Effect of remote ischemic conditioning on neurological function,brain injury markers and vascular inflammatory mediators in patients with acute ischemic stroke after intravenous thrombolysis
10.7683/xxyxyxb.2024.06.014
- VernacularTitle:远隔缺血适应对静脉溶栓后急性缺血性脑卒中患者神经功能、脑损伤标志物及血管炎症介质的影响
- Author:
Fang XUE
1
;
An LI
;
Guowei XU
Author Information
1. 新乡医学院,河南 新乡 453003;郑州大学附属郑州中心医院神经内科,河南 郑州 450007
- Keywords:
remote ischemic conditioning;
intravenous thrombolysis;
acute ischemic stroke;
brain injury markers;
vascular inflammatory mediators
- From:
Journal of Xinxiang Medical College
2024;41(6):575-580
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of remote ischemic conditioning(RIC)on neurological function,brain injury markers and vascular inflammatory mediators in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods Ninety AIS patients admitted to the Department of Neurology of Zhengzhou Central Hospital Affiliated to Zhengzhou University from May 2022 to October 2022 were selected as the research subjects.The patients were divided into the RIC group(n=29),the pseudo-RIC group(n=30)and the control group(n=31)according to the treatment method.All patients in the three groups were treated with intravenous thrombolysis with alteplase.After 24 hours of thrombolysis,the patients in the RIC group were given RIC treatment,the patients in the pseudo-RIC group were given pseudo-RIC treatment,and the patients in the control group were not given RIC treatment.All patients in the three groups were treated for 14 days.Clinical data of patients in the three groups were collected,including age,gender,and history of smoking,drinking,hypertension,diabetes mellitus,coronary artery disease and stroke.About 4-5 mL of the fasting peripheral venous blood was drawn from the patients within 24 hours after admission to the hospital and was centrifuged to obtain the serum.The levels of triacylglycerol(TG),total cholesterol(TC),glycated hemoglobin(HbA1c)and serum creatinine(Scr)were detected;the levels of fibrinogen(FIB)and D-dimer were detected by using a blood coagulation analyzer.The peripheral venous blood(4-5 mL)was drawn from the patients in the three groups before treatment and on the 7th and 14th days of treatment and was centrifuged to obtain the serum.The levels of S100 calcium-binding protein β(S100β),lipoprotein-associated phospholipase A2(Lp-PLA2)and interleukin(IL)-6 were detected by using the enzyme-linked immunosorbent assay(ELISA).The neuron specific enolase(NSE)level was detected by using the double antibody sandwich ELISA.The National Institutes of Health Stroke Scale(NIHSS)and the modified Rankin scale(mRS)were used to assess the neurological impairment of patients in the three groups.The adverse reactions during RIC treatment in the three groups were recorded.Results The overall effective rates of patients in the control group,pseudo-RIC group and RIC group were 90.32％(28/31),90.00％(27/30)and 100.00％(29/29),respectively;there was no statistically significant difference in the overall effective rate among the three groups(x2=3.059,P＞0.05).There was no statistically significant difference in the serum TG,TC,HbA1c,Scr,FIB and D-dimer levels of patients among the control group,pseudo-RIC group and RIC group before treatment(P＞0.05).Before treatment,there was no statistically significant difference in the serum Lp-PLA2,IL-6,S100β and NSE levels among the three groups(P＞0.05).The serum Lp-PLA2,IL-6,S100β and NSE levels of patients on the 7th and 14th days of treatment were significantly lower than those before treatment in the three groups(P＜0.05).On the 7th and 14th days of treatment,the serum Lp-PLA2,IL-6,S100β and NSE levels of patients in the RIC group were significantly lower than those in the pseudo-RIC group and control group(P＜0.05),and these indexes showed no statistically significant difference between the control group and the pseudo-RIC group(P＞0.05).There was no statistically significant difference in the NIHSS and mRS scores of patients among the three groups before treatment(P＞0.05).The NIHSS scores on the 7th and 14th days of treatment and the mRS scores on the 14th,90th days of treatment of patients were significantly lower than those before treatment in the three groups(P＜0.05).The NIHSS score on the 14th day of treatment and the mRS score on the 90th day of treatment in the RIC group were significantly lower than those in the pseudo-RIC group and control group(P＜0.05);there was no significant difference in the NIHSS and mRS scores between the control group and the pseudo-RIC group at each time points(P＞0.05).In the RIC group,2 patients developed upper limb pain and numbness during the treatment,and the symptoms disappeared after the treatment was suspended;no adverse reactions occurred in the pseudo-RIC group and the control group.Conclusion RIC therapy after intravenous thrombolysis can significantly promote neurological recovery,attenuate brain damage,and reduce the expression levels of vascular inflammatory mediators and brain damage markers in patients with AIS.
