乔鹏

【摘要】 目的：探讨天智颗粒联合高压氧治疗急性一氧化碳中毒迟发型脑病（DEACMP）的临床效果及对活化蛋白（AP）-1、核因子-κB（NF-κB）、炎症因子的影响。方法：选取2018年10月—2022年9月通辽市医院神经内科收治的DEACMP患者60例，随机分为高压氧组和联合组，各30例。高压氧组予高压氧及常规治疗，联合组在高压氧组治疗基础上予天智颗粒口服治疗，两组均持续治疗3个月。观察两组临床疗效、脑电图恢复时间及神经症状、体征消失时间情况；比较治疗前后简易精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分、日常生活活动能力量表（ADL）评分，血清干扰素（IFN）-γ、白细胞介素（IL）-8、IL-10含量及外周血单个核细胞中活化蛋白（AP）-1、核因子-κB（NF-κB）相对表达水平。结果：与高压氧组相比，联合组总有效率明显提高，电图恢复时间及症状体征消失时间均缩短，差异均有统计学意义（P<0.05）。与治疗前相比，两组治疗后MMSE、MoCA、ADL评分均升高，血清IFN-γ、IL-8均降低，IL-10升高，外周血单个核细胞AP-1、NF-κB相对表达量均降低，差异均有统计学意义（P<0.05）；与高压氧组治疗后相比，联合组MMSE、MoCA、ADL评分均升高，血清IFN-γ、IL-8均降低，IL-10升高，外周血单个核细胞AP-1、NF-κB相對表达量均降低，差异均有统计学意义（P<0.05）。结论：天智颗粒联合高压氧治疗DEACMP有良好的临床效果，其机制可能与抑制炎症反应有关。

【关键词】 天智颗粒 高压氧 急性一氧化碳中毒迟发型脑病 炎症反应

Clinical Study on Tianzhi Granules Combined with Hyperbaric Oxygen in the Treatment of Delayed Encephalopathy after Acute Carbon Monoxide Poisoning/QIAO Peng. //Medical Innovation of China， 2024， 21（07）： 0-049

[Abstract] Objective： To explore the clinical efficacy of Tianzhi Granules combined with hyperbaric oxygen in the treatment of delayed encephalopathy after acute carbon monoxide poisoning （DEACMP） and its effect on blood activating protein （AP）-1， nuclear factor-κB （NF-κB） and inflammatory factors.

Method： From October 2018 to September 2022， 60 patients with DEACMP disease admitted to Neurology of Tongliao City Hospital were selected and randomly divided into hyperbaric oxygen group and combined group， with 30 patients in each group. The hyperbaric oxygen group was treated with hyperbaric oxygen and conventional therapy， while the combined group received oral Tianzhi Granules treatment on the basis of the hyperbaric oxygen group， both groups were continued to receive treatment for 3 months. The clinical efficacy， recovery time of electroencephalography and disappearance time of neurological symptoms and signs of the two groups were observed， the scores of mini-mental state examination （MMSE）， Montreal cognitive assessment （MoCA）， activities of daily living scale （ADL）， serum interferon （IFN）-γ， interleukin （IL）-8， IL-10 content and activated protein （AP）-1， nuclear factor-κB （NF-κB） in peripheral blood mononuclear cell relative expression level were compared before and after treatment. Result： Compared with the hyperbaric oxygen group， the total effective rate in the combined group was significantly improved， the recovery time of electrograms and the disappearance time of symptoms and signs were shorter， the differences were statistically significant （P<0.05）. Compared with before treatment， MMSE， MoCA， ADL scores were increased in both groups after treatment， and serum IFN-γ and IL-8 content were decreased， IL-10 content were increased， AP-1 and NF-κB in peripheral blood mononuclear cell were decreased， the differences were statistically significant （P<0.05）; compared with the hyperbaric oxygen group after treatment， MMSE， MoCA， ADL scores were increased in the combined group， and serum IFN-γ， IL-8 levels were decreased， IL-10 was increased， and the relative expression of AP-1 and NF-κB in peripheral blood mononuclear cell were decreased， the differences were statistically significant （P<0.05）. Conclusion： Tianzhi Granules combined with hyperbaric oxygen has good clinical effect in the treatment of DEACMP， and its mechanism may be related to the inhibition of inflammatory reaction.

[Key words] Tianzhi Granules Hyperbaric oxygen Delayed encephalopathy after acute carbon monoxide poisoning Inflammatory reaction

First-author's address： The Third Department of Neurology， Tongliao City Hospital， Tongliao 028000， China

doi：10.3969/j.issn.1674-4985.2024.07.011

急性一氧化碳中毒（ACMP）经抢救后意识清醒的患者有10%～30%会在假愈期（2～60 d）发生迟发型脑病（DEACMP），其临床表现主要为精神异常、痴呆、锥体外系及锥体系损伤，未获得有效治疗可严重患者生活质量，甚至发生致残或致死事件，加重家属经济负担[1-2]。高压氧可加速碳氧血红蛋白解离，促进一氧化碳（carbon monoxide，CO）從体内排出、缩短CO半清除时间，是治疗DEACMP的一种重要治疗方法[3]。天智颗粒对缺血性脑病、认知障碍及阿尔茨海默病等疾病均有明确疗效[4-6]，可提高患者认知能力及生活能力。但天智颗粒对DEACMP引起的认知障碍及神经症状的临床疗效却鲜有报道，本研究拟采用天智颗粒联合高压氧治疗DEACMP，并观察患者临床症状和体征消失时间及对精神状态、认知能力、生活能力、炎症因子相关因子的影响，现报道如下。……