接受高压氧综合治疗的老年急性脑梗死患者血清YKL-40、VEGF的动态变化及其与预后的相关性  

Dynamic Changes of Serum YKL-40 and VEGF in Elderly Patients with Acute Cerebral Infarction Treated with Hyperbaric Oxygen and the Correlation of Prognosis

作　　者：陶兴 白永杰[2] 王佳 楚金亭[1] 孟凡超[2] 杨旭 孙世龙 白文杰[1] 周伟民 TAO Xing;BAI Yongjie;WANG Jia;CHU Jinting;MENG Fanchao;YANG Xu;SUN Shilong;BAI Wenjie;ZHOU Weimin(Department of Hyperbaric Oxygen Medicine,Zhengzhou Second People’s Hospital,Zhengzhou 450006,China;Department of Neurology,Zhengzhou Second People’s Hospital,Zhengzhou 450006,China;Disease Control Department,Zhengzhou Second People’s Hospital,Zhengzhou 450006,China)

机构地区：[1]郑州市第二人民医院高压氧医学科,河南郑州450006 [2]郑州市第二人民医院神经内科,河南郑州450006 [3]郑州市第二人民医院疾病控制科,河南郑州450006

出　　处：《河南医学研究》2024年第3期412-417,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191022)。

摘　　要：目的 探讨高压氧综合治疗老年急性脑梗死患者人类软骨糖蛋白39(YKL-40)、血管内皮生长因子(VEGF)动态变化及其与预后的相关性。方法 选取2019年1月至2022年12月郑州市第二人民医院神经内科收治的老年急性脑梗死患者51例,依据患者的治疗方式分为对照组23例,高压氧治疗组28例,对照组接受溶栓、营养神经、改善脑部循环、抗自由基等治疗;高压氧组则在常规治疗的基础上行高压氧治疗,舱压0.2 MPa,每日1次,10次为1个疗程,治疗2个疗程。分别于入院第1天和治疗后,观察并分析两组患者的美国国立卫生研究院卒中量表,并观察高压氧综合治疗对不同时间(入院第1、4、7、14天)血清YKL-40、VEGF动态变化水平和预后相关性分析。结果 对照组、高压氧组血清YKL-40水平随着病程进展呈动态变化,于发病第4天达峰值,第7天出现下降(P<0.05),高压氧组低于对照组(P<0.05),VEGF水平随着病程进展逐渐升高,于发病第7天达峰值(P<0.05),高压氧组高于对照组(P<0.05)。高压氧组好转患者多于未好转者,好转组发病第4、7天血清YKL-40水平低于未好转组(P<0.05),血清VEGF治疗第4、7天高于未好转组(P<0.05)。相关分析示血清YKL-40水平与脑梗死患者近期预后呈负相关(P<0.05),血清VEGF与脑梗死患者近期预后呈正相关(P<0.05)。二元logistic回归分析结果显示:高压氧治疗后VEGF(β=0.033,P=0.045)、YKL-40(β=-0.098,P=0.025)与老年脑梗死患者预后独立相关。结论 高压氧治疗可有效改善脑梗死患者神经功能缺失,减轻患者机体炎症反应,YKL-40水平可以作为评价高压氧综合治疗后脑梗死患者病情和判断预后的指标。Objective To investigate the changes of serum human cartilage glycoprotein 39(YKL-40)and vascular endothelial growth factor(VEGF)levels and the correlation of prognosis in hyperbaric oxygen comprehensive treatment in elderly acute cerebral infarction.Methods Fifty-one cases of elderly patients with acute cerebral infarction admitted to the Department of Neurology of the Zhengzhou Second People’s Hospital from January 2019 to December 2022 were selected and divided into 23 cases in the control group and 28 cases in the hyperbaric oxygen therapy group according to the treatment modality of the patients.The control group received conventional treatment such as thrombolysis,improvement of microcirculation and nerve nutrition.The hyperbaric oxygen group was given conventional treatment along with hyperbaric oxygen therapy,hyperbaric oxygen therapy was administered at a chamber pressure of 0.2 MPa once a day,10 times for 1 course of treatment,2 courses of treatment.The National Institute of Health stroke scale was observed and analyzed before and after treatment,and the dynamic changes in serum YKL-40 and VEGF levels at different times(admission,4,7 and 14 days)and prognostic correlation were observed by hyperbaric oxygen therapy.Results The serum YKL-40 levels in the control group and hyperbaric group changed dynamically as the disease progressed,peaking at fourth day after onset and decreasing at seventh day(P<0.05),and the hyperbaric group was lower than the control group(P<0.05).The VEGF levels gradually increased as the disease progressed,peaking at seventh day after onset(P<0.05),and the hyperbaric group was higher than the control group(P<0.05).Improved patients in hyperbaric oxygen group were more than non-improved patients.The serum YKL-40 level was lower in the improved group than in the non-improved group on the 4th and 7th day of treatment(P<0.05),and the serum VEGF level was higher in the improved group than that in the non-improved group on the 4th and 7th day of treatment(P<0.05).Correlation analysis s

关 键 词：高压氧 急性脑梗死 人类软骨糖蛋白39 血管内皮生长因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]