treatment for 1 day, 7 days, 14 days, in the neurological function score of the four groups evaluated by National Institutes of Health Stroke Scale（NIHSS） and modified Rankin Scale（m RS）（P〉0.05）. Compared with the control group, after the treatment for 28 days, 3 months, 6 months, 1 year, 2 years, the NIHSS and m RS scores of the three treatment groups（G-CSF only, EPO only, G-CSF combined with EPO） obviously exceeded that of the control group, and the difference was significant（P〈0.05 or P〈0.01）; and the curative effect of G-CSF＋EPO

关 键 词：脑梗死 重组人粒细胞集落刺激因子 重组人促红细胞生长素 

分 类 号：R743[医药卫生—神经病学与精神病学]