缺血前預處理改善腦缺血后再灌注損傷預后的效果研究

謝凱勝 盤慶飛 黃賢 李圣海 何秀麗

[摘要]目的 探討缺血前預處理改善腦缺血后再灌注損傷預后的效果。方法 隨機選取75只健康雄性小鼠分為3組，包括假手術組（15只）、對照組（28只）、觀察組（32只），其中假手術組小鼠僅結扎右側頸總動脈，對照組、觀察組小鼠均以線栓法建立小鼠腦缺血模型，并在小鼠缺血2 h后進行再灌注24 h，對照組灌注前給予生理鹽水處理，觀察組使用頭孢曲松處理，觀察三組小鼠腦組織梗死的容積、神經功能缺陷評分以及組織內白介素1β（IL-1β）炎性因子的水平情況。結果 觀察組小鼠神經功能評分高于對照組，皮層腦內IL-1β水平低于對照組，腦梗死容積小于對照組，差異有統計學意義（P<0.05）；兩組紋狀體炎性因子水平及梗死容積比較，差異無統計學意義（P>0.05）；假手術組神經功能評分高于對照組與觀察組，IL-1β水平低于對照組與觀察組，梗死容積小于對照組與觀察組，差異有統計學意義（P<0.05）。結論 臨床在腦缺血再灌注前使用頭孢曲松進行預處理，能夠降低腦內IL-1β炎性因子的表達、分泌，有效減少腦梗死容積，減輕腦神經功能損失。

[關鍵詞]預處理；損傷；缺血再灌注；腦組織

[中圖分類號] R743 [文獻標識碼] A [文章編號] 1674-4721（2018）4（c）-0116-03

Effect study of ischemic pretreatment on improving the prognosis of reperfusion injury after cerebral ischemia

XIE Kai-sheng1 PAN Qing-fei1 HUANG Xian1 LI Sheng-hai1 HE Xiu-li2

1.Department of Emergency，Shiyan People′s Hospital of Shenzhen City in Guangdong Province，Shenzhen 518100，China；2.Department of Emergency，Luohu People′s Hospital of Shenzhen City in Guangdong Province，Shenzhen 518100，China

[Abstract]Objective To investigate the effect of ischemic pretreatment on improving the prognosis of cerebral ischemia-reperfusion injury.Methods A total of 75 healthy male mice were randomly divided into 3 groups：sham operation group （n=15），control group （n=28） and observation group （n=32）.In the sham operation group，only right common carotid artery was ligated.In the observation and control groups，the cerebral ischemic model in mice was established by suture method.The mice were reperfused 24 hours after ischemia for 2 hours.In the control group，saline was used before perfusion，while in the observation group，ceftriaxone was applied.The infarct volume，neurological deficit scores and interleukin-1β （IL-1β） inflammatory cytokines levels in the three groups of mice were observed.Results The score of neurological function in the observation group was higher than that in the control group.The level of IL-1β in the cortex was lower than that in the control group.The volume of cerebral infarction was smaller than that in the control group，the difference was statistically significant （P<0.05）.The levels of inflammatory cytokines and infarcted volume of corpus striatum were not displayed statistical differences （P>0.05）.The scores of neurological function in the sham operation group were higher than those in control group and observation group.The IL-1β level and infarct volume in the sham operation group were also lower than those in the other two groups，，the difference was statistically significant （P<0.05）.Conclusion Application of ceftriaxone for pretreatment before cerebral ischemia-reperfusion can decrease the expression and secretion of IL-1β inflammatory factor，effectively reduce the volume of cerebral infarction，and alleviate neurological deficit.

[Key words]Pretreatment；Injury；Ischemia-reperfusion；Cerebral tissue

腦是人體中重要的功能性器官之一，也是最為耗氧的器官，但近幾年腦卒中、腦梗死等疾病發病率明顯上升，患者發病時腦部均會有不同程度的缺血，研究提示腦缺血是造成患者神經功能障礙、死亡的主要原因[1]。為有效減輕腦疾病患者的腦缺血，臨床需及時恢復缺血區域的血液灌注，但大量研究提示缺血再灌注會對患者腦組織造成二次損傷，不僅無法起到良好的治療效果，同時還會導致腦細胞死亡，危及患者的生命安全[2]。有學者提出對腦缺血患者再灌注前可行預處理，以減輕腦組織損失，避免腦梗死的面積擴大[3]。……