刘建熙;秦晓明;王佳惠;

• 1:河南省人民医院华中阜外医院

摘要(Abstract)：

目的探讨神经节苷脂联合纳洛酮治疗重型颅脑损伤患者的疗效及对血清炎性因子与预后的影响。方法选取2014-01—2019-12河南省人民医院收治的60例重型颅脑损伤患者,按随机数表法分为2组,对照组采用神经节苷脂治疗,研究组采用神经节苷脂联合纳洛酮治疗,比较2组神经功能变化情况、生存质量、血清炎性因子水平变化及预后情况。结果研究组治疗后NIHSS、中国卒中量表(CSS)评分均低于对照组(P<0.05)。研究组疾病知识、治疗态度、心理状态、疲劳、饮食、精神、睡眠等生存质量评分均高于对照组(P<0.05)。研究组治疗后血清神经肽Y(NYP)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均低于对照组(P<0.05)。与对照组相比,研究组预后更好(P<0.05)。结论神经节苷脂联合纳洛酮治疗重型颅脑损伤的疗效优于单用神经节苷脂,可促进患者神经功能恢复,改善患者预后,提高生存质量,降低致残率。

关键词(KeyWords)： 重型颅脑损伤;神经节苷脂;纳洛酮;神经功能缺损;继发性脑损伤;生存质量

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划联合共建项目(编号:LHGJ20190779)

作者(Authors): 刘建熙;秦晓明;王佳惠;

参考文献(References)：

• [1] KOPEIKINA E,DUKHINOVA M,YUNG A W Y,et al.Platelets promote epileptic seizures by modulating brain serotonin level,enhancing neuronal electric activity,and contributing to neuroinflammation and oxidative stress[J].Prog Neurobiol,2020,188:101783.DOI:10.1016/j.pneurobio.2020.101783.
• [2] ZHANG H M,LIU P,JIANG C,et al.Notch signaling inhibitor DAPT provides protection against acute craniocerebral injury[J].PLoS ONE,2018,13(2):e0193037-e0193039.DOI:10.1371/journal.pone.0193037.
• [3] MCINTOSH T K,FERNYAK S,HAYES R L,et al.Beneficial effect of the nonselective opiate antagonist naloxone hydrochloride and the thyrotropin-releasing hormone (TRH) analog YM-14673 on long-term neurobehavioral outcome following experimental brain injury in the rat[J].J Neurotrauma,1993,10(4):373-384.DOI:10.1089/neu.1993.10.373.
• [4] CHEN B,LIU Y S.Randomized double-blind clinical trial of moderate dosage naloxone in acute moderate and severe traumatic brain injury[J].Hunan Yi Ke Da Xue Xue Bao,2002,27(1):58-60.
• [5] HWANG J,KWON Y J,KIM J K,et al.Recurrent Guillain-Barré Syndrome with Anti-GT1a and Anti-GQ1b Ganglioside Antibodies[J].J Clin Neurol,2019,15(3):404-407.DOI:10.3988/jcn.2019.15.3.404.
• [6] SCHNEIDER J S,DUNBAR G L.Altered expression of genes involved in ganglioside biosynthesis in substantia nigra neurons in Parkinson's disease[J].Plos One,2018,13(6):e0199189-e0199192.DOI:10.1371/journal.pone.0199189.
• [7] ZHANG Y M,CHEN A L,TANG C Z,et al.Clinical observation on electroacupuncture for arousing consciousness of comatose patients with severe trauma brain injury[J].Zhen Ci Yan Jiu,2013,38(2):158-162.
• [8] DU X D,LI H,LIAO L.Experimental study on protective effects of dexamethasone on traumatic brain injury in rats[J].Sichuan Da Xue Xue Bao Yi Xue Ban,2009,40(3):486-489.
• [9] ZHANG H,WANG X,LI Y,et al.Naloxone for severe traumatic brain injury:a meta-analysis[J].PLoS One,2014,9(12):e113093.DOI:10.1371/journal.pone.0113093.
• [10] MAXIME B,JULIEN B,LUSTREMANT C,et al.Inhibition of Lysosome Membrane Recycling Causes Accumulation of Gangliosides that Contribute to Neurodegeneration[J].Cell Rep,2018,23(13):3813-3826.DOI:10.1016/j.celrep.2018.05.098.
• [11] SHI J,DONG B,MAO Y,et al.Review:Traumatic brain injury and hyperglycemia,a potentially modifiable risk factor[J].Oncotarget,2016,7(43):71052-71061.DOI:10.18632/oncotarget.11958.
• [12] TAGLIAPIETRA M,ZANUSSO G,FERRARI S,et al.Myelin uncompaction and axo-glial detachment in chronic ataxic neuropathy with monospecific IgM antibody to ganglioside GD1b[J].J Peripher Nerv Syst,2020,25(1):54-59.DOI:10.1111/jns.12359.
• [13] 宋红林.脑脊液降钙素原及C反应蛋白对颅脑损伤的诊断价值[J].中国实用神经疾病杂志,2018,21(5):543-546.DOI:10.12083/SYSJ.2018.05.139.
• [14] LESNIAK A,LESZCZYNSKI P,BUJALSKA-ZADROZNY M,et al.Naloxone exacerbates memory impairments and depressive-like behavior after mild traumatic brain injury (mTBI) in mice with upregulated opioid system activity[J].Behav Brain Res,2017,326:209-216.DOI:10.1016/j.bbr.2017.03.015.
• [15] 钟宝,万野,邹敏,等.颅脑损伤后血清IL-1βIL6的变化及临床意义[J].中国实用神经疾病杂志,2018,21(2):184-187.DOI:10.12083/SYSJ.2018.02.048.
• [16] 刘兴海,刘俊,常谦.持续颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的影响[J].中国实用神经疾病杂志,2018,21(9):1003-1006.DOI:10.12083/SYSJ.2018.09.251.
• [17] NI X,LIU Z,XIE Q,et al.Cerebral injury induced by heat stroke and the therapeutic effect of hyperbaric oxygen therapy[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2017,29(6):572-576.DOI:10.3760/cma.j.issn.2095-4352.2017.06.020.
• [18] JORGE R E,LI R,LIU X,et al.Treating Alcohol Use Disorder in U.S.Veterans:The Role of Traumatic Brain Injury[J].J Neuropsychiatry Clin Neurosci,2019,31(4):319-327.DOI:10.1176/appi.neuropsych.18110250.
• [19] KE S,DIAN-SAN S,XIANG-RUI W.Delta opioid agonist[D-Ala2,D-Leu5]enkephalin (DADLE) reduced oxygen-glucose deprivation caused neuronal injury through the MAPK pathway[J].Brain Res,2009,1292:100-106.DOI:10.1016/j.brainres.2009.06.104.
• [20] CALVANIO R,BURKE D T,KIM H J,et al.Naltrexone:effects on motor function,speech,and activities of daily living in a patient with traumatic brain injury[J].Brain Inj,2000,14(10):933-942.DOI:10.1080/026990 500445745.
• [21] LIU X,PAN Y,HUANG Z,et al.Diammonium glycyrrhizinate promotes the regeneration and repair of central nervous system in rats with severe traumatic brain injury by Wnt/β-catenin signaling pathway[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2019,31(12):1451-1456.DOI:10.3760/cma.j.issn.2095-4352.2019.12.004.
• [22] CARR K R,SHAH M,GARVIN R,et al.Post-Traumatic brain injury (TBI) presenting with Guillain-Barré syndrome and elevated anti-ganglioside antibodies:a case report and review of the literature[J].Int J Neurosci,2015,125(7):486-492.DOI:10.3109/00207454.2014.957760.