关键词: 脑梗死, 早期康复, 脑源性神经营养因子, 血管内皮生长因子, 中高海拔

Abstract:

Objective To investigate the effects of early rehabilitation training on neurological recovery and serum levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in patients with cerebral infarction (CI) at medium-to-high altitudes. Methods This multicenter, prospective, nonrandomized controlled study included 320 patients with acute cerebral infarction (ACI) admitted to Qinghai University Affiliated Hospital (medium altitude, 2, 260 m) and Hainan Tibetan Autonomous Prefecture Hospital (high altitude, 3, 200 m) from January 2022 to December 2023. According to whether they received systematic early rehabilitation training, patients were assigned to the rehabilitation group (n=160) and the control group (n=160). The rehabilitation group began individualized rehabilitation training within 48 h of onset, whereas the control group received routine care. At admission and on days 7, 30, and 90, neurological and functional outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Fugl-Meyer Assessment (FMA), and serum BDNF and VEGF levels were measured. Repeated-measures analysis of variance and logistic regression were used for statistical analysis. Results On days 30 and 90, NIHSS scores were significantly lower in the rehabilitation group than in the control group, whereas BI and FMA scores were significantly higher in the rehabilitation group (interaction P<0.05). Repeated-measures analysis of variance showed statistically significant differences in NIHSS, BI, FMA, BDNF, and VEGF levels between groups, over time, and for the time-by-group interaction (NIHSS: between-group F=18.450, P<0.01; interaction F=8.672, P<0.01; BI: between-group F=32.100, P<0.01, interaction F=11.240, P<0.01; FMA: between-group F=28.960, P<0.01, interaction F=9.870, P<0.01; BDNF: between-group F=41.580, P<0.01, interaction F=15.320, P<0.01; VEGF: between-group F=35.210, P<0.01, interaction F=12.760, P<0.01). Serum BDNF and VEGF levels in the rehabilitation group were significantly higher than those in the control group on days 30 and 90 (P<0.01). Multivariate regression analysis showed that early rehabilitation was an independent protective factor for neurological recovery (OR=0.580, 95%CI: 0.39-0.87). There was no significant difference in the incidence of adverse events between the two groups (P>0.05). Conclusion Early systematic rehabilitation training can significantly improve neurological deficits and activities of daily living in patients with CI at medium-to-high altitudes. Its mechanism may be related to upregulation of serum BDNF and VEGF levels. The approach is safe and worthy of clinical promotion.

Key words: cerebral infarction, early rehabilitation, brain-derived neurotrophic factor, vascular endothelial growth factor, medium-to-high altitudes