The Effect Of Hyperbaric Oxygen Therapy On Bone Mass In Stroke Patients With Hemiplegia

【Objective】Observe the changes of bone mineral density（Bone Mineral Density,BMD）and serum bone turnover markers（BTMs）in stroke patients with hemiplegia before and after treatment,and explore the effect of hyperbaric oxygen therapy（HBOT）on bone mass and its possible mechanisms.【Methods】Using a randomized controlled study method,A total of 52 patients with cerebral apoplexy and hemiplegia who were admitted to the 900th Hospital of the Joint Logistic Protection Force of the People’s Liberation Army from June 2019 to January 2021 were selected and randomly divided into hyperbaric oxygen group and control group.Patients in both groups received conventional drug therapy and conventional rehabilitation training.Patients in the hyperbaric oxygen group were supplemented with HBOT intervention on this basis,and were treated with YC32130/0.3-24 hyperbaric oxygen treatment chamber.Treatment plan:20 minutes in the boost phase to increase the pressure in the cabin To reach 2.0ATA,wear a mask to inhale oxygen for 30minutes during the stabilization phase,take a rest for 5 minutes to inhale the air in the cabin,then wear a mask to inhale oxygen for 30 minutes,decompress for 20 minutes to normal pressure out of the cabin,the total time is 105 minutes,once a day,5 times a week,treatment for 3 months.All subjects used Discovery-A dual energy X-ray Absorptiometry（DXA）to detect lumbar spine L_1-4and bilateral femoral neck BMD before and after treatment.And cobas e 602 immunoassay analyzer was used to detect serum BTMs.Theβ-Cross Laps of bone resorption markers,Total type I procollagen amino-terminal peptide（TPINP）and bone glaprotein（BGP）of bone formation markers in the system are quantitatively detected,and the ratio of TPINP/β-Cross Laps（%）is calculated.Observe the changes of L_1-4,bilateral femoral neck BMD and serum BTMs in stroke patients with hemiplegia.【Results】1.Before treatment,clinical data of the two groups such as age,stroke type,course of disease,BMI,Fugl-Meyer motor function score,history of hypertension,serum calcium ion(Ca²⁺),25 hydroxy vitamin D（25（OH）D）,there was no statistical difference（P>0.05）.2.After treatment,the BMD of the bilateral femoral neck of all patients was significantly lower than before,and there was a significant statistical difference（P<0.001）.Before and after treatment,the BMD of the ipsilateral femoral neck of all patients was lower than that of the healthy side,and there was a statistical difference（P<0.05）.3.After treatment,the BMD of the lumbar spine L_1-4and bilateral femoral neck of the two groups were significantly lower than before,with significant statistical differences（P<0.001）.4.Between groups analysis,the reduction of BMD of the lumbar spine L_1-4and the affected side of the femoral neck in the hyperbaric oxygen group was delayed compared with the control group,and there was a statistical difference（P=0.002 and P=0.030）;the reduction of BMD of the healthy side of the femoral neck was not significantly different（P=0.565）.5.After treatment,serumβ-Cross Laps,TPINP,BGP,TPINP/β-Cross Laps ratios（%）of the two groups were significantly higher than before,with significant statistical differences（P<0.001）.6.Between groups analysis,the TPINP and BGP in the hyperbaric oxygen group were significantly higher than those in the control group（P=0.035 and P=0.047）;the degree ofβ-Cross Laps increase was not significantly different（P=0.256）.【Conclusions】1.The healthy and affected limbs in stroke patients with hemiplegia have bone loss,the affected side is more obvious;2.Patients with stroke and hemiplegia have increased BTMs concentration,bone formation and bone resorption are active;3.HBOT can effectively delay the bone loss in stroke patients with hemiplegia,and can be used as one of the effective clinical methods to prevent and treat osteoporosis.Its mechanism may be closely related to the increase in serum levels of bone formation markers TPINP and BGP.