Effects of reduced glutathione under general anesthesia on inflammatory cytokines,cognitive function,and stress indicators in stroke patients

Liu Zhifei; Yan Lihui; Hao Xiaofeng; Sun Liying; Guo Quanzhou; Miao Zhenhua; Jiang Zhixia

doi:10.11986/j.issn.1673-873X.2025.07.09

Abstract：Objective To investigate the effects of reduced glutathione(GSH)administered under general anesthesia on inflam-matory cytokines,cognitive function,and stress-related indicators in patients with acute ischemic stroke(AIS),and to provide clinical reference.Methods From May 2022 to July 2024,202 AIS patients who underwent mechanical thrombectomy(MT)under general anesthesia at Xingtai Central Hospital were enrolled.Patients were assigned,using a random number table,to a control group(n=101)and an observation group(n=101).After successful induction of anesthesia,the observation group received reduced GSH 30 mg/kg dissolved in 50 mL normal saline,infused intravenously at 15 mg/(kg·h);the control group received an equal volume of normal saline.Levels of interleukin(IL)-1β,IL-33,transforming growth factor β1(TGF-β1),su-peroxide dismutase(SOD),glutathione peroxidase(GSH-Px),malondialdehyde(MDA),myelin basic protein(MBP)and nerve growth factor(NGF)were measured at anesthesia induction immediate(T0),10 minutes after surgery start(T1),end of surgery(T2),6 h postoperatively(T3)and 24 h postoperatively(T4).Cognitive function was assessed with the Montreal Cognitive Assessment(MoCA)and the Mini-Mental State Examination(MMSE)before surgery and on postoperative day 3.Results No significant differences between groups in IL-1β,IL-33 or TGF-β1 were noted at T0(P＞0.05).From T1to T4,IL-1β,IL-33,and TGF-β1 levels were elevated compared with T0 in both groups,and levels in the control group were higher than those in the observation group,with statistically significant differences(P＜0.05).Preoperatively,Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)scores did not differ significantly between groups(P＞0.05).On postoperative day 3,both groups' MoCA and MMSE scores were significantly higher than preoperative values,and the observation group scored significantly higher than the control group(P＜0.05).At T0,there were no significant differ-ences in SOD,GSH-Px or MDA between groups(P＞0.05).From T1to T4,SOD and GSH-Px decreased relative to T0 in both groups,with the control group showing significantly lower values than the observation group;conversely,MDA increased relative to T0 in both groups,and MDA levels were significantly higher in the control group than in the observation group(P＜0.05).At T0,MBP and NGF did not differ significantly between groups(P＞0.05).From T1 to T4,MBP increased relative to T0 in both groups,with significantly higher MBP in the control group than in the observation group;NGF decreased relative to T0 in both groups,with the control group showing significantly lower NGF than the observation group(P＜0.05).Conclu-sion Administration of reduced GSH during general anesthesia can attenuate inflammatory and stress responses,reduce neural tissue injury,and ameliorate cognitive function in AIS patients undergoing MT.GSH merits consideration for clinical applica-tion.