重复经颅磁刺激联合丁苯酞对脑卒中后运动功能恢复及血清学指标的影响-东南大学学报医学版

重复经颅磁刺激联合丁苯酞对脑卒中后运动功能恢复及血清学指标的影响

作者：程明王跃

单位：四川省医学科学院·四川省人民医院骨科, 四川成都 610072

分类号：R743.33

出版年·卷·期（页码）：2017·36·第六期（946-950）

摘要：

目的：探讨重复经颅磁刺激联合丁苯酞对脑卒中患者运动功能及血清学指标的影响。方法：将167例脑卒中患者随机分为观察组85例和对照组82例。两组均常规补液联合丁苯酞治疗，在此基础上，观察组予重复经颅磁刺激治疗。分别于治疗前和治疗后7、14、28 d对患者行美国国立卫生研究院卒中量表（NIHSS）评分，并于治疗前和治疗28 d后测量运动诱发电位（MEP）潜伏期，计算中枢运动传导时间（CMCT），同时检测两组血清NSE、S100B和GFAP水平。结果：观察组治疗7 d后临床症状明显改善，对照组治疗28 d后症状好转；治疗14、28 d神经功能恢复观察组优于对照组，且治疗后28 d有效率和痊愈率观察组高于对照组；MEP潜伏期和CMCT观察组均较对照组明显缩短（P<0.05），血清NSE、S100B和GFAP水平观察组明显低于对照组，差异均有统计学意义（P<0.05）。结论：重复经颅磁刺激联合丁苯酞治疗能明显促进脑卒中患者的运动功能恢复，并降低患者血清NSE、S100B和GFAP表达水平。

Objective: To investigate the effects of repetitive transcranial magnetic stimulation combined with butylphthalide on motor function and serum makers in stroke patients. Methods: One hundred and sixty-seven patients with stroke were divided into two groups: the observation group (n=85) and the control group(n=82). Both groups were given the routine treatment and butylphthalide. On this basis the observation group was treated with repetitive transcranial magnetic stimulation.All the patients were evaluated using America National Institutes of Health Stroke Scale(NIHSS) before and 7,14,28 d after treatment.The motor evoked potentials (MEP) and central motor conduction time (CMCT) were measured before and at 28 d after the treatment; serum NSE,S100B and GFAP levels in the two groups were also tested. Results: The clinical symptoms of patients in observation group were improved at 7 d, while patients in the control group were improved at 28 d. NIHSS of patients in the observation group was better than patients in the control group at 14 and 28 d, the effective and the cure rate of the observation group were significantly higher than those of the control group. MEP, CMCT were shorter in the observation group than those in the control group(P<0.05) and serum NSE, S100B and GFAP levels in the observation group were lower than those in the control group, the difference were statistically significant(P<0.05). Conclusion: Repetitive transcranial magnetic stimulation combined with butylphthalide can improve motor function,and down-regulate the expression of serum NSE, S100B and GFAP in patients with stroke.

参考文献：

[1] 肖斌.低频重复经颅磁刺激联合丁苯酞治疗对脑梗死患者神经及运动功能的影响[J].中国实用神经疾病杂志,2017,20(4):59-61.
[2] 万长明.丁苯酞治疗急性脑梗死老年患者的疗效及对血清中S100 B、Hcy和ANG-1的影响[J].东南大学学报:医学版,2015,34(1):79-82.
[3] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[4] SUN Y,LIU K,ZHANG T,et al.The neuroprotective effect and probable mechanism of DL-3-n-butylphthalide in brain diseases[J].Integr Med Int,2014(1):51-55.
[5] YAN H,YAN Z,NIU X,et al.Dl-3-n-butylphthalide can improve the cognitive function of patients with acute ischemic stroke:a prospective intervention study[J].Neurol Res,2017,39(4):1-7.
[6] CHEN X,WANG K.The fate of medications evaluated for ischemic stroke pharmacotherapy over the period 1995-2015[J].Acta Pharm Sin B,2016,6(6):522-530.
[7] CORTI M,PATTEN C,TRIGGS W.Repetitive transcranial magnetic stimulation of motor cortex after stroke:a focused review[J].Am J Phys Med Rehabil,2012,91(3):254-270.
[8] MICHALSKI D,HEINDL M,KACZA J,et al.Spatio-temporal course of macrophage-like cell accumulation after experimental embolic stroke depending on treatment with tissue plasminogen activator and its combination with hyperbaric oxygenation[J].Eur J Histochem,2012,56(2):78-89.
[9] RODRÍGUEZ-RODRÍGUEZ A,EGEA-GUERRERO J J,GORDILLO-ESCOBAR E,et al.S100B and neuron-specific enolase as mortality predictors in patients with severe traumatic brain injury[J].Neurol Res,2016,38(2):130-137.
[10] BIELEWICZ J,KURZEPA J,CZEKAJSKA-CHEHAB E,et al.Worse neurological state during acute ischemic stroke is associated with a decrease in serum albumin levels[J].J Mol Neurosci,2016,58(4):493-496.
[11] THELIN E P,NELSON D W,BELLANDER B M.A review of the clinical utility of serum S100B protein levels in the assessment of traumatic brain injury[J].Acta Neurochir (Wien),2017,159(2):209-225.
[12] STANCA D M,MARGINEAN I C,SORITAU O,et al.GFAP and antibodies against NMDA receptor subunit NR2 as biomarkers for acute cerebrovascular diseases[J].J Cell Mol Med,2015,19(9):2253-2261.
[13] el-HELOW M R,ZAMZAM M L,FATHALLA M M,et al.Efficacy of modified constraint-induced movement therapy in acute stroke[J].Eur J Phys Rehabil Med,2015,51(4):371-379.

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