摘要
目的探讨神经节苷脂对弥漫性轴索损伤的神经保护作用及其对脑脊液神经元特异性烯醇化酶E(NSE)、S100B蛋白、髓鞘碱性蛋白(MBP)水平的影响。方法选取2013年12月至2016年12月确诊治疗的弥漫性轴索损伤患者100例,依据随机数表法随机分为联合苷脂组和常规高氧组,每组50例。常规高氧组患者给予常规激素、脱水降颅压、止血、维持水电解质平衡、营养神经、营养支持及补液等对症支持治疗和伤后48 h内的0.25 MPa高压氧治疗,联合苷脂组患者在此基础上给予40~80 mg神经节苷脂静脉滴注治疗,1次/d,随访6个月,采用美国国立卫生研究院卒中量表(NIHSS)评估神经功能,采用酶联免疫吸附法(ELISA)检测脑脊液NSE、S100B、MBP水平,采用日常生活能力量表(ADL)评估生活质量,统计分析所有患者治疗疗效、神经功能、觉醒、并发症、死亡发生情况和治疗前后脑脊液NSE、S100B、MBP水平及治疗后1、3、6个月生活质量情况。结果联合苷脂组患者治疗后NIHSS得分明显低于常规高氧组,前者治疗显效率明显高于后者,差异有统计学意义(P<0.05);联合苷脂组患者治疗后脑脊液NSE、S100B、MBP水平明显低于常规高氧组,差异有统计学意义(P<0.05);联合苷脂组患者治疗后觉醒率明显高于常规高氧组,前者平均觉醒时间、死亡率明显低于后者,差异有统计学意义(P<0.05);联合苷脂组和常规高氧组患者并发症发生率基本相同,差异无统计学意义(P<0.05);联合苷脂组患者治疗后3、6个月的ADL得分明显高于常规高氧组,差异有统计学意义(P<0.05)。结论神经节苷脂治疗可有效提高弥漫性轴索损伤患者的治疗疗效及神经保护作用,可有效促进患者觉醒和神经功能的恢复,有利于改善患者的生活质量及降低其死亡风险,其机制可能与改善脑内NSE、S100B、MBP水平有关,且无增加患者并发症发生的风险,值得临床作进一步推广。
Objective To investigate the neuroprotective effects and effects of ganglioside on neuron specificity enolization enzyme E（ NSE）,S100B protein and myelin basic protein（ MBP） levels in cerebrospinal fluid of patients with diffuse axonal injury. Methods One hundred patients with diffuse axonal injury who were treated in our hospital from December 2013 to December 2016 were randomly divided into combination treatment group,and conventional treatment group,with 50 patients in each group. The patients in conventional treatment groups were treated by conventional hormone,dehydration to decrease intracranial pressure,stopping bleeding,maintaining balance of water and electrolyte,trophic nerve,nutrition support,fluid replacement and 0. 25 MPa hyperbaric oxygen within 48 h after injury, however,the patients in combination treatment group,on the basis of conventional treatment group,were given ganglioside 40 ~ 80 mg by intravenous drip,once a day,then these patients were followed up for 6 months,the patient ＇s nerve function was evaluated by using U. S. national institutes of health stroke scale（ NIHSS） scores,and the levels of NSE,S100B,MBP in cerebrospinal fluid were detected by enzyme-linked immunosorbent assay（ ELISA）,and patient＇s life quality was evaluated by daily life ability scale（ ADL）,moreover,the therapeutic effects,neurological function,wakefulness,complications,death rates and the changes of NSE,S100B,MBP levels before and after treatment as well as patient＇s life quality on 1m,3m,6m after treatment were statistical analyzed and compared between two groups. Results After treatment the NIHSS scores in combination treatment group were significantly lower than those in conventional treatment group,moreover,the excellence rates in combination treatment group were significantly higher than those in conventional treatment group（ P 〈0. 05）. Moreover the levels of NSE,S100B,MBP in combination treatment group were significantly lower than those in conventional treatment group（ P 〈0.
出处
《河北医药》
CAS
2018年第3期332-336,共5页
Hebei Medical Journal
