高压氧治疗创伤性脑损伤的临床疗效及对血清NGAL和泛素羧基末端水解酶L1表达的影响  

Clinical efficacy of hyperbaric oxygen in treatment of traumatic brain injury and effect on expressions of serum NGAL and ubiquitin carboxyl terminal hydrolase

作　　者：李建[1] 于朝霞[1] 王鑫[1] 李晓鹏[1] 于湘友[1] LI Jian;YU Zhao-xia;WANG Xin;LI Xiao-peng;YU Xiang-you(Intensive Care Unit,First Affiliated Hospital of Xinjiang Medical University,Uriimqi 830011,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830011

出　　处：《生物医学工程与临床》2020年第5期560-564,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的评价高压氧辅助治疗创伤性脑损伤患者的临床疗效及对血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和泛素羧基末端水解酶L1(UCH-L1)表达的影响。方法选择2018年4月至2019年4月入新疆医科大学第一附属医院诊断创伤性脑损伤患者68例,其中其中男性46例,女性22例;年龄23~69岁,平均年龄45.9岁;体质量(68.6±8.9) kg;格拉斯哥昏迷评分(GCS)3~11分,平均GCS为8.4分;发病时间为(6.8±2.5) h。随机分为对照组和观察组,每组34例。对照组常规外科手术和药物治疗,观察组联合高压氧辅助治疗,疗程为1个月。对比两组临床疗效,治疗前后血清氧化应激指标包括NGAL、基质金属蛋白酶(MMP)-9、脑氧摄取率(CERO2)和活性氧(ROS)水平,神经营养因子包括UCHL1、神经元特异性烯醇化酶(NSE)和S100-β水平。结果观察组总有效率显著高于对照组(94.1%vs 76.5%;P <0.05)。两组治疗后血清氧化应激指标NGAL、MMP-9和ROS水平较治疗前降低[观察组:(63.5±22.4) ng/mL vs (125.3±45.6) ng/mL;(68.5±21.2) ng/mL vs (168.8±55.6) ng/mL;(16.8±6.3) U/mL vs (27.4±7.9) U/mL。对照组:(88.9±23.5) ng/mL vs (123.8±44.9) ng/mL;(96.3±25.7) ng/mL vs (165.8±52.3) ng/mL;(21.2±6.6) U/mL vs (26.8±7.5) U/mL],CERO2增加[观察组:(39.6±12.2)%vs (30.3±9.2)%;对照组:(35.2±10.3)%vs (30.6±9.5)%],神经营养因子UCH-L1、NSE和S100-β水平较治疗前降低[观察组:(201.3±46.8) ng/mL vs (328.6±75.4) ng/mL;(167.8±35.8) ng/mL vs (267.9±65.3) ng/mL;(85.6±25.7) ng/mL vs (168.9±48.7) ng/mL。对照组:(256.4±53.2) ng/mL vs (326.5±65.8) ng/mL;(203.2±46.3) ng/mL vs (265.3±52.7) ng/mL;(112.3±35.6) ng/mL vs (165.9±45.3) ng/mL],且观察组较对照组改善更明显(P <0.01)。结论高压氧辅助治疗创伤性脑损伤患者有较好的安全性和有效性,可明显抑制中枢神经氧化应激和神经营养因子释放和表达。Objective To study the clinical efficacy of hyperbaric oxygen adjuvant therapy in traumatic brain injury patients,and effect on serum neutrophil gelatinase-associated lipocalin(NGAL) and ubiquitin carboxyl terminal hydrolase L1(UCHL1) expressions. Method A total of 68 patients with traumatic brain injury from April 2018 to April 2019 were enrolled,which included 46 males and 22 females, aged 23-69 years old with mean age of 45.9 years old;body mass was(68.6 ± 8.9) kg,Glasgow coma score(GCS) was 3-11 with mean GCS of 8.4, onset time(6.8 ± 2.5) hours. They were randomly divided into control and observation groups, each of 34 cases, the control group received routine surgery and drug therapy and observation group combined hyperbaric oxygen adjuvant therapy at mean time for one month. Clinical efficacy, serum oxidative stress indicators, including NGAL, matrix metalloproteinase(MMP)-9, cerebral extraction rate of oxygen(CERO2) and reactive oxygen species(ROS), neurotrophic factors including UCH-L1, neuron-specific enolase(NSE) and S100-β levels, before and after treatment were compared. Results The total clinical efficacy rate in observation group was significantly higher than control group(P < 0.05).The serum levels of oxidative stress indicators NGAL, MMP-9 and ROS after treatment were lower[observation group:(63.5 ±22.4) ng/mL vs(125.3 ± 45.6) ng/mL;(68.5 ± 21.2) ng/mL vs(168.8 ± 55.6) ng/mL;(16.8 ± 6.3) U/mL vs(27.4 ± 7.9) U/mL.Control group:(88.9 ± 23.5) ng/mL vs(123.8 ± 44.9) ng/mL;(96.3 ± 25.7) ng/mL vs(165.8 ± 52.3) ng/mL;(21.2 ± 6.6) U/mL vs(26.8 ± 7.5) U/mL] and CERO2 were higher than before in 2 groups[observation group:(39.6 ± 12.2) % vs(30.3 ± 9.2) %;control group:(35.2 ± 10.3) % vs(30.6 ± 9.5) %]. Neurotrophic factors such as UCH-L1, NSE and S100-β were significantly lower after treatment than before[observation group:(201.3 ± 46.8) ng/mL vs(328.6 ± 75.4) ng/mL;(167.8 ± 35.8) ng/mL vs(267.9 ± 65.3) ng/mL;(85.6 ± 25.7) ng/mL vs(168.9 ± 48.7) ng/mL. Control group:(256.4 ± 53.2)

关 键 词：高压氧 创伤性脑损伤 临床疗效 中性粒细胞明胶酶相关载脂蛋白 泛素羧基末端水解酶L1 氧化应激 神经营养因子 

分 类 号：R651.15[医药卫生—外科学] R459.6[医药卫生—临床医学]