2022 年第 2 期 第 17 卷

远隔缺血后适应治疗对急性脑梗死患者近期神经功能以及血清血管内皮生长因子和基质细胞衍生因子1α表达的影响 

Effects of remote ischemic postconditioning on short-term neurological function and expressions of serum vascular endothelial growth factor and stromal cell-derived factor-1α in patients with acute cerebral infarction

作者：李梦雨1吴小坤1刘斌1李长颖1王瑞敏2毛文静1任伯1邓春颍1

英文作者：Li Mengyu1 Wu Xiaokun1 Liu Bin1 Li Changying1 Wang Ruimin2 Mao Wenjing1 Ren Bo1 Deng Chunying1

单位：1华北理工大学附属医院神经内一科，唐山063000；2华北理工大学公共卫生学院，唐山063000

英文单位：1First Department of Neurology North China University of Science and Technology Affiliated Hospital Tangshan 063000 China; 2School of Public Health North China University of Science and Technology Tangshan 063000 China

关键词：脑梗死；远隔缺血后适应；神经功能；血管内皮功能；血管内皮生长因子；基质细胞衍生因子1α

英文关键词：Cerebralinfarction;Remoteischemicpostconditioning;Neurologicalfunction;Endothelialfunction;Vascularendothelialgrowthfactor;Stromalcell-derivedfactor-1α

• 摘要：

• 目的  探讨远隔缺血后适应（RIPostC）治疗对急性脑梗死患者近期神经功能以及血清血管内皮生长因子（VEGF）和基质细胞衍生因子1α（SDF-1α）表达的影响。方法  选择2019年1—12月华北理工大学附属医院神经内科住院，发病时间不超过72 h，入院时美国国立卫生研究院卒中量表（NIHSS）评分5～15分，且首次发病的前循环急性脑梗死患者239例作为研究对象。采用分层随机法将患者分为观察组（119例）和对照组（120例）。对照组给予常规药物治疗，观察组在其基础上加用RIPostC治疗。观察患者治疗前和治疗14、30、90 d时NIHSS评分，并随访90 d的复发情况。采用酶联免疫吸附试验法检测患者治疗前、治疗14 d时血清中VEGF和SDF-1α水平。结果  观察组NIHSS评分随时间降低的幅度大于对照组（F组间=5.485，P组间=0.020；F时间=1 130.875，P时间＜0.001；F交互=49.797，P交互＜0.001）。随访90 d结果显示，观察组复发率显著低于对照组［7.6%(9/119)比16.7%(20/120)］，差异有统计学意义（P＜0.05）。治疗14 d时，2组患者血清中VEGF、SDF-1α水平均高于治疗前，且观察组均高于对照组，差异均有统计学意义（均P＜0.05）。多因素分析结果显示，排除其他因素影响后，是否给予RIPostC治疗对患者血管内皮功能有影响（P＜0.05）。结论  RIPostC可显著改善急性脑梗死患者近期神经功能，降低复发率，并可上调血清VEGF和SDF-1α水平。

• Objective To observe the effects of remote ischemic postconditioning (RIPostC) on the short-term neurological function, serum vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1α(SDF-1α) expressions in patients with acute cerebral infarction. Methods Totally 239 patients with anterior circulation acute cerebral infarction admitted to Department of Neurology, North China University of Science and Technology Affiliated Hospital from January to December 2019 were enrolld. The patients were first onset of acute cerebral infarction, the onset time did not exceed 72 h and National Institutes of Health Stroke Scale (NIHSS) of patients ranged in 5-15 at admission . Patients were divide into observation group (119 cases) and control group (120 cases) by stratified random method. The control group was given conventional drug treatment, and the observation group was treated with RIPostC based on the control group. The NIHSS score before treatment, 14, 30 and 90 d after treatment, and recurrence followed-up 90 d were observed.Enzyme-linked immunosorbent assay was used to detect the serum VEGF and SDF-1α levels before treatment and 14 d after treatment. Results The extent of NIHSS score decreased over time in the observation group were greater than that in the control group （Ffor group=5.485，Pfor group=0.020；Ffor time=1 130.875，Pfor time＜0.001；Ffor interaction=49.797，Pfor interaction＜0.001）. Followed-up for 90 d, the recurrence rate in the observation group was significantly lower than that in the control group［7.6%(9/119) vs 16.7%(20/120)］（P＜0.05）. The serum levels of VEGF and SDF-1α in the two groups were higher than those before treatment on the 14th day, and those in the observation group were higher than those in the control group (all P＜0.05). Multivariate analysis showed that RIPostC treatment has an impact on the patient′s vascular endothelial function(P＜0.05). Conclusion RIPostC can significantly improve the short-term neurological function of patients with acute cerebral infarction, reduce the recurrence rate, and increase serum levels of VEGF and SDF-1α.