常压氧联合高压氧对急性脑梗死患者血清细胞间黏附分子及基质金属蛋白酶-9的影响

Effect of normobaric oxygen combined with hyperbaric oxygen on serum soluble intercellular adhesion molecule and matrix metalloproteinase-9 in patients with acute cerebral infarction

摘要:

目的 探讨常压氧（NBO）联合高压氧（HBO）对急性脑梗死血清细胞间黏附分子及基质金属蛋白酶-9（MMP-9）水平的影响。方法 选择2011年12月至2014年3月在青岛市中心医院神经内科住院且发病24h内来院就诊的168例急性脑梗死患者为急性脑梗死组，将其随机分为常规治疗、HBO治疗及NBO联合HBO治疗3个亚组，分别在治疗前、治疗10d后采用酶联免疫吸附法（ELISA）测定各亚组血清可溶性细胞间黏附分子（sICAM-1）、可溶性E-选择素（sE-selectin，sES）及MMP-9水平，分析各亚组治疗前后神经功能缺损变化。另以50名正常人组成正常对照组。结果 3个亚组治疗10d后，血清sICAM-1、sES和MMP-9水平分别较治疗前显著下降（t＝8.754～11.351，P＜0.01）；HBO亚组、NBO＋HBO亚组患者显著低于常规亚组（t＝2.237～4.162，P＜0.05或0.01）；与HBO亚组比较，NBO+HBO亚组患者血清sICAM-1、sES和MMP-9水平均显著下降（t＝2.141～2.366，P＜0.01）；HBO亚组、NBO＋HBO亚组治疗10d后，NIHSS评分较常规亚组显著下降（t＝5.367，P＜0.01；t＝9.943，P＜0.01），而NBO＋HBO亚组较HBO亚组治疗后NIHSS评分显著下降，差异具有统计学意义（t＝2.827，P＜0.01）。结论 NBO联合HBO治疗抑制血清sICAM-1、sES和MMP-9水平优于HBO亚组，且更能改善急性脑梗死患者临床预后。

Abstract:

Objective To determine the effect of the combination of normobaric oxygen (NBO) and hyperbaric oxygen (HBO) on the serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin, sES) and matrix metalloproteinase-9 (MMP-9) in the patients with acute cerebral infarction. Methods A total of 168 patients with acute cerebral infarction within 24 h after onset hospitalized in our department from December 2011 to March 2014 were enrolled in this study as acute cerebral ischemia group. They were prospectively and randomly divided into 3 subgroups, that is, routine treatment subgroup, HBO subgroup and NBO+HBO subgroups. Their serum levels of sICAM-1, sES and MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA) before and at 10d after treatment. The National Institutes of Health Stroke Scale (NIHSS) was employed to assess their neurological defects. The other 50 practical health persons were enrolled as control group. Results After 10 days’ treatment, the serum levels of sICAM-1, sES and MMP-9 were significantly decreased in all 3 treatment groups. (t＝8.754?11.351，P＜0.01), with those of HBO and NBO+HBO subgroups obviously lower than the routine group (t＝2.237?4.162, P＜0.05 or 0.01). Compared with the HBO subgroup, these levels were more significantly decreased in the NBO+HBO subgroup (t＝2.141?2.366, P＜0.01). The HBO and NBO+HBO subgroups had markedly lower NIHSS scores than the routine subgroup at 10d after treatment (t＝5.367, P＜0.01; t＝9.943, P＜0.01), and the scores of the NBO+HBO subgroup were more significantly decreased than that of HBO subgroup (t＝2.827, P＜0.01). Conclusion The combined therapy of NBO+HBO is superior to HBO monotheray in the inhibition of serum sICAM-1, sES and MMP-9 levels, and improves the clinical prognosis of the patients with acute cerebral infarction.