神经节苷脂钠联合亚低温治疗重度颅脑损伤对神经细胞Fas/FasL信号通路以及细胞凋亡的影响

目的　探究与分析神经节苷脂钠联合亚低温治疗重度颅脑损伤对神经细胞Fas/FasL信号通路以及细胞凋亡的影响。方法　选取晋城市人民医院2020年2月至2022年2月收治的重度颅脑损伤患者118例，按照不同治疗方案分为对照组与观察组，每组59例，其中对照组有7例，观察组有5例患者因死亡、中途退出研究者导致临床资料缺失，最终对照组有52例，观察组有54例纳入到最后研究。对照组中男30例，女22例，年龄（35.69±3.14）岁；观察组中男28例，女26例，年龄为（35.77±3.20）岁。对照组给予常规降低颅内压、保护脑细胞、抗感染以及解痉挛等治疗，观察组在其基础上给予神经节苷脂钠联合亚低温治疗，对比两组临床疗效、治疗前后格拉斯哥昏迷评分法（GCS）评分、大脑中动脉（MCA）血流速度及脑脊液中肿瘤坏死因子-α（TNF-α）、Fas、Fas配体（FasL）、半胱天冬氨酸酶-9（Caspase-9）蛋白水平和住院时间。采用χ²检验、t检验、F检验。结果　对照组总有效率为82.69%（43/52）、住院时间为（44.05±13.52）d，观察组总有效率为96.30%（52/54）、住院时间为（35.36±14.11）d，观察组与对照组相比临床总有效率较高，住院时间较短，差异均有统计学意义（χ²=5.271，P=0.022，t=3.236，P=0.002）。治疗后1周、2周、4周对照组GCS评分分别为（6.96±0.87）分、（7.54±1.02）分、（8.98±1.12）分，观察组分别为（7.43±0.86）分、（8.58±0.99）分、（10.58±1.24）分，两组治疗后1周、2周、4周分别与治疗前相比GCS较高，观察组治疗后1周、2周及4周分别与对照组治疗后1周、2周及4周相比，GCS较高，差异均有统计学意义（t=2.796，P=0.006；t=5.324，P<0.001；t=6.977，P<0.001）。治疗后1周、2周、4周对照组MCA分别为（88.47±7.58）cm/s、（81.98±12.84）cm/s、（72.87±12.84）cm/s，观察组分别为（85.33±8.10）cm/s、（75.45±14.15）cm/s、（66.86±13.78）cm/s，两组治疗后1周、2周、4周分别与治疗前相比MCA血流速度较低，观察组治疗后1周、2周、4周分别与对照组治疗后1周、2周、4周相比，MCA血流速度较低，差异均有统计学意义（t=2.062，P=0.042；t=2.490，P=0.014；t=2.234，P=0.022）。治疗后2周、4周对照组的TNF-α、Fas、FasL及Caspase-9分别为（1.04±0.51）mg/L、（0.79±0.32）mg/L，（34.55±7.25）μg/L、（27.10±5.58）μg/L，（89.34±5.77）μg/L、（20.87±6.55）μg/L，（23.54±5.47）pmol/L、（14.23±4.69）pmol/L；观察组分别为（0.83±0.41）mg/L、（0.36±0.12）mg/L，（40.14±8.20）μg/L、（10.35±4.14）μg/L，（102.47±5.78）μg/L、（17.53±5.28）μg/L，（40.69±6.78）pmol/L、（8.69±0.25）pmol/L，两组治疗后4周与治疗后2周相比，TNF-α、Fas、FasL及Caspase-9较低，观察组治疗后2周与对照组治疗后2周相比，TNF-α较低，Fas、FasL及Caspase-9较高，观察组治疗后4周与对照组治疗后4周相比，TNF-α、Fas、FasL及Caspase-9较低，差异均有统计学意义（均P<0.05）。结论　神经节苷脂钠联合亚低温治疗重度颅脑损伤可改善患者的昏迷程度，临床效果突出，通过作用于神经Fas/FasL信号通路的过程，对细胞凋亡的发生产生抑制效果，缩短住院时间，获得良好预后。

Effects of ganglioside sodium combined with mild hypothermia on Fas/FasLsignaling pathway and apoptosis of nerve cells in patients with severecraniocerebral injury

Objective　To explore and analyze the effects of ganglioside sodium combined withmild hypothermia on the Fas/FasL signaling pathway and apoptosis of nerve cellsin patients with severe craniocerebral injury. Methods　A total of 118 patients with severe craniocerebral injury who wereadmitted to Jincheng People's Hospital from February 2020 to February 2022 wereselected and divided into a control group and an observation group according todifferent treatment plans, with 59 cases in each group. Seven cases in thecontrol group and 5 in the observation group died or dropped out of theresearch, resulting in missing clinical data. In the end, there were 52 casesin the control group, including 30 males and 22 females who were (35.69±3.14)years old, and 54 cases in the observation group, including 28 males and 26females who were (35.77±3.20) years old. The control group were givenconventional treatments, such as lowering intracranial pressure, protectingbrain cells, anti-infection, and antispasmodic; in addition, the observationgroup were treated with ganglioside sodium and mild hypothermia. The clinicalefficacies, Glasgow Coma Scale (GCS) scores, middle cerebral artery (MCA) bloodflow velocities, tumor necrosis factor-α (TNF-α) in cerebrospinal fluid, Fas,Fas ligand (FasL), and caspase-9 (Caspase-9) protein before and after thetreatment, and hospital stay were compared between the two groups. χ² t, and F test wereapplied. Results　The total effectiverate and the hospitalization time were 82.69% (43/52)) and (44.05±13.52) d inthe control group, and were 96.30% (52/54) and (35.36±14.11) d in theobservation group, with statistical differences (χ²=5.271, P=0.022; t=3.236, P=0.002). The GCS scores 1, 2, and 4 weeks after the treatment werehigher than those before the treatment in both groups, and were higher in theobservation group than in the control group [(7.43±0.86) vs. (6.96±0.87),(8.58±0.99) vs. (7.54±1.02), and (10.58±1.24) vs. (8.98±1.12)], withstatistical differences between these two groups (t=2.796, P=0.006; t=5.324, P<0.001; t=6.977, P<0.001). The MCA blood flowvelocities 1, 2, and 4 weeks after the treatment were lower than those beforethe treatment in both groups, were (88.47±7.58) cm/s, (81.98±12.84) cm/s, and(72.87±12.84) cm/s in the control group, and were (85.33±8.10) cm/s,(75.45±14.15) cm/s, and (66.86±13.78) cm/s in the observation group, withstatistical differences between these two groups (t=2.062, P=0.042; t=2.490, P=0.014; t=2.234, P=0.022). The levels of TNF-α, Fas,FasL, and Caspase-9 2 and 4 weeks after the treatment were (1.04±0.51) mg/L and(0.79±0.32) mg/L, (34.55±7.25) μg/L and (27.10±5.58) μg/L, (89.34±5.77) μg/Land (20.87±6.55) μg/L, and (23.54±5.47) pmol/L and (14.23±4.69) pmol/L in thecontrol group, and were (0.83±0.41) mg/L and (0.36±0.12) mg/L, (40.14±8.20)μg/L and (10.35±4.14) μg/L, (102.47±5.78) μg/L and (17.53±5.28) μg/L, and(40.69) ±6.78) pmol/L and (8.69±0.25) pmol/L in the observation group; thelevels of TNF-α, Fas, FasL, and Caspase-9 were lower 4 than 2 weeks after thetreatment in both groups; 2 weeks after the treatment, the TNF-α level waslower and the levels of Fas, FasL, and Caspase-9 were higher in the observationgroup than in the control group; 4 weeks after the treatment, the levels ofTNF-α, Fas, FasL, and Caspase-9 were lower in the observation group than in thecontrol group; there were statistical differences (all P<0.05). Conclusion　Ganglioside sodiumcombined with mild hypothermia in the treatment of patients with severecraniocerebral injury can improve their coma degree with outstanding clinicaleffect. It can inhibit cell apoptosis by acting on the process of neuralFas/FasL signaling pathway, shorten hospital stay, and get a good prognosis.