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远程缺血预处理促进急性缺血性脑卒中后运动功能恢复。

Remote Ischemic Conditioning for Motor Recovery after Acute Ischemic Stroke.

机构信息

Department of Neurology and Beijing Key Laboratory of Hypoxia Translational Medicine, Xuanwu Hospital.

Center of Stroke, Beijing Institute for Brain Disorder.

出版信息

Neurologist. 2023 Nov 1;28(6):367-372. doi: 10.1097/NRL.0000000000000498.

Abstract

BACKGROUND

Remote ischemic conditioning (RIC) has shown an impressive neuroprotective effect on acute ischemic stroke (AIS) in animal experiments. But whether chronic RIC improves long-term functional outcomes remains unclear.

MATERIALS AND METHODS

We performed a non-randomized controlled trial. Eligible patients (aged 18 -80 y) with hemiplegia caused by AIS were allocated to the RIC group and the control group. All participants received normal protocol rehabilitation therapy. Patients in the RIC group underwent RIC twice daily for 90 days. The outcome included the 90-day Fugl-Meyer Assessment (FMA) scores and modified Rankin's scale (mRS) scores, as well as changes in angiogenesis-related factors in serum from baseline to 90 days.

RESULTS

Twenty-seven patients were included in the analysis (13 in the RIC group and 14 in the control group). There was no significant difference in 90-day total FMA scores between the two groups. Lower limb FMA scores at day 90 were significantly higher in the RIC group (32.8±8.7 vs. 24.8±5.4, adjusted P =0.042). The proportion of favorable outcome (mRS<2) was higher in the RIC group than that in the control group, but no significant difference was detected (8 [61.5%] vs. 7 [50%], P =0.705). A significant increase has been found in the level of epidermal growth factor (EGF) in serum (9.4 [1.1 to 25.7] vs. -8.7 [-15.1 to 4.7], P =0.036) after chronic RIC procedure.

CONCLUSION

This study investigated the role that RIC plays in AIS recovery, especially in motor function. RIC may have beneficial effects on lower limbs recovery by enhancing the EGF level. The effect of RIC on motor recovery should be further validated in future studies.

摘要

背景

远程缺血预处理(RIC)在动物实验中显示出对急性缺血性脑卒中(AIS)有显著的神经保护作用。但慢性 RIC 是否能改善长期功能结局尚不清楚。

材料与方法

我们进行了一项非随机对照试验。入选的 AIS 偏瘫患者(年龄 18-80 岁)被分配到 RIC 组和对照组。所有患者均接受常规康复治疗方案。RIC 组患者每天接受 RIC 治疗 2 次,共 90 天。主要结局为 90 天 Fugl-Meyer 评估(FMA)评分和改良 Rankin 量表(mRS)评分,以及血清中血管生成相关因子从基线到 90 天的变化。

结果

共 27 例患者纳入分析(RIC 组 13 例,对照组 14 例)。两组 90 天总 FMA 评分无显著差异。RIC 组患者第 90 天下肢 FMA 评分明显升高(32.8±8.7 vs. 24.8±5.4,调整 P=0.042)。RIC 组患者预后良好(mRS<2)的比例高于对照组,但差异无统计学意义(8 [61.5%] vs. 7 [50%],P=0.705)。慢性 RIC 后,血清中表皮生长因子(EGF)水平显著升高(9.4 [1.1 至 25.7] vs. -8.7 [-15.1 至 4.7],P=0.036)。

结论

本研究探讨了 RIC 在 AIS 恢复中的作用,尤其是在运动功能方面。RIC 通过提高 EGF 水平可能对下肢恢复有有益作用。RIC 对运动恢复的影响需要进一步在未来的研究中验证。

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