国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
1期
39-43
,共5页
李影%黄永璐%张敬苗%瞿萍%高宗良
李影%黃永璐%張敬苗%瞿萍%高宗良
리영%황영로%장경묘%구평%고종량
卒中%脑缺血%羟甲基戊二酰基CoA还原酶抑制剂%阿托伐他汀%物理治疗方法%脑源性神经营养因子
卒中%腦缺血%羥甲基戊二酰基CoA還原酶抑製劑%阿託伐他汀%物理治療方法%腦源性神經營養因子
졸중%뇌결혈%간갑기무이선기CoA환원매억제제%아탁벌타정%물리치료방법%뇌원성신경영양인자
Stroke%Brain Ischemia%Hydroxymethylglutaryl-CoA Reductase Inhibitors%Atorvastatin%Physical Therapy Modalities%Brain-Derived Neurotrophic Factor
目的 探讨早期物理治疗联合阿托伐他汀对急性缺血性卒中患者血清脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)水平和神经功能的影响.方法 50例急性缺血性卒中患者随机分为阿托伐他汀组(单用组,25例)和早期物理治疗联合阿托伐他汀组(联用组,25例).所有患者均根据缺血性卒中诊治指南给予规定药物,单用组加用阿托伐他汀钙(20 mg,每晚1片),联用组在单用组基础上给予早期物理治疗.在治疗前以及治疗2周和6周时采用双抗体夹心酶联免疫吸附试验检测血清BDNF水平,采用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评定神经功能缺损程度,Barthel指数(Barthel Index,BI)评定日常生活活动能力,改良Rankin量表(modified RankinScale,mRS)评定残疾程度.结果 单用组和联用组人口统计学和基线资料均无显著性差异.两组治疗后NIHSS、BI和mRS评分均显著性优于治疗前(P均＜0.001),治疗前和治疗2周时两组间NIHSS、BI和mRS评分均无显著性差异,但在治疗6周时,联用组NIHSS[(2.40±1.38)分对(3.36±1.73)分,P=0.035]和mRS评分[(1.40±0.87)分对(1.96±0.94)分,P=0.047]显著性低于单用组,BI评分[(92.60±7.50)分对(85.20±11.68)分,P=0.011]显著性高于单用组.两组治疗后血清BDNF水平均显著性增高,各时间点之间差异有显著性(P均＜0.001);联用组血清BDNF水平在治疗2周时[(3.07±0.93)ng/ml对(2.45±0.76) ng/ml;t=2.559,P=0.014]和6周时[(2.90±0.93) ng/ml对(2.31±0.77)ng/ml;t=2.433,P=0.019]均显著高于单用组.Spearman相关性分析显示,血清BDNF水平与NIHSS(r=-0.738,P＜0.001)和mRS评分(r=-0.654,P＜0.001)呈显著性负相关,而与BI评分呈显著性正相关(r=0.716,P＜0.001).两组患者均未出现严重不良反应.结论 早期物理治疗与阿托伐他汀联合应用治疗急性缺血性卒中能更有效地促进神经功能恢复,其机制可能与提高血清BDNF水平有关.
目的 探討早期物理治療聯閤阿託伐他汀對急性缺血性卒中患者血清腦源性神經營養因子(brain-derived neurotrophic factor,BDNF)水平和神經功能的影響.方法 50例急性缺血性卒中患者隨機分為阿託伐他汀組(單用組,25例)和早期物理治療聯閤阿託伐他汀組(聯用組,25例).所有患者均根據缺血性卒中診治指南給予規定藥物,單用組加用阿託伐他汀鈣(20 mg,每晚1片),聯用組在單用組基礎上給予早期物理治療.在治療前以及治療2週和6週時採用雙抗體夾心酶聯免疫吸附試驗檢測血清BDNF水平,採用美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評定神經功能缺損程度,Barthel指數(Barthel Index,BI)評定日常生活活動能力,改良Rankin量錶(modified RankinScale,mRS)評定殘疾程度.結果 單用組和聯用組人口統計學和基線資料均無顯著性差異.兩組治療後NIHSS、BI和mRS評分均顯著性優于治療前(P均＜0.001),治療前和治療2週時兩組間NIHSS、BI和mRS評分均無顯著性差異,但在治療6週時,聯用組NIHSS[(2.40±1.38)分對(3.36±1.73)分,P=0.035]和mRS評分[(1.40±0.87)分對(1.96±0.94)分,P=0.047]顯著性低于單用組,BI評分[(92.60±7.50)分對(85.20±11.68)分,P=0.011]顯著性高于單用組.兩組治療後血清BDNF水平均顯著性增高,各時間點之間差異有顯著性(P均＜0.001);聯用組血清BDNF水平在治療2週時[(3.07±0.93)ng/ml對(2.45±0.76) ng/ml;t=2.559,P=0.014]和6週時[(2.90±0.93) ng/ml對(2.31±0.77)ng/ml;t=2.433,P=0.019]均顯著高于單用組.Spearman相關性分析顯示,血清BDNF水平與NIHSS(r=-0.738,P＜0.001)和mRS評分(r=-0.654,P＜0.001)呈顯著性負相關,而與BI評分呈顯著性正相關(r=0.716,P＜0.001).兩組患者均未齣現嚴重不良反應.結論 早期物理治療與阿託伐他汀聯閤應用治療急性缺血性卒中能更有效地促進神經功能恢複,其機製可能與提高血清BDNF水平有關.
목적 탐토조기물리치료연합아탁벌타정대급성결혈성졸중환자혈청뇌원성신경영양인자(brain-derived neurotrophic factor,BDNF)수평화신경공능적영향.방법 50례급성결혈성졸중환자수궤분위아탁벌타정조(단용조,25례)화조기물리치료연합아탁벌타정조(련용조,25례).소유환자균근거결혈성졸중진치지남급여규정약물,단용조가용아탁벌타정개(20 mg,매만1편),련용조재단용조기출상급여조기물리치료.재치료전이급치료2주화6주시채용쌍항체협심매련면역흡부시험검측혈청BDNF수평,채용미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평정신경공능결손정도,Barthel지수(Barthel Index,BI)평정일상생활활동능력,개량Rankin량표(modified RankinScale,mRS)평정잔질정도.결과 단용조화련용조인구통계학화기선자료균무현저성차이.량조치료후NIHSS、BI화mRS평분균현저성우우치료전(P균＜0.001),치료전화치료2주시량조간NIHSS、BI화mRS평분균무현저성차이,단재치료6주시,련용조NIHSS[(2.40±1.38)분대(3.36±1.73)분,P=0.035]화mRS평분[(1.40±0.87)분대(1.96±0.94)분,P=0.047]현저성저우단용조,BI평분[(92.60±7.50)분대(85.20±11.68)분,P=0.011]현저성고우단용조.량조치료후혈청BDNF수평균현저성증고,각시간점지간차이유현저성(P균＜0.001);련용조혈청BDNF수평재치료2주시[(3.07±0.93)ng/ml대(2.45±0.76) ng/ml;t=2.559,P=0.014]화6주시[(2.90±0.93) ng/ml대(2.31±0.77)ng/ml;t=2.433,P=0.019]균현저고우단용조.Spearman상관성분석현시,혈청BDNF수평여NIHSS(r=-0.738,P＜0.001)화mRS평분(r=-0.654,P＜0.001)정현저성부상관,이여BI평분정현저성정상관(r=0.716,P＜0.001).량조환자균미출현엄중불량반응.결론 조기물리치료여아탁벌타정연합응용치료급성결혈성졸중능경유효지촉진신경공능회복,기궤제가능여제고혈청BDNF수평유관.
Objective To investigate the effects of early physiotherapy in combination with atorvastatin on the levels of serum brain-derived neurotrophic factor (BDNF) and neurological function in patients with acute ischemic stroke.Methods Fifty patients with acute ischemic stroke were randomly divided into either an atorvastatin group (monotherapy group,n =25) or a early physiotherapy + atorvastatin group (combination treatment group,n =25).All patients received the prescribed drugs according to the diagnosis and treatment guidelines for ischemic stroke.The monotherapy group added atorvastatin calcium (20 mg,1 tablet every night orally).On the basis of the monotherapy group,the combination treatment group also conducted early physical therapy.At 2 and 6 weeks before and after treatment,a double-antboody sandwich enzyme-linked immunosorbent assay was used to detect the serum BDNF levels.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit.Barthel index (BI) was used to evaluate the activities of daily living.The modified Rankin scale (mRS) was used to assess the degree of disability.Results There was no significant difference in demographics and baseline data between the monotherapy group and the combination treatment group.The scores of NIHSS,BI,and mRS in both groups after treatment were significantly better than those before treatment (all P ＜ 0.001).There were no difference in the scores of NIHSS,BI and mRS at 2 weeks before and after treatment,but at 6 weeks after treatment,the scores of NIHSS (2.40 ± 1.38 vs.3.36 ± 1.73; P =0.035) and mRS (1.40 ± 0.87 vs.1.96 ±0.94; P =0.047) of the combination treatment group were significantly lower than those of the monotherapy group,and the BI scores (92.60 ±7.50 vs.85.20 ± 11.68; P=0.011) were significantly higher than those of the monotherapy group.After treatment,the serum BDNF levels were increased significantly in both groups.There were significant differences among all the time points (all P＜0.001).At 2 weeks after treatment,the serum BDNF levels (3.07 ±0.93 ng/ml vs.2.45 ±0.76 ng/ml; t =2.559,P =0.014) and at 6 weeks after treatment,those (2.90 ± 0.93 ng/ml vs.2.31 ± 0.77 ng/ml; t =2.433,P =0.019) in the combination treatment group were significantly higher than those in the monotherapy group.Spearman correlation analysis showed that the serum BDNF levels were significantly negatively correlated with the scores of NIHSS (r =-0.738,P ＜ 0.001) and mRS (r =-0.654,P ＜ 0.001),but they were significantly positively correlated with the BI scores (r =0.716,P ＜ 0.001).No serious adverse reaction occurred in both groups.Conclusions Early physiotherapy in combination with atorvastatin for the treatment of acute ischemic stroke can more effectively promote the recovery of neurological function,and its mechanism may be associated with the increased serum BDNF levels.
