| Objective: to observe the dynamic changes of serum levels of inflammatory factors in patients with acute cerebral infarction,and to explore the relationship between inflammatory factors and neurological functional injury in the acute stage of cerebral infarction.Furthermore,the effect of transcutaneous auricular vagus nerve stimulation on serum levels of inflammatory factors and the degree of neurological dysfunction in patients with acute cerebral infarction was further studied to explore the effect of transcutaneous auricular vagus nerve stimulation on acute cerebral infarction and its possible pathophysiological merchanism.Methods:According to the inclusion criteria and exclusion criteria,72 patients with cerebral infarction were seleced and defined as the cerebral infarction group,including 44 males and 28 females,the ages ranged from 42 to 95 years(mean66.08±10.38 years).According to the different treatment plans during hospitalization,the patients in the cerebral infarction group were divided into the conventional group and tVNS group by using the random number table.There were 34 patients in the conventional group,including 22 males and 12 females,the ages ranged from 42 to 85years(mean 66.68±10.30 years).There were 38 patients in the tVNS group,including22 males and 16 females,the ages ranged from 49 to 95 years(mean 65.55±10.57years).A total of 62 healthy physical examinees of the same period in our hospital were selected as the control group,including 31 males and 31 females,the ages ranged from 39 to 79 years(mean 61.66±9.37 years).The conventional group received only basic treatment,and the tVNS group received both basic treatment and tVNS treatment.The ear branch distribution of the vagus nerve was stimulated with a percutaneous vagal nerve stimulator with a frequency of 20 Hz,a wave width of 0.2ms,and an intensity of the ranged from 4 to 8 m A,each time 30 min,twice a day,for 7days.To evaluate whether the subjects had a history of smoking,coronary heart disease,hyperlipidemia,hypertension,diabetes and antithrombotic therapy.In the cerebral infarction group,5ml of venous blood was taken after 12 hours of fasting under aseptic conditions on the first day of admission and 7 days after treatment.The control group had their blood taken once.Serum interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-8(IL-8)and tumor necrosis factor-alpha(TNF-α)were measured with the IMMULITE 1000 automatic chemiluminescence immunoanalyzer manufactured by Siemens(pg/ml).The NIHSS score was measured in the cerebral infarction group on the day of blood collection;on the third day after admission,the head was examined by MRI,and the volume of the responsible infarct(cm3)was calculated using the pullicino method.All observed index results of the cerebral infarction group were recorded as “1” on the first day of admission(the first time,before treatment),and “2” on the seventh day after treatment(the second time,after treatment),the results obtained by subtracting “2” from “1” of all the observed indexes are benoted as the difference value.When the measurement data conform to the nomal distribution,they are described as mean ± standard deviation,and when they are skewed distribution,they are described as median and quartile spacing,All date were processed by SPSS22.0 statistical software,and the significance level of the test was P <0.05.Results:1.There were no significant differences in age,sex,smoking history,antithrombotic history,diabetes,coronary heart disease,hypertension and hyperlipidemia between the cerebral infarction group and the control group,the conventional group and the tVNS group.2.The serum levels of IL-1β(41.50(20.30,74.95)vs.16.05(9.30,30.40)),IL-6(262.00(147.00,508.00)vs.103.10(36.30,238.00)),IL-8(2975.50(1970.00,4684.00)vs.1924.00(983.00,2624.75)),TNF-α(169.50.00(118.00,267.00)vs.103.70(45.78,185.75))in the two cerebral infarction group were significantly higher than the serum levels of IL-1β(8.19(5.00,23.88)),IL-6(48.85(5.48,100.15)),IL-8(706.00(32.50,2140.75)),TNF-α(36.85(13.53,88.88))in the control group(all P<0.001 for the first time,P=0.007,P=0.001,P=0.001,P<0.001 for the second time).The level of serum levels of IL-1β,IL-6,IL-8,TNF-α in the second time of cerebral infarction group was significantly lower than that in the first time(all P<0.001).3.The serum levels of IL-1β,IL-6 and IL-8 at the first time in the cerebral infarction group were significantly positively correlated(r=0.255,P=0.031;r=0.336,P=0.004;r=0.464,P<0.001)with the infarcted volume(2.57±5.31),while TNF-αlevel was not significantly correlated with the infarcted volume.The serum levels of IL-1β,IL-8 at the second times in the cerebral infarction group were significantly positively correlated(r=0.251,P=0.034;r=0.422,P<0.001)with the infarcted volum,while IL-6,TNF-α level was not significantly correlated with the infarcted volume.There was no significant correlation between the difference of cytokines and the infarct volume.4.The serum levels of IL-1β,IL-6 and IL-8 at the first time in the cerebral infarction group were significantly positively correlated(r=0.383,P=0.001;r=0.233,P=0.049;r=0.311,P=0.008)with the NIHSS1 score(3.94±1.58),and significantly positively correlated(r=0.442,P<0.001;r=0.312,P=0.008;r=0.331,P=0.004)with the NIHSS difference,while TNF-α level was not significantly correlated with the NIHSS1 score and the NIHSS difference;The serum levels of IL-1β,IL-6,IL-8 and TNF-α at the second times in the cerebral infarction group were significantly positively correlated(r=0.275,P=0.019;r=0.267,P=0.023;r=0.262,P=0.026;r=0.362,P=0.002)with the NIHSS2 score(2.83±1.70);The difference of IL-1β in the cerebral infarction group was significantly positively correlated(r=0.402,P<0.001)with the NIHSS1 score,while the difference of other cytokines was not significantly correlated with the NIHSS1 score;There were no significant correlation between the difference of each cytokines and NIHSS2 score,and the difference of NIHSS was significantly positive(r=0.498,P<0.001;r=0.390,P=0.001;r=0.372,P=0.001;r=0.266,P=0.024).5.The serum levels of IL-1β(48.55(18.83,93.63)vs.32.00(22.03,69.10)),IL-6(280.50(98.78,750.25)vs.222.50(150.00,367.50)),IL-8(3305.50(1836.00,5122.00)vs.2678.00(1972.25,4641.50))and TNF-α(175.00(124.75,287.50)vs.162.00(114.00,233.25))were not significantly different between the tVNS group and the conventional group before treatment.The serum levels of IL-1β(12.25(7.74,26.80)),IL-8(1382.00(597.50,2203.75))in the tVNS group after treatment were significantly lower than the serum levels of IL-1β(19.80(13.03,32.40)),IL-8(2126.50(1429.25,3720.50))in the conventional group(P values were 0.035 and 0.016respectively),the serum levels IL-6(85.05(10.31,192.50)),TNF-α(91.75(44.13,144.00))in the tVNS group after treatment were not significantly different from the serum levels of IL-6(115.50(56.05,319.25)),TNF-α(120.00(51.98,204.75))in the conventional group.The difference of IL-1β(35.01(7.59,80.42)),IL-6(155.50(38.80,328.50)),IL-8(1712.50(869.25,3023.50))and TNF-α(66.70(28.10,208.93))in the tVNS group was significantly greater than the difference of IL-1β(11.36(4.76,36.33)),IL-6(69.15(8.59,195.75)),IL-8(583.00(95.50,1505.25))and TNF-α(42.00(2.45,89.00))in the conventional group(P values were 0.026,0.043,0.001 and 0.031 respectively).6.The NIHSS1 score(4.00±1.56),NIHSS2 score(2.74±1.66)and NIHSS difference(1.18±1.18)of patients in the tVNS group were no significant differences with the conventional group((3.88±1.63),(2.94±1.76),(0.94±1.25)).7.In the tVNS group,there was one patient with mild hearth rate slowing,and no symptoms of discomfort,and there were nine patients with mild acupuncture pain or itching at the stimulating site during the treatment of tVNS,which disappeared after treatment.Conclusion:1.The level of serum inflammatory factor(IL-1β,IL-6,IL-8,TNF-α)in patients with acute cerebral infarction is significantly increased,and there is a dynamic change.The level can reflect the severity of the condition,and the higher the level,the more serious the condition.2.tVNS can significantly reduce the level of serum inflammatory factors in patients with acute cerebral infarction and has anti-inflammatory effects.3.Short-term application of tVNS in the treatment of acute cerebral infarction is safe,but the short-term prognosis of acute cerebral infarction is not significantly improved. |
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