Alferova V V, Uzbekov M G, Misionzhnik E Iu, Luk'ianiuk E V, Gekht A B, Shklovskiĭ V M
Zh Nevrol Psikhiatr Im S S Korsakova. 2010;110(4 Suppl 2):36-41.
An aim of the study was to assess the severity of the syndrome of nonspecific metabolic endogenous intoxication (EI) and characteristics of compensatory reaction of serum albumin (SA) in patients in the early restoration period (4-5 months) of ischemic stroke (II). We measured levels of middle-sized molecules (MSM) and malonic dialdehyde (MDA) and determined parameters of functional activity of SA in 30 patients (mean age 69 +/- 8 years) after the first II and in 17 age- and sex-matched healthy people. Neurological deficit and functional restoration of patients were assessed with the NIHSS and Barthel index. The increase of MSM and MDA concentrations was found in 98% and 88% patients, respectively, as compared to healthy people (p<0,01). These metabolic disturbances were associated with the formation of EI and caused functional-structural changes of SA molecules. The correlation between changes of effective concentrations of SA and MDA was characteristic of the group of patients with II. The increase of total SA concentration was found in 87% of cases compared to controls (p<0,01) that indicated the manifestation of compensatory reaction of SA in response to EI. The decrease of all SA parameters, including the total concentration, was noted in 13% of patients and was associated with the decompensatory reaction to SA. The rehabilitation of CNS dysfunctions was associated with the undamaged SA compensatory reaction. The functional-structural changes of SA molecules in patients in the restoration period of II may lead to the changes in drug disposition, i.e. pharmacokinetics and pharmacodynamics, thus reducing possibilities of rehabilitation therapy.
本研究的目的是评估缺血性中风（II）早期恢复期（4 - 5个月）患者非特异性代谢性内源性中毒（EI）综合征的严重程度以及血清白蛋白（SA）代偿反应的特征。我们测量了30例首次发生II型中风患者（平均年龄69±8岁）和17例年龄及性别匹配的健康人的中分子物质（MSM）和丙二醛（MDA）水平，并测定了SA的功能活性参数。采用美国国立卫生研究院卒中量表（NIHSS）和巴氏指数评估患者的神经功能缺损和功能恢复情况。与健康人相比，分别有98%和88%的患者MSM和MDA浓度升高（p<0.01）。这些代谢紊乱与EI的形成有关，并导致SA分子的功能结构变化。SA有效浓度与MDA变化之间的相关性是II型中风患者组的特征。与对照组相比，87%的病例总SA浓度升高（p<0.01），这表明SA对EI有代偿反应。13%的患者所有SA参数（包括总浓度）下降，这与SA的失代偿反应有关。中枢神经系统功能障碍的康复与未受损的SA代偿反应有关。II型中风恢复期患者SA分子的功能结构变化可能导致药物处置的改变，即药代动力学和药效学的改变，从而降低康复治疗的可能性。
