| BackgroundStroke is not only characterized by high morbidity,high mortality and high disability,but also a major factor affecting the quality of life and survival time after stroke.Previous studies have confirmed that certain ischemic stimulation after cerebral apoplexy,such as transient limb ischemia,can induce the body to produce endogenous protective mechanism,thereby producing brain protection.Our previous study found that remote limb ischemic postconditioning can reduce infarct volume and improve cerebral perfusion in patients with acute cerebral infarction,thereby improving the prognosis.This study will continue to explore the protective effects of remote limb ischemic postconditioning on cognitive impairment after acute ischemic stroke and its possible mechanism.PART1 Protective effect of remote limb ischemic postconditioning on cognitive impairment after acute ischemic stroke ObjectiveWe aimed to evaluate the efficacy of repeated episodes of limb ischemia and reperfusion(remote limb ischemic postconditioning [RIPostC])in patients with cognitive impairment after ischemic stroke.MethodForty-eight patients with acute ischemic stroke who were treated in the department of neurology,Henan Provincial People’s Hospital from June 2016 to August 2017 were enrolled in this study,randomized 1:1 to receive 4 cycles of RIPostC(23 patients)or sham ischemia-reperfusion cycles(25 patients)daily for 14 days,two groups of patients were given conventional drug treatment.The primary outcome was tolerability,feasibility and safety.Secondary outcomes included cognitive function and clinical efficacy at the end of 90-day follow-up.Result1.There was no significant difference in the adverse events between the two groups of patients during the whole treatment and follow-up period.(P>0.05).2.At 90 days,the cognitive function of the limb ischemic post treatment group was better than that of the control group(P<0.05).3.RIPostC group improved the NIHSS score of the patients with acute cerebral infarction at 90 days,RIPostC may improve neurological outcome(P<0.05).Conclusion1.RIPostC seems to be safe,feasible and well tolerated in patients with cognitive impairment after acute ischemic stroke.2.RIPostC can slow the cognitive decline after acute ischemic stroke.3.RIPostC may improve the cognitive function after acute ischemic stroke by improving the neurological outcomePATR2 The effect of remote limb ischemic postconditioning on cerebral blood flow after acute ischemic stroke ObjectiveTo investigate the effect of remote limb ischemic postconditioning on cerebral blood perfusion in patients with acute ischemic stroke,explore the relationship between cerebral blood perfusion and cognitive impairment after acute ischemic stroke.MethodForty-eight patients with acute ischemic stroke who were treated in the department of neurology,Henan Provincial People’s Hospital from June 2016 to August 2017 were enrolled in this study,randomized 1:1 to receive 4 cycles of RIPostC(23 patients)or sham ischemia-reperfusion cycles(25 patients)daily for 14 days,two groups of patients were given conventional drug treatment.The cerebral blood flow perfusion in the two groups was observed at the time of admission and 14 days.Result1.At the time of admission,there was no significant difference in rCBV,rCBF,rMTT and rTTP between the RIPostC group and the control group(P>0.05).2.At 14 days,rCBF of RIPostC group was higher than that of the control group,while rMTT and rTTP were lower than the control group,and the difference was statistically significant(P<0.05).Conclusion1.The remote limb ischemic postconditioning can improve the cerebral blood flow perfusion in patients with acute ischemic stroke.2.The remote limb ischemic postconditioning may improve the cognitive function after acute ischemic stroke by improving cerebral blood flow perfusion.PART3 Remote limb ischemic postconditioning on HSP27 and HSP70 in patients with cognitive impairment after acute ischemic stroke ObjectiveTo observe the changes of plasma heat shock protein 27(HSP70)and plasma heat shock protein 70(HSP70)in patients with acute cerebral infarction(ACI),and to explore the possible mechanism of remote limb ischemic postconditioning on cognitive impairment after acute ischemic stroke.MethodForty-eight patients with acute ischemic stroke treated and completed the whole limb ischemia postconditioning from June 2016 to August 2017 in the neurology department of Henan Province People’s Hospital treatment.An enzyme-linked immunosorbent assay(ELISA)applied to measure plasma levels of HSP27 and HSP70 at the time of admission,7days,and 14 days.Analysis the relationship between plasma HSP27,HSP70 and cognitive impairment after acute ischemic stroke.Result1.At 7 days,the plasma HSP27 decreased gradually in the two groups,and the degree of decrease in the control group was higher than that in RIPostC group.The HSP70 in the RIPostC group increased,and the HSP70 in the control group decreased,the difference was statistically significant(P<0.05).2.At 14 days,the plasma in RIPostC group was higher than that at the time of admission,and the control group was lower than that at admission.HSP70 continued to increase compared with the admission in RIPostC,and the control group continued to decrease,the difference was statistically significant(P < 0.05).ConclusionRIPost C may improve the cognitive impairment after acute ischemic stroke by upregulation the expression of plasma HSP27 and HSP70. |
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