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目的探讨高压氧(HBO)治疗对急性脑梗死患者血清细胞黏附分子及基质金属蛋白-9 (MMP-9)水平的影响及其临床意义。方法将112例颈内动脉系统脑梗死患者随机分为HBO治疗组(HBO组)50例和常规治疗组(常规组)62例。常规组仅给予临床常规治疗,HBO组在常规治疗的基础上加用HBO治疗。另选择性别、年龄与之匹配的正常人30名,作为正常对照组(对照组)。采用酶联免疫吸附法检测HBO组和常规组患者治疗前、后以及对照组血清可溶性细胞间黏附分子(sICAM-1)、可溶性血管细胞黏附分子(sVCAM-1)、可溶性E-选择素(sE-selectin)以及MMP-9的水平。于治疗前与治疗10,30 d后,采用美国国立卫生院脑卒中评分量表(NIHSS)对HBO组和常规组进行评分,评定其临床疗效。结果与对照组比较,HBO组和常觇组入院时血清sICAM-1、sVCAM-1、sE-selectin和MMP-9浓度均明显增高(P<0.01)。HBO组和常规组各检测指标治疗前比较,差异无统计学意义(P>0.05),治疗10d后均有下降(P<0.01),且HBO组低于常规组(P<0.05或0.01)。HBO组与常规组经治疗后,NIHSS评分明显下降(P<0.05或0.01),治疗30d后,HBO组NIHSS评分明显低于常规组(P<0.05),2组临床疗效比较,HBO组优于常规组(P<0.05)。结论HBO辅助治疗能显著降低脑梗死患者血清sICAM-1、sVCAM-1、sE-selectin和MMP-9的水平,提高临床疗效;HBO可能通过影响细胞黏附功能和MMP-9的表达发挥治疗作用。
Objective To investigate the effects of hyperbaric oxygen therapy (HBO) on the serum levels of cell adhesion molecules and matrix metalloprotein-9 (MMP-9) in patients with acute cerebral infarction and its clinical significance. Methods One hundred and twelve patients with internal carotid artery cerebral infarction were randomly divided into HBO treatment group (HBO group) 50 cases and routine treatment group (conventional group) 62 cases. The routine group was given only routine clinical treatment, HBO group on the basis of conventional treatment plus HBO treatment. In addition, 30 healthy subjects matched with their gender and age were selected as normal control group (control group). Serum levels of soluble intercellular adhesion molecule (sICAM-1), soluble vascular cell adhesion molecule (sVCAM-1) and soluble E-selectin (sE) were measured by enzyme-linked immunosorbent assay before and after treatment in HBO group and control group -selectin) and MMP-9 levels. Before treatment and after treatment for 10 and 30 days, the National Institutes of Health Stroke Scale (NIHSS) was used to score HBO group and conventional group, and the clinical efficacy was evaluated. Results Compared with the control group, the concentrations of sICAM-1, sVCAM-1, sE-selectin and MMP-9 in HBO group and normal control group were significantly increased at admission (P <0.01). There was no significant difference between the HBO group and the routine group before treatment (P> 0.05). The levels of HBO group and conventional group were lower than those of the conventional group (P <0.05 or 0.01) after 10 days of treatment. After treatment, the NIHSS scores decreased significantly in HBO group and conventional group (P <0.05 or 0.01). After 30 days of treatment, the NIHSS score in HBO group was significantly lower than that in routine group (P <0.05). The clinical efficacy was better in HBO group than in HBO group Conventional group (P <0.05). Conclusion HBO adjuvant therapy can significantly reduce the serum levels of sICAM-1, sVCAM-1, sE-selectin and MMP-9 in patients with cerebral infarction and improve the clinical curative effect. HBO may play a therapeutic role by affecting cell adhesion and MMP-9 expression.