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银杏叶提取物联合低频重复经颅磁刺激治疗缺血性脑卒中的临床研究

彭羽 林赟 余能伟 廖晓灵 石柳

彭羽, 林赟, 余能伟, 等. 银杏叶提取物联合低频重复经颅磁刺激治疗缺血性脑卒中的临床研究[J]. 四川大学学报(医学版), 2021, 52(5): 883-889. doi: 10.12182/20210960202
引用本文: 彭羽, 林赟, 余能伟, 等. 银杏叶提取物联合低频重复经颅磁刺激治疗缺血性脑卒中的临床研究[J]. 四川大学学报(医学版), 2021, 52(5): 883-889. doi: 10.12182/20210960202
PENG Yu, LIN Yun, YU Neng-wei, et al. The Clinical Efficacy and Possible Mechanism of Combination Treatment of Cerebral Ischemic Stroke with Ginkgo Biloba Extract and Low-Frequency Repetitive Transcranial Magnetic Stimulation[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 883-889. doi: 10.12182/20210960202
Citation: PENG Yu, LIN Yun, YU Neng-wei, et al. The Clinical Efficacy and Possible Mechanism of Combination Treatment of Cerebral Ischemic Stroke with Ginkgo Biloba Extract and Low-Frequency Repetitive Transcranial Magnetic Stimulation[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(5): 883-889. doi: 10.12182/20210960202

银杏叶提取物联合低频重复经颅磁刺激治疗缺血性脑卒中的临床研究

doi: 10.12182/20210960202
基金项目: 成都市重大科技应用示范项目(No. 2019-YF09-00142-SN)资助
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The Clinical Efficacy and Possible Mechanism of Combination Treatment of Cerebral Ischemic Stroke with Ginkgo Biloba Extract and Low-Frequency Repetitive Transcranial Magnetic Stimulation

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  • 摘要:   目的  探讨银杏叶提取物联合低频重复经颅磁刺激(low frequency repetitive transcranial magnetic stimulation, LF-rTMS)治疗对缺血性脑卒中(cerebral ischemic stroke, CIS)患者氧化应激反应及脑神经递质的影响。  方法  采用回顾性分析,选择2018年1月−2020年1月四川省人民医院收治的CIS患者93例为研究对象,按治疗方法不同分为常规组、LF-rTMS组、联合组,每组各31例。常规组给予常规药物治疗及康复疗法,LF-rTMS组在常规组的基础上给予LF-rTMS治疗(20~30 min/次,1次/d,5次/周),联合组在LF-rTMS组的基础上给予银杏叶提取物注射(静脉滴注,1次/d)。连续治疗4周。治疗4周末,比较3组临床疗效、氧化应激反应及脑氧代谢指标、脑神经递质频率等。  结果  联合组有效率(96.77%)高于LF-rTMS组(80.65%)和常规组(54.84%)(P<0.05),LF-rTMS组有效率高于常规组(P<0.05)。联合组血清超氧化物歧化酶(superoxide dismutase, SOD)高于LF-rTMS组及常规组,丙二醛(malondialdehyde, MDA)和内皮素-1(endothelin-1, ET-1)低于LF-rTMS组及常规组(P<0.05),LF-rTMS组患者血清SOD高于常规组,MDA和ET-1低于常规组(P<0.05)。联合组动脉血氧(arterial oxygen content, CaO2)含量、动静脉血氧含量差(arterial-venous oxygen content difference, Ca-vO2)和脑氧摄取率(cerebral extraction rate of oxygen, CERO2)低于LF-rTMS组与常规组(P<0.05),LF-rTMS组上述3个指标低于常规组(P<0.05)。联合组γ-氨基丁酸(gamma-aminobutyric acid, GABA)、5-羟色胺(5-hydroxytryptamine, 5-HT)和多巴胺(dopamine, DA)脑电频率高于LF-rTMS组与常规组,乙酰胆碱(acetylcholine, Ach)脑电频率低于LF-rTMS组与常规组(P<0.05),LF-rTMS组GABA、5-HT和DA脑电频率高于常规组,Ach脑电频率低于常规组(P<0.05)。随访6个月,联合组复发率(3.23%)低于LF-rTMS组(19.35%)、常规组(25.81%)(P<0.05)。  结论  银杏提取物联合LF-rTMS治疗有助于提高CIS患者临床疗效,可能与抑制氧化应激反应、改善脑氧代谢、调节脑神经递质等因素有关。
  • 图  1  三组患者治疗前后氧化应激指标比较(n=31)

    Figure  1.  Before and after-treatment comparison of oxidative stress indicators of three groups of patients (n=31)

    *P<0.05, vs. before treatment; #P<0.05, vs. other groups at the after treatment. MDA: Malondialdehyde; SOD: Superoxide dismutase; ET-1: Endothelin-1.

    图  2  三组患者治疗前后脑氧代谢指标比较(n=31)

    Figure  2.  Before and after-treatment comparison of cerebral oxygen metabolism of the three patient groups (n=31 )

    *P<0.05, vs. before treatment; # P<0.05, vs. other groups at the after treatment. CaO2: Arterial oxygen content; Ca-vO2: Arterio-venous oxygen content difference; CERO2: Cerebral extraction rate of oxygen.

    图  3  三组患者治疗前后脑神经递质频率比较(n=31)

    Figure  3.  Before and after-treatment comparison of EEG frequency of brain neurotransmitters of the three groups of patients (n=31 )

    *P<0.05, vs. before treatment; # P<0.05, vs. other groups at the after treatment. GABA: Gamma-amminobutyric acid; 5-HT: 5-hydroxytryptamine; Ach: Acetylcholine; DA: Dopamine.

    表  1  三组CIS患者基线资料比较

    Table  1.   Comparison of the baseline data of the three groups of CIS patients in the study

    Baseline dataRegular treatment group (n=31)LF-rTMS group (n=31)Combinatin treatment group (n=31)F/χ2P
    Gender/case (%) χ2=0.784 0.657
     Male 20 (64.52) 17 (54.84) 16 (51.61)
     Female 11 (35.48) 14 (45.16) 15 (48.39)
    Age/yr. 55.42±7.25 56.24±7.37 57.32±7.47 F=0.776 0.652
    Disease course/h 25.12±4.34 25.36±4.69 26.45±5.14 F=0.845 0.624
    Infarction area/case (%) χ2=0.785 0.657
     Basal ganglia 17 (54.84) 16 (51.61) 15 (48.39)
     Frontal lobe 7 (22.58) 8 (25.81) 10 (32.26)
     Temporal lobe 4 (12.90) 5 (16.13) 4 (12.90)
     Brain stem 3 (9.68) 2 (6.45) 2 (6.45)
    Comorbidity/case (%)
     Hypertension 7 (22.58) 8 (25.81) 9 (29.03) χ2=0.562 0.924
     Diabests 3 (9.68) 5 (16.13) 6 (19.35) χ2=0.812 0.643
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出版历程
  • 收稿日期:  2020-10-26
  • 修回日期:  2021-07-16
  • 网络出版日期:  2021-12-06
  • 刊出日期:  2021-09-20

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