甲泼尼龙琥珀酸钠对急性脊髓缺血再灌注损伤患者预后及外周血标志物表达水平的影响  

Effect of methylprednisolone sodium succinate on prognosis and peripheral blood marker levels in patients with acute SCIRI

作　　者：黄勉 李琳[1] 李芬[1] 刘超强 邓雪梅 王峥[1] Huang Mian;Li Lin;Li Fen;Liu Chaoqiang;Deng Xuemei;Wang Zheng(Department of Neurology,Wuhan Third Hospital/Tongren Hospital Affiliated to Wuhan University,Wuhan 430074,Hubei Province,China)

机构地区：[1]武汉市第三医院武汉大学附属同仁医院神经内科,430074

出　　处：《中华老年心脑血管病杂志》2022年第10期1068-1072,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：湖北省科技计划项目(2019CFB762)。

摘　　要：目的 探讨半胱氨酸天冬氨酸蛋白酶3(Caspase-3)、长链非编码RNA(lncRNA)在急性脊髓缺血再灌注损伤(SCIRI)患者中的表达情况,并分析注射用甲泼尼龙琥珀酸钠(MP)干预后的Caspase-3、lncRNA表达规律及作用。方法 前瞻性纳入2019年3月~2021年3月武汉市第三医院收治的严重脊髓压迫需进行椎板减压手术的240例患者作为病例组,并选取同期200例健康体检者作为正常对照组(正常组),分别检测血清Caspase-3水平和血浆lncRNA水平;根据随机数字表法再次将病例组分为MP(甲强龙)组和对照组,各组120例。对照组不使用任何糖皮质激素,术后仅接受甘露醇减轻水肿和神经营养药物治疗;甲强龙组在术中、术后均接受MP静脉滴注治疗。比较2组术前术后日本骨科协会(JOA)评分、血清肝肾功能、空腹血糖、Caspase-3及血浆lncRNA水平差异,2组术后SCIRI发生率及不良反应发生情况。结果 病例组血清Caspase-3及血浆lncRNA水平均显著高于正常组(P<0.01)。甲强龙组术后SCIRI发生率明显低于对照组(0.83%vs 3.33%,P<0.05)。与术前比较,术后1周、术后1个月、术后3个月对照组和甲强龙组JOA评分均显著升高(P<0.05),与对照组比较,甲强龙组术后1周、术后1个月、术后3个月JOA评分显著升高,差异有统计学意义(P<0.05,P<0.01)。甲强龙组术后6 h、1 d及7 d血清Caspase-3及血浆lncRNA水平均显著低于对照组,差异有统计学意义(P<0.01)。对照组和甲强龙组治疗前后血清丙氨酸转氨酶、天冬氨酸转氨酶、尿素及肌酐水平比较,差异无统计学意义(P>0.05)。甲强龙组术后3 d空腹血糖水平显著高于对照组[(13.24±1.35)mmol/L vs(10.17±0.92)mmol/L,P=0.000]。甲强龙组和对照组患者均未出现延迟愈合或伤口感染等不良反应发生。结论 SCIRI患者血清Caspase-3及血浆lncRNA水平高于健康人,经MP干预后可明显降低其术后发生SCIRI的风险,提高其JOA评分,安全性较好。Objective To investigate the expression of cysteine aspartic protease 3(Caspase-3) and long-chain non-coding RNA(lncRNA) in patients with acute spinal cord ischemia-reperfusion injury(SCIRI),and analyze the expression profiles and roles of Caspase-3 and lncRNA after the intervention of methylprednisolone sodium succinate injection.Methods A total of 240 patients requiring laminectomy due to severe spinal cord compression admitted to the Wuhan Third Hospital from March 2019 to March 2021 were prospectively included as the case group, and 200 healthy subjects taking physical examination in the same period were selected as the normal control group(normal group).Serum Caspase-3 level and plasma lncRNA level were measured, respectively.The patients of the case group were further randomly divided into methylprednisolone sodium succinate intervention subgroup and control subgroup, with 120 cases in each group.The control subgroup received no any glucocorticoid and only received mannitol to reduce edema and neurotrophic drugs after operation.The intervention subgroup was treated with intravenous infusion of methylprednisolone sodium succinate during and after operation.The preoperative and postoperative Japanese Orthopedics Association(JOA) score, serum liver and kidney function indicators, fasting blood glucose, serum Caspase-3 level and plasma lncRNA level, and incidences of SCIRI and adverse reactions were compared between the two subgroups.Results The serum Caspase-3 level and plasma lncRNA level were significantly higher in the case group than the normal control group(P<0.01).The incidence of SCIRI after surgery was obviously lower in the intervention subgroup than the control subgroup(0.83% vs 3.33%,P<0.05).The JOA score was notably increased in the both subgroups in 1 week, and 1 and 3 months after surgery(P<0.05),and the score was remarkably higher in the intervention subgroup than the control subgroup at above time points(P<0.05,P<0.01).The levels of serum Caspase-3 and plasma lncRNA were significantly lower in

关 键 词：甲泼尼龙 脊髓缺血 再灌注损伤 半胱氨酸天冬氨酸蛋白酶3 RNA 长链非编码 

分 类 号：R651.2[医药卫生—外科学]