CAJ | 학술논문

目的观察早期运动训练对急性脑卒中(AIS)患者内皮祖细胞(EPCs)含量及临床疗效的影响.方法共选取AIS患者120例,按照随机数字表法将其分为运动组(60例)和对照组(60例).所有患者均接受脑卒中常规治疗及基本康复训练,运动组在此基础上辅以早期运动训练.运动前及运动14d后,抽取患者静脉血5 ml(抗凝),采用流式细胞术(FCM)检测EPCs含量,另抽取5 ml静脉血(非抗凝),采用酶联免疫吸附法(ELISA)测定血清血管内皮细胞生长因子(VEGF)含量,并采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能评分(FMA)、改良Barthel指数(MBI)对患者的神经功能、运动功能及日常生活活动(ADL)能力进行评定.结果 2组患者EPCs细胞数、VEGF含量及NIHSS评分与组内运动前比较,差异均有统计学意义(P＜0.05).运动14 d后,运动组患者EPCs细胞数由[(27.93±6.08)个/ml]升高到[(457.49±73.02)个/ml] (P ＜0.05),对照组患者EPCs细胞数由[(28.29±5.93)个/ml]升高到[(81.87±9.92)个/ml] (P＜ 0.05).运动14 d后,运动组VEGF的表达量[(968.19±67.40) ng/L]较对照组[(353.85 ±74.03)ng/L]明显升高(P＜0.05).2组患者运动14 d后NIHSS、FMA、MBI评分间比较,差异均无统计学意义(P＞0.05).结论早期运动训练能够促进AIS患者EPCs数量增加,显著改善患者的神经功能,其机制可能与VEGF水平上调有关.
목적 관찰조기운동훈련대급성뇌졸중(AIS)환자내피조세포(EPCs)함량급림상료효적영향.방법 공선취AIS환자120례,안조수궤수자표법장기분위운동조(60례)화대조조(60례).소유환자균접수뇌졸중상규치료급기본강복훈련,운동조재차기출상보이조기운동훈련.운동전급운동14d후,추취환자정맥혈5 ml(항응),채용류식세포술(FCM)검측EPCs함량,령추취5 ml정맥혈(비항응),채용매련면역흡부법(ELISA)측정혈청혈관내피세포생장인자(VEGF)함량,병채용미국국립위생연구원졸중량표(NIHSS)、Fugl-Meyer운동공능평분(FMA)、개량Barthel지수(MBI)대환자적신경공능、운동공능급일상생활활동(ADL)능력진행평정.결과 2조환자EPCs세포수、VEGF함량급NIHSS평분여조내운동전비교,차이균유통계학의의(P＜0.05).운동14 d후,운동조환자EPCs세포수유[(27.93±6.08)개/ml]승고도[(457.49±73.02)개/ml] (P ＜0.05),대조조환자EPCs세포수유[(28.29±5.93)개/ml]승고도[(81.87±9.92)개/ml] (P＜ 0.05).운동14 d후,운동조VEGF적표체량[(968.19±67.40) ng/L]교대조조[(353.85 ±74.03)ng/L]명현승고(P＜0.05).2조환자운동14 d후NIHSS、FMA、MBI평분간비교,차이균무통계학의의(P＞0.05).결론 조기운동훈련능구촉진AIS환자EPCs수량증가,현저개선환자적신경공능,기궤제가능여VEGF수평상조유관.
Objective To observe the effects on and the possible mechanism of early exercise training underlying the mobilization of circulating endothelial progenitor cells in patients with acute ischemic stroke.Methods One hundred and twenty patients with acute ischemic stroke were randomized into two groups:an early exercise group (treated with exercise training,n =60) and a control group(no exercise training,n =60).Meanwhile,each group was divided into two different age groups (50-68 years group of 32 cases,＞ 68 years group of 28 cases in exercise group;50-68 years group of 29 cases,＞ 68 years of 31 cases in control group).The amount of circulating endothelial progenitor cells in peripheral blood was accounted by flow cytometry (FCM),while the level of vascular endothelial cell growth factor (VEGF) in blood serum was examined by enzyme-linked immunoassay (ELISA).National Institutes of Health Stroke Scale (NIHSS),Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) were used to evaluate the patients at 1st day and 14th day after exercise.Results The amount of circulating progenitor cells after 14 days of exercise training in exercise group (from 27.93 ± 6.08/ml to 457.49 ± 73.02/ml)is higher than in control group(from 28.29 ± 5.93/ml to 81.87 ± 9.92/ml) (P ＜ 0.01).Compared with the control group,the level of VEGF at 14th day of exercise group is significantly higher (P ＜ 0.01).The score of NIHSS,FMA,MBI were not significantly different between exercise group and control group (P ＜ 0.01).However,the score of NIHSS was decrease in both exercise group and control group after treatment.Furthermore,the amount of circulating progenitor cells was not significantly different between the age groups either in exercise group or control group (P ＞ 0.05).Conclusion Early Exercise training may promote the mobilization of the circulating progenitor cells,which might be related to the increase of VEGF.The mobilization of the EPCs has no effect on the early neurological function after acute ischemic stroke.Age is not associated with the amount of circulating endothelial progenitor cells.