方理超; 安堃; 华燕琴; 范诚; 王晓旻; 乔世刚

doi:10.3760/cma.j.issn.1671-0282.2019.03.009

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• 颅脑急危重症 •

依达拉奉辅助脑苷肌肽对重症颅脑损伤患者的保护作用

中华急诊医学杂志, 2019,28(3) : 319-323. DOI: 10.3760/cma.j.issn.1671-0282.2019.03.009

摘要

目的

探究依达拉奉辅助脑苷肌肽治疗重症颅脑损伤患者的作用效果以及与神经胶质纤维酸性蛋白（glial fiber acidic protein, GFAP）、泛素羧基末端水解酶-L1（ubiquitin carboxyl terminal-L1, UCH-L1）的影响。

方法

纳入苏州市相城人民医院于2016年1月至2017年12月期间收治的123例重症颅脑损伤患者。根据随机数字表法分为观察组和对照组，其中观察组61例，对照组62例。对照组给予脑苷肌肽治疗，观察组在对照组基础上给予依达拉奉治疗。比较两组患者的临床疗效，同时监测治疗前后血清丙二醇（malonaldehyde, MDA）、超氧化物歧化酶（superoxide dismutase, SOD）、髓过氧化物酶（myeloperoxidase, MPO）、基质金属蛋白酶-9（matrix metalloproteinases, MMP-9）、GFAP、UCH-L1水平及治疗过程中不良反应发生率。

结果

治疗后两组APACHEⅡ评分均降低（t=15.88，P=0.008；t=25.17，P=0.003），且观察组低于对照组，差异有统计学意义（t=15.95，P=0.013）；治疗后两组日常生活能力（ADL）评分均升高（t=5.58，P=0.025；t=19.13，P=0.008），且观察组高于对照组，差异有统计学意义（t=11.24，P=0.012）；治疗后两组MDA、SOD、MPO均升高，且观察组高于对照组，差异有统计学意义（t=11.41，P=0.024；t=2.03，P=0.22；t=7.16，P=0.038）；治疗后两组MMP-9均下降，且观察组低于对照组，差异有统计学意义（t=16.25，P=0.012）；治疗后两组GFAP（t=31.79，P=0.016；t=53.83，P=0.011）、UCH-L1（t=10.27，P=0.047；t=18.31，P=0.019）均下降，且观察组低于对照组，差异有统计学意义（t=43.90，P=0.014；t=15.31，P=0.035）。观察组不良反应总发生率为8.06%，对照组不良反应总发生率为9.83%，差异无统计学意义（χ²=0.088，P=0.719）。

结论

依达拉奉辅助脑苷肌肽治疗重症颅脑损伤，可以有效保护神经细胞，改善神经功能，提高临床疗效，显著提高机体抗氧化能力，降低血清GFAP、UCH-L1水平，且安全性较好。

引用本文: 方理超, 安堃, 华燕琴, 等. 依达拉奉辅助脑苷肌肽对重症颅脑损伤患者的保护作用 [J] . 中华急诊医学杂志, 2019, 28(3) : 319-323. DOI: 10.3760/cma.j.issn.1671-0282.2019.03.009.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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颅脑损伤是指外力作用于头部引起的颅骨、脑膜、脑组织及脑血管等损伤导致的神经外科疾病，具有较高的伤残率和致死率^[1,2]。由于颅脑机械损伤可引起神经功受损、颅内压增高、局部脑组织缺氧缺血，重症患者的病情进展迅速多变，严重威胁患者的生命安全^[3]。脑苷肌肽能够改善脑组织的新陈代谢与血液功能，常用于治疗颅脑损伤引起的功能障碍。依达拉奉具有清除氧自由基的作用，可以抑制脑水肿和脑组织损伤。神经胶质纤维酸性蛋白（glial fiber acidic protein, GFAP）主要由神经元细胞和神经胶质细胞分泌，可反映神经损伤程度；泛素羧基末端水解酶-L1（ubiquitin carboxyl terminal-L1，UCH-L1）是一种半胱氨酸特异性水解酶，在一定程度上可反映颅脑损伤的程度^[4]。本研究通过依达拉奉联合辅助脑苷肌肽治疗重症颅脑损伤的作用效果，并探究其对GFAP、UCH-L1水平的影响。

贡献者信息

方理超

苏州市相城人民医院重症医学科　215131

安堃

苏州市相城人民医院重症医学科　215131

华燕琴

苏州市相城人民医院重症医学科　215131

范诚

苏州市相城人民医院重症医学科　215131

王晓旻

苏州市相城人民医院重症医学科　215131

乔世刚

苏州科技城医院麻醉及围术期医学科　215153；南京医科大学附属苏州医院临床医学研究所　215153

通信作者

乔世刚

苏州科技城医院麻醉及围术期医学科　215153；南京医科大学附属苏州医院临床医学研究所　215153

Email：qiaoshigang@163.com

关键词

重症颅脑损伤; 依达拉奉; 神经胶质纤维酸性蛋白; 泛素羧基末端水解酶-L1;

基金项目

苏州市"科教兴卫"青年计划项目（KJXW2015062）

苏州市相城区科技计划项目（XJ201657）

苏州市高新区医疗卫生科技计划重点项目（2016Z002）

江苏省青年医学人才项目（QNRC2016219）

历史

出版日期：2019-03-10

收稿日期：2018-07-26

本文编辑

郑辛甜

Cerebral Critical Illness

Effect of edaravin combined with cerebroside-kinin maintenance of neurological function in patients with severe craniocerebral injury

Lichao Fang, Kun An, Yanqin Hua, Cheng Fan, Xiaomin Wang, Shigang Qiao

Published 2019-03-10

Cite as Chin J Emerg Med, 2019, 28(3): 319-323. DOI: 10.3760/cma.j.issn.1671-0282.2019.03.009

Abstract

Objective

To observe the influence of edaravin combined with cerebroside-kinin on the level of glial fiber acidic protein (GFAP) and ubiquitin carboxyl terminal-L1 (UCH-L1) in the treatment of severe craniocerebral injury.

Methods

From January 2016 to December 2017, a total of 123 patients with severe craniocerebral injury were selected in our hospital, and randomly(random number) assigned to the observation group (61 cases) and control group (62 cases). Patients in the control group were given cerebroside-kinin, and patients in the observation group were given cerebroside-kinin and edaravone. The acute physiology and chronic health evaluation score (APACHEⅡ), activities of daily living (ADL) score, serum malonaldehyde (MDA), superoxide dismutase (SOD), myeloperoxidase (MPO), matrix metalloprotein 9 (MMP-9), GFAP and UCH-L1 before and after treatment were observed. The side effects were also recorded.

Results

The APACHEⅡ score was significantly reduced in both groups after treatment (P=0.008; P=0.003), and was lower in the observation group than that in the control group (P=0.013). The ADL score of both groups increased after treatment (P=0.025; P=0.008), and was higher in the observation group than that in the control group (P=0.012). After treatment the levels of MDA, SOD and MPO in the observation group were significantly higher than those in the control group (P<0.05); the level of MMP-9 in the observation group was significantly lower than that in the control group (P=0.012); the levels of GFAP and UCH-L1 in the observation group were significantly higher than those in the control group (P=0.014; P=0.035). There was no significant difference of the total side effect incidence between the observation group and the control group (8.06% vs 9.83%,χ²=0.088, P=0.719).

Conclusions

The treatment by edaravone combined with cerebroside-kinin on severe craniocerebral injury may effectively protect the nerve cells, improve nerve function, clinical efficacy and the body's antioxidant capacity, reduce the serum levels of GFAP, UCH-L1, and have better safety.

Key words:

Severe craniocerebral injury; Edaravone; Glial fiber acidic protein; Ubiquitin carboxyl terminal-L1

Contributor Information

Lichao Fang