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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (01) : 51 -56. doi: 10.3877/cma.j.issn.2095-123X.2023.01.006

临床研究

胞磷胆碱对大脑中动脉缺血性脑卒中恢复期的疗效
胡飞龙1,†(), 路璐1   
  1. 1. 236800　安徽亳州，亳州市人民医院老年医学科
  • 收稿日期:2022-07-12 出版日期:2023-02-15
  • 通信作者: 胡飞龙

Effect of citicoline on the recovery period of middle cerebral artery ischemic stroke

Feilong Hu1,†(), Lu Lu1   

  1. 1. Department of Geriatrics, Bozhou People's Hospital, Bozhou 236800, China
  • Received:2022-07-12 Published:2023-02-15
  • Corresponding author: Feilong Hu
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引用本文：

胡飞龙, 路璐. 胞磷胆碱对大脑中动脉缺血性脑卒中恢复期的疗效[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(01): 51-56.

Feilong Hu, Lu Lu. Effect of citicoline on the recovery period of middle cerebral artery ischemic stroke[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(01): 51-56.

目的

探究胞磷胆碱联合常规西药对大脑中动脉缺血性脑卒中恢复期患者的治疗效果及对脑血流变化的影响。

方法

选取自2018年7月至2021年12月亳州市人民医院老年医学科收治的134例大脑中动脉缺血性脑卒中恢复期患者，按照随机数字表法分为试验组和常规组，每组67例。2组患者均服用西药（阿司匹林肠溶片、丁苯酞软胶囊）、实施常规康复训练及控制血压、血糖、血脂等，试验组在常规组基础上增加胞磷胆碱。对比2组患者治疗前后美国国立卫生研究院卒中量表（NIHSS）评分、大脑中动脉脑血流参数[平均脑血流速度（Vm）、脑血流量（CBF）、搏动指数（PI）、阻力指数（RI）]、血清炎性因子水平[白介素-6（IL-6）、单核细胞趋化蛋白-1（MCP-1）、超敏C-反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）]，临床疗效和不良反应发生率。

结果

治疗后2组患者NIHSS评分、大脑中动脉PI与RI以及血清IL-6、MCP-1、hs-CRP、TNF-α水平均低于治疗前，大脑中动脉Vm、CBF均高于治疗前，差异具有统计学意义（P<0.05）；治疗后试验组NIHSS评分、大脑中动脉PI与RI以及血清IL-6、MCP-1、hs-CRP、TNF-α水平均低于常规组，大脑中动脉Vm、CBF均高于常规组，差异具有统计学意义（P<0.05）。试验组NIHSS评分、大脑中动脉脑血流参数（Vm、CBF、PI、RI）和血清炎性因子（IL-6、MCP-1、hs-CRP、TNF-α）水平的治疗前后差值大于常规组，差异具有统计学意义（P<0.05）。试验组总有效率（94.03%）高于常规组（82.09%），差异具有统计学意义（P<0.05）。2组患者不良反应发生率比较差异无统计学意义（P>0.05）。

结论

对大脑中动脉缺血性脑卒中恢复期患者采用胞磷胆碱联合其他西药进行治疗能降低神经功能缺损评分与炎性因子水平，并可改善大脑中动脉脑血流，提升临床疗效，且安全性好。

关键词: 大脑中动脉, 缺血性脑卒中, 恢复期, 胞磷胆碱, 脑血流, 炎性因子
Objective

To explore the efficacy of citicoline combined with conventional western medicine in convalescence patients with middle cerebral artery ischemic stroke and its influence on cerebral blood flow.

Methods

One hundred and thirty-four conventional patients with middle cerebral artery ischemic stroke from July 2018 to December 2021 admitted in Geriatrics Department of Bozhou People's Hospital were selected, and they were divided into the experimental group and the conventional group through the random number table, with 67 cases in each group. Both groups were given western medicine (aspirin enteric-coated tablets, butylphthalide soft capsules), carried out routine rehabilitation training and controlled blood pressure, blood glucose and blood lipid, while citicoline were added to the experimental group on the basis of the conventional group. The National Institute of Health stroke scale (NIHSS) scores, the changes of cerebral blood flow parameters of middle cerebral artery [mean cerebral blood flow velocity (Vm), mean cerebral blood flow (CBF), pulsatility index (PI), resistance index (RI)] and the levels of serum inflammatory factors [interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α)] before and after treatment, clinical efficacy and the incidences of adverse reactions were compared between the two groups.

Results

After treatment, the NIHSS scores, PI and RI of middle cerebral artery and the levels of serum IL-6, MCP-1, hs-CRP and TNF-α of the two groups were lower than those before treatment, but the Vm and CBF of middle cerebral artery were higher than those before treatment (P<0.05). After treatment, the NIHSS score, PI and RI of middle cerebral artery and the levels of serum IL-6, MCP-1, hs-CRP and TNF-α in the experimental group were lower than those in the conventional group (P<0.05), but the Vm and CBF of middle cerebral artery were higher than those in the conventional group (P < 0.05). The D-values before and after treatment of the NIHSS score, blood flow parameters of middle cerebral artery (Vm, CBF, PI, RI) and serum inflammatory factors (IL-6, MCP-1, hs-CRP, TNF-α) in the experimental group were greater than those in the conventional group (P<0.05). The total effective rate of the experimental group (94.03%) was higher than that of the conventional group (82.09%) (P<0.05). There was no significant difference in the incidence of adverse reactions between the both groups (P>0.05).

Conclusion

Citicoline combined with other western medicine in the treatment of convalescence patients with middle cerebral artery ischemic stroke can reduce neurological deficit scores and inflammatory factor levels, improve the cerebral blood flow of middle cerebral artery, enhance clinical efficacy, and have good safety.

Key words: Middle cerebral artery, Cerebral ischemic stroke, Convalescence, Citicoline, Cerebral blood flow, Inflammatory factors
表1 2组患者的一般资料比较
Tab.1 Comparison of general data between two groups
资料 试验组（n=67） 常规组（n=67） χ2/t/Z值 P值
性别     0.135 0.713
男 44 46    
女 23 21    
年龄（岁，Mean±SD） 67.19±7.65 68.49±7.01 1.026 0.307
病程（d，Mean±SD） 62.16±11.83 63.45±12.57 0.612 0.542
体质量指数（kg/m2，Mean±SD） 22.31±2.41 22.46±2.39 0.362 0.718
Holden步行能功分级     0.369 0.682
1级 5 6    
2级 12 13    
3级 16 16    
4级 22 20    
5级 12 12    
合并症        
高血压 34 32 0.119 0.730
2型糖尿病 23 21 0.135 0.713
高脂血症 35 34 0.030 0.863
表2 2组患者治疗前后NIHSS评分比较（分，Mean±SD）
Tab.2 Comparison of NIHSS scores between two groups before and after treatment (score, Mean±SD)
组别 例数 治疗前 治疗后 t值 P值
试验组 67 13.93±3.05 5.37±0.85 22.129 <0.001
常规组 67 13.84±3.01 5.91±1.08 20.298 <0.001
t值   0.172 3.216    
P值   0.864 0.002    
表3 2组患者的临床疗效比较[例（%）]
Tab.3 Comparison of clinical efficacy between two groups [n(%)]
组别 例数 痊愈 显效 进步 无效 加重 总有效率
试验组 67 30（44.78） 19（28.36） 14（20.90） 4（5.97） 0（0.00） 63（94.03）
常规组 67 27（40.30） 15（22.39） 13（19.40） 12（17.91） 0（0.00） 55（82.09）
Z/χ2值       4.785     4.542
P值       0.031     0.033
表4 2组患者治疗前后大脑中动脉脑血流变化情况比较（Mean±SD）
Tab.4 Comparison of changes in cerebral blood flow of the middle cerebral artery between two groups before and after treatment (Mean±SD)
指标   试验组（n=67） 常规组（n=67） t值 P值
Vm（cm/s） 治疗前 69.93±10.02 70.25±9.84 0.187 0.852
治疗后 93.15±11.17 89.36±10.28 2.044 0.043
t值 12.666 10.992    
P值 <0.001 <0.001    
CBF[mL/（s·100 g）] 治疗前 464.17±43.08 466.85±43.24 0.359 0.720
治疗后 602.01±63.19 578.31±62.85 2.177 0.031
t值 14.753 11.959    
P值 <0.001 <0.001    
PI 治疗前 1.27±0.21 1.24±0.23 0.788 0.432
治疗后 0.88±0.15 0.93±0.12 2.131 0.035
t值 12.370 9.781    
P值 <0.001 <0.001    
RI 治疗前 1.06±0.14 1.03±0.12 1.332 0.185
治疗后 0.68±0.12 0.73±0.14 2.220 0.028
t值 16.869 13.317    
P值 <0.001 <0.001    
表5 2组患者治疗前后的血清炎性因子水平变化情况比较（Mean±SD）
Tab.5 Comparison of changes in serum inflammatory factor levels before and after treatment between two groups (Mean±SD)
指标   试验组（n=67） 常规组（n=67） t值 P值
IL-6（ng/L） 治疗前 336.41±50.38 325.19±52.47 1.263 0.209
治疗后 221.03±38.42 237.64±41.15 2.415 0.017
t值 14.908 10.747    
P值 <0.001 <0.001    
MCP-1（pg/mL） 治疗前 145.82±20.69 143.07±20.13 0.780 0.437
治疗后 96.73±11.64 101.62±13.47 2.248 0.026
t值 16.926 14.008    
P值 <0.001 <0.001    
hs-CRP（mg/L） 治疗前 17.48±3.05 17.19±3.01 0.554 0.581
治疗后 5.73±1.15 6.23±1.24 2.420 0.017
t值 29.506 27.558    
P值 <0.001 <0.001    
TNF-α（ng/L） 治疗前 531.69±75.61 527.38±77.26 0.326 0.745
治疗后 383.74±63.85 409.13±62.18 2.332 0.021
t值 12.237 9.760    
P值 <0.001 <0.001    
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