何任红,范建中,邱玲.脑损伤后脑内神经递质的变化及其与意识障碍的关系[J].中华物理医学与康复杂志,2020,42(3):223-227
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| 脑损伤后脑内神经递质的变化及其与意识障碍的关系 |
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| DOI：DOI:10.3760/cma.j.issn.0254-1424.2020.03.008 |
| 中文关键词: 脑损伤 昏迷 脑涨落图 神经递质 多巴胺 |
| 英文关键词: Brain injury Coma Encephalofluctuography Neurotransmitters Dopamine |
| 基金项目:广东省援疆科技项目专项基金（2017B020247001） |
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| 中文摘要: |
| 目的 探讨脑损伤昏迷和清醒患者间的脑内神经递质的差异性，以期了解不同意识状态与脑内神经递质间的关系。 方法 回顾分析脑损伤患者52例，其中昏迷患者30例（格拉斯哥昏迷量表≤9分），设为昏迷组；清醒患者22例（格拉斯哥昏迷量表＞9分），设为清醒组。采集2组患者基本资料，然后提取神经递质的评估结果（使用脑涨落图评估），并对结果指标进行统计学分析，包括γ-氨基丁酸、5-羟色胺、去甲肾上腺素、多巴胺等递质的递质功率、递质相对功率和指数分析（指数分析包括总功率、运动指数、兴奋抑制指数和血管舒缩指数）。采用二分类Logistic回归分析2组间递质的差异性。 结果 与清醒组比较，昏迷组患者的各项脑内递质功率均显著低于清醒患者,差异均有统计学意义（P＜0.05）；2组间的递质相对功率比较,差异无统计学意义（P＞0.05）。指数分析中除了总功率组间具有显著差异（P＜0.05），其他指数无显著差异，Logistic回归分析显示，脑内多巴胺的减少是脑损伤患者昏迷的重要危险因素（Wald=5.684, P=0.017）。 结论 脑损伤后昏迷患者的大部分脑内神经递质均显著减少，尤其是脑内多巴胺的减少是引起昏迷的一个危险因素，在临床促醒治疗中可考虑应用增强多巴胺递质效能的药物或康复治疗。 |
| 英文摘要: |
| Objective To explore the difference in neurotransmitter levels between persons who had been comatose after a brain injury and healthy counterparts, and to explore the relationship between neurotransmitters and different states of consciousness. Methods A total of 52 persons with brain injury were analyzed retrospectively and divided into a coma group of 30 with Glasgow coma scale scores ≤9 and a sober group of 22 with scores ＞9. γ-GABA, 5-hydroxytryptamine, noradrenaline and dopamine levels were measured using encephalofluctuography and compared between the two groups. Results The levels of all of the neurotransmitters tested were significantly lower in the coma group than in the sober group. There were, however, no significant differences between the two groups in terms of relative levels of the neurorsmters. Logistic regression showed that dopamine deficiency is an important risk factor for coma after a brain injury. Conclusions Most neurotransmitters decrease significantly among those comatose after a brain injury. Dopamine deficiency seems to be a risk factor for the incidence of coma. Therefore, drugs or rehabilitation therapies which can improve dopamine levels can be considered to help coma patients regain consciousness. |
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