摘要目的 探讨高压氧(HBO)治疗对脑卒中后抑郁(PSD)患者血清细胞因子[肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(TL-1β)]和抑郁状态的影响及其临床意义.方法 将60例PSD患者随机分为高压氧治疗组(HBO组)30例和常规治疗组(常规组)30例,常规组仅给予临床常规治疗,HBO组在常规治疗的基础上加用HBO治疗.应用双抗体夹心酶联免疫吸附法(ELISA)检测HBO组和常规组治疗前、后血清TNF-α及IL-1β的水平.于治疗前与治疗30 d后,采用汉密尔顿抑郁量表(HAMD)、中国卒中量表(CSS)、改良Barthel指数(MBI)评定2组的疗效.结果 治疗前,脑卒中后重度抑郁患者的血清TNF-α、IL-1β水平显著高于轻、中度抑郁的患者(P<0.01),中度抑郁患者血清TNF-α、IL-1β水平与轻度抑郁患者比较,差异有统计学意义(P<0.01).HBO组血清TNF-α及IL-1β的水平与常规组比较,差异无统计学意义(P>0.05).治疗30 d后,HBO组和常规组血清TNF-α及IL-1β浓度均有下降(P<0.05),且HBO组低于常规组(P<0.01);HBO组和常规组HAMD、CSS、MBI评分较治疗前均显著下降(P<0.01),且HBO组各项评分明显优于常规组(P<0.05).结论 细胞因子TNF-α、IL-1β参与了PSD的发生和发展,细胞因子的血清水平可在一定程度上反映PSD的严重程度;HBO辅助治疗能够明显降低PSD患者血清TNF-α和IL-1β的水平,显著改善患者的抑郁状态.HBO可能通过减轻脑梗死急性期继发的炎性损伤发挥治疗作用.

abstractsObjective To investigate the effects of hyperbaric oxygenation(HBO)therapy on serum cytokines and depression in post-stroke depression(PSD)and to study it's clinical implications.Methods Sixty patients with PSD were divided into two groups.Patients in routine treatment group(RT group)were treated with routine clinical treatment,whereas those in HBO group were treated with HBO therapy in addition to routine clinical treatment.The serum cytokines of tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)were measured by enzyme-linked immunosorbent assay(ELISA)before and after 30 days of treatment.All the patients were evaluated with Hamilton depression scale(HAMD),Chinese stroke scale(CSS)and Barthel index(BI).The evaluations were carried out at the 0 and 30 d.Results Before treatment,the concentrations of TNF-α and IL-1β in patients with PSD were significantly higher than those in patients with cerebral infarction without depression(P＜0.01),and the serum levels of TNF-α and IL-1β in those with serious depression were higher than those with moderate and mild depression(P＜0.01),and that in moderate depression patients were higher than that in mild depression patients{P＜0.01).At the 30th d post-treatment,those parameters all decreased significantly in RT group and HBO group(P＜0.01,P＜0.05).Moreover,those parameters were lower in HBO group than those in RT group(P＜0.01),and HAMD,CSS and BI scores in HBO group were significantly better than that in RT group(P＜0.05,P＜0.01).Conclusions Serum cytokines levels increased significantly in patients with PSD and were associated with the severity of depression.Serum cytokines might played an important role in pathogenesis of PSD.HBO therapy could help decrease the levels of TNF-α and IL-1β.HBO might exert therapeutic effect by reducing secondary the inflammatory injury in acute cerebral infarction.