依达拉奉联合川芎嗪治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的疗效及治疗前后血浆sICAM-1、NF-κB及ET-1水平变化情况  

Efficacy of edaravone combined with ligustrazine in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage and the changes of plasma sICAM-1,NF-κB and ET-1 levels before and after treatment

作　　者：赵立斌 贺红艳[2] 武文兴 唐阔海 ZHAO Libin;HE Hongyan;WU Wenxing;TANG Kuohai(Department of Neurosurgery,Qinhuangdao Funing District People′s Hospital,Qinhuangdao,Hebei 066300,China;Department of Otorhinolaryngology,Qinhuangdao Second Hospital,Qinhuangdao,Hebei 066600,China;Department of Surgical,Qinhuangdao Funing District Traditional Chinese Medicine Hospital,Qinhuangdao,Hebei 066300,China)

机构地区：[1]河北省秦皇岛市抚宁区人民医院神经外科,河北秦皇岛066300 [2]河北省秦皇岛市第二医院耳鼻喉科,河北秦皇岛066600 [3]河北省秦皇岛市抚宁区中医院外科,河北秦皇岛066300

出　　处：《国际检验医学杂志》2022年第3期280-284,共5页International Journal of Laboratory Medicine

基　　金：河北省2019年度医学科学研究课题计划(20190190)。

摘　　要：目的探讨依达拉奉联合川芎嗪治疗动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛(CVS)的疗效及治疗前后患者血浆可溶性细胞间黏附分子(sICAM)-1、核转录因子(NF)-κB及内皮素(ET)-1水平变化情况。方法选择秦皇岛市抚宁区人民医院2018年9月至2019年10月收治的74例aSAH后CVS患者,采用随机数字表法将其分成观察组(37例)与对照组(37例)。对照组采取尼莫地平持续静脉输注治疗,观察组则在此基础上联合依达拉奉+川芎嗪静脉滴注治疗,两组均连续治疗7 d。治疗后对两组进行疗效评估,并比较不良反应发生情况。采用经颅多普勒血流分析仪检测治疗前后患者脑血流动力学[收缩期血流峰速度(Vs)、舒张期血流峰速度(Vd)和阻力指数(RI)]变化情况。采用酶联免疫吸附试验检测血浆sICAM-1、NF-κB和ET-1水平,同时对所有患者进行美国国立卫生研究院卒中量表(NIHSS)和格拉斯哥昏迷量表(GCS)评分。结果观察组总有效率(94.59%)明显高于对照组(72.97%),组间比较差异有统计学意义(P<0.05)。治疗后两组大脑中动脉Vs、Vd降低(P<0.05),且观察组低于对照组(P<0.05);治疗后观察组大脑中动脉RI降低(P<0.05),但对照组无明显变化(P>0.05);治疗后两组血浆sICAM-1、NF-κB及ET-1水平降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后两组NIHSS评分降低(P<0.05),GCS评分升高(P<0.05),且治疗后观察组NIHSS评分低于对照组,GCS评分高于对照组(P<0.05)。两组不良反应例数均较少,症状轻微。结论aSAH后CVS患者血浆中sICAM-1、NF-κB及ET-1水平处于过度表达状态,采用依达拉奉+川芎嗪进行辅助治疗可进一步下调患者血浆中上述指标的水平,从而有助于控制病情,改善预后。因此在该病的临床防治中应重点监测患者血浆中sICAM-1、NF-κB和ET-1的水平变化情况。Objective To investigate the efficacy of edaravone combined with ligustrazine in the treatment of cerebral vasospasm(CVS)after aneurysmal subarachnoid hemorrhage(aSAH),and the changes of plasma soluble intercellular adhesion molecule(sICAM)-1,nuclear transcription factor(NF)-κB and endothelin(ET)-1 levels in patients before and after treatment.Methods A total of 74 patients with CVS after aSAH who were admitted to the People′s Hospital of Funing District,Qinhuangdao City from September 2018 to October 2019 were selected and divided into an observation group(37 cases)and a control group(37 cases)by random number table method.The control group was treated with continuous intravenous infusion of nimodipine,while the observation group was treated with edaravone+ligustrazine intravenous infusion on the basis of the treatment regimen of the control group.Both groups were treated for 7 d.After treatment,the curative effect was evaluated in the two groups,and the occurrence of adverse reactions was compared.Transcranial doppler flow analyzer was used to detect the changes of cerebral hemodynamic indicators such as systolic peak velocity(Vs),diastolic peak velocity(Vd)and resistance index(RI)before and after treatment.Plasma levels of sICAM-1,NF-κB and ET-1 were detected by enzyme-linked immunosorbent assay,and all patients were scored with the national institutes of health stroke scale(NIHSS)and glasgow coma scale(GCS).Results The total effective rate(94.59%)of the observation group was significantly higher than that of the control group(72.97%),and the difference was statistically significant(P<0.05).After treatment,the Vs and Vd of the middle cerebral artery in the two groups decreased(P<0.05),and the observation group was lower than the control group(P<0.05);the middle cerebral artery RI in the observation group decreased(P<0.05),but there was no significant change in the control group(P>0.05);the plasma levels of sICAM-1,NF-κB and ET-1 in the two groups decreased(P<0.05),and the observation group was lower than

关 键 词：动脉瘤性蛛网膜下腔出血 脑血管痉挛 可溶性细胞间黏附分子-1 核转录因子-κB 内皮素-1 

分 类 号：R743.35[医药卫生—神经病学与精神病学]