天麻钩藤饮辅助治疗痰瘀阻络型急性脑梗死及对血管内皮功能、Hcy、D-二聚体和hs-CRP水平影响的临床研究
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摘要
目的:观察天麻钩藤饮辅助治疗痰瘀阻络型急性脑梗死患者的临床疗效,及对患者血管内皮功能、同型半胱氨酸(Hcy)、D-二聚体和超敏C-反应蛋白(hs-CRP)水平的影响。方法:选取2016年3月至2018年3月江苏省中医院收治的急性脑梗死患者102例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组51例。对照组采用常规西医治疗,观察组在对照组基础上结合天麻钩藤饮治疗。2组疗程均为14 d。比较2组治疗疗效,以及治疗前后NIHSS评分、Balthel指数评分、血管内皮功能、Hcy、D-二聚体和hs-CRP水平的变化。结果:观察组治疗总有效率(92. 16%)高于对照组(70. 59%),差异有统计学意义(P <0. 05)。2组治疗后NIHSS评分较治疗前降低(P <0. 05),而Balthel指数评分较治疗前增加(对照组:t=13. 427、17. 445,观察组:t=22. 986、22. 959,P <0. 05);观察组治疗后NIHSS评分低于对照组,而Balthel指数评分高于对照组(t=17. 375、12. 702,P <0. 05)。2组治疗后ET-1水平较治疗前降低,而NO水平较治疗前增加(对照组:t=11. 236、7. 209,观察组:t=16. 042、19. 336,P <0. 05);观察组治疗后ET-1水平低于对照组,而NO水平高于对照组(t=8. 159、7. 801,P <0. 05)。2组治疗后血清Hcy、D-二聚体和hs-CRP水平较治疗前降低(对照组:t=10. 854、8. 630、12. 002,观察组:t=24. 812、20. 559、18. 890,P <0. 05);观察组治疗后血清Hcy、D-二聚体和hs-CRP水平低于对照组(t=10. 642、12. 775、10. 884,P <0. 05)。结论:天麻钩藤饮辅助治疗痰瘀阻络型急性脑梗死患者临床疗效显著,可改善患者血管内皮功能,降低Hcy、D-二聚体和hs-CRP水平,值得临床借鉴。
Objective: To investigate the clinical efficacy of Tianma Gouteng Decoction as auxiliary treatment in the treatment of acute cerebral infarction with TCM pattern of phlegm and stasis blocking collaterals,and to study the changes in patient' s vascular endothelial function,levels of homocysteine( Hcy),D-dimer and hypersensitivity C-reactive protein( hs-CRP). Methods: A total of102 patients with acute cerebral infarction treated in Jiangsu Province Hospital of Chinese Medicine from March 2016 to March2018 were selected. According to the random number table method,the patients were divided into two groups,with 51 cases in the control group and 51 cases in the treatment group. The control group was treated with conventional western medicine,while the treatment group was treated with Tianma Gouteng Decoction on top of the treatment performed in the control group. The treatment course of both groups were 14 d. The therapeutic effect,NIHSS score,Balthel index,endothelial function,Hcy,D-dimer and hs-CRP levels before and after treatment were compared between the 2 groups. Results: The total effective rate of the treatment group( 92. 16%) was higher than that of the control group( 70. 59%),and the difference was statistically significant( P < 0. 05). After the treatment,in both groups,the score of NIHSS was lower than that before the treatment,and the score of Balthel index was increased compared with that before the treatment( the control group: t = 13. 427,17. 445,the treatment group: t = 22. 986,22. 959,P < 0. 05); and after the treatment,the NIHSS score in the treatment group was lower than that of the control group,while its Balthel index score was higher than that of the control group( t = 17. 375,12. 702,P < 0. 05). The levels of ET-1 in the 2 groups were lower than that before the treatment,and the levels of NO were increased compared with that before treatment( control group: t =11. 236,7. 209,treatment group: t = 16. 042,19. 336,P < 0. 05); and after the treatment,the level of ET-1 in the treatment group was lower than that of the control group,while the NO level was higher than that of the control group( t = 8. 159,7. 801,P < 0. 05).After the treatment,the levels of serum Hcy,D-dimer and hs-CRP were lower in the 2 groups than before the treatment( control group: t = 10. 854,8. 630,12. 002,treatment group: t = 24. 812,20. 559,18. 890,P < 0. 05); after the treatment,the serum Hcy,Ddimer and hs-CRP levels were lower in the treatment group than in the control group( t = 10. 642,12. 775,10. 884,P < 0. 05).Conclusion: The clinical efficacy of Tianma Gouteng Decoction as auxiliary treatment in the treatment of acute cerebral infarction with TCM pattern of phlegm and stasis obstructing collaterals is significant. It can improve patient' s vascular endothelial function and reduce the levels of Hcy,D-dimer and hs-CRP,which is worthy of clinical reference.
Objective: To investigate the clinical efficacy of Tianma Gouteng Decoction as auxiliary treatment in the treatment of acute cerebral infarction with TCM pattern of phlegm and stasis blocking collaterals,and to study the changes in patient' s vascular endothelial function,levels of homocysteine( Hcy),D-dimer and hypersensitivity C-reactive protein( hs-CRP). Methods: A total of102 patients with acute cerebral infarction treated in Jiangsu Province Hospital of Chinese Medicine from March 2016 to March2018 were selected. According to the random number table method,the patients were divided into two groups,with 51 cases in the control group and 51 cases in the treatment group. The control group was treated with conventional western medicine,while the treatment group was treated with Tianma Gouteng Decoction on top of the treatment performed in the control group. The treatment course of both groups were 14 d. The therapeutic effect,NIHSS score,Balthel index,endothelial function,Hcy,D-dimer and hs-CRP levels before and after treatment were compared between the 2 groups. Results: The total effective rate of the treatment group( 92. 16%) was higher than that of the control group( 70. 59%),and the difference was statistically significant( P < 0. 05). After the treatment,in both groups,the score of NIHSS was lower than that before the treatment,and the score of Balthel index was increased compared with that before the treatment( the control group: t = 13. 427,17. 445,the treatment group: t = 22. 986,22. 959,P < 0. 05); and after the treatment,the NIHSS score in the treatment group was lower than that of the control group,while its Balthel index score was higher than that of the control group( t = 17. 375,12. 702,P < 0. 05). The levels of ET-1 in the 2 groups were lower than that before the treatment,and the levels of NO were increased compared with that before treatment( control group: t =11. 236,7. 209,treatment group: t = 16. 042,19. 336,P < 0. 05); and after the treatment,the level of ET-1 in the treatment group was lower than that of the control group,while the NO level was higher than that of the control group( t = 8. 159,7. 801,P < 0. 05).After the treatment,the levels of serum Hcy,D-dimer and hs-CRP were lower in the 2 groups than before the treatment( control group: t = 10. 854,8. 630,12. 002,treatment group: t = 24. 812,20. 559,18. 890,P < 0. 05); after the treatment,the serum Hcy,Ddimer and hs-CRP levels were lower in the treatment group than in the control group( t = 10. 642,12. 775,10. 884,P < 0. 05).Conclusion: The clinical efficacy of Tianma Gouteng Decoction as auxiliary treatment in the treatment of acute cerebral infarction with TCM pattern of phlegm and stasis obstructing collaterals is significant. It can improve patient' s vascular endothelial function and reduce the levels of Hcy,D-dimer and hs-CRP,which is worthy of clinical reference.
引文
[1]Nishikawa H,Nakatsuka Y,Shiba M,et al.Increased Plasma Galectin-3 Preceding the Development of Delayed Cerebral Infarction and Eventual Poor Outcome in Non-Severe Aneurysmal Subarachnoid Hemorrhage[J].Transl Stroke Res,2018,9(2):110-119.
[2]Yu S,Ma SJ,Liebeskind DS,et al.ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic stroke patients[J].J Cereb Blood Flow Metab,2018,38(3):382-392.
[3]Nogueira RG,Frei D,Kirmani JF,et al.Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention:A Randomized Clinical Trial[J].JAMA Neurol,2018,75(3):304-311.
[4]Oda S,Shimoda M,Hirayama A,et al.Retrospective review of previous minor leak before major subarachnoid hemorrhage diagnosed by MRI as a predictor of occurrence of symptomatic delayed cerebral ischemia[J].J Neurosurg,2018,128(2):499-505.
[5]Gason J,Badacz R,Stepien E,et al.Diagnostic and prognostic microRNAs in ischaemic stroke due to carotid artery stenosis and in acute coronary syndrome:a four-year prospective study[J].Kardiol Pol,2018,76(2):362-369.
[6]孙君灯.中医辨证结合西医分期治疗急性脑梗死疗效评价[J].临床研究,2017,25(10):168-169.
[7]肖建兵.中西医结合疗法对急性脑梗死患者血清v WF、APN水平的影响分析[J].中国中医药现代远程教育,2016,14(15):104-106.
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[10]朱东碧.自拟益气通脉活血汤结合西药治疗急性脑梗死120例[J].浙江中医杂志,2016,51(9):638-638.
[11]曹盼盼,吴明华.中西医结合治疗急性脑梗死痰瘀阻络证40例临床研究[J].江苏中医药,2017,49(6):26-29.
[12]王艳旭,李世举,王芳,等.天麻钩藤饮对风阳上扰型急性脑梗死患者血脂,CAT水平的影响[J].中国实验方剂学杂志,2016,13(9):139-142.
[13]王军红.补阳还五汤联合天麻钩藤饮治疗脑梗死的效果观察[J].河南医学研究,2016,25(7):1271-1272.
[14]顾峰.补阳还五汤联合天麻钩藤饮治疗脑梗死的临床效果[J].中国当代医药,2016,23(33):156-158.
[15]张文静,朱涛,张永,等.血管内皮功能与急性脑梗死患者梗死类型及颈动脉斑块性质的相关性[J].现代生物医学进展,2016,16(30):5886-5889.
[16]张阿宁,王剑.急性脑梗死患者血管内皮功能及同型半胱氨酸水平的变化[J].中国微生态学杂志,2017,29(9):1059-1062.
[17]贾二娟.血清Hcy、hs-CRP、IL-6和TNF-α水平与急性脑梗死严重程度的关系[J].实验与检验医学,2017,35(3):382-384.
[18]王伦善,贾建安,黄其峰,等.FDP和D-二聚体在急性脑梗塞和深静脉血栓中的诊断价值[J].临床输血与检验,2016,18(2):133-136.
[19]钱文忠,张富山,杨小旺,等.血浆D-二聚体与急性脑梗死的相关性研究[J].现代临床医学,2017,43(2):127-128.
[20]李冬松,王世君,郜锦英,等.血清hs-CRP水平与急性脑梗死病情程度及近期预后的相关性分析[J].河北医学,2017,23(6):1005-1008.
[2]Yu S,Ma SJ,Liebeskind DS,et al.ASPECTS-based reperfusion status on arterial spin labeling is associated with clinical outcome in acute ischemic stroke patients[J].J Cereb Blood Flow Metab,2018,38(3):382-392.
[3]Nogueira RG,Frei D,Kirmani JF,et al.Safety and Efficacy of a 3-Dimensional Stent Retriever With Aspiration-Based Thrombectomy vs Aspiration-Based Thrombectomy Alone in Acute Ischemic Stroke Intervention:A Randomized Clinical Trial[J].JAMA Neurol,2018,75(3):304-311.
[4]Oda S,Shimoda M,Hirayama A,et al.Retrospective review of previous minor leak before major subarachnoid hemorrhage diagnosed by MRI as a predictor of occurrence of symptomatic delayed cerebral ischemia[J].J Neurosurg,2018,128(2):499-505.
[5]Gason J,Badacz R,Stepien E,et al.Diagnostic and prognostic microRNAs in ischaemic stroke due to carotid artery stenosis and in acute coronary syndrome:a four-year prospective study[J].Kardiol Pol,2018,76(2):362-369.
[6]孙君灯.中医辨证结合西医分期治疗急性脑梗死疗效评价[J].临床研究,2017,25(10):168-169.
[7]肖建兵.中西医结合疗法对急性脑梗死患者血清v WF、APN水平的影响分析[J].中国中医药现代远程教育,2016,14(15):104-106.
[8]吴逊.全国第四届脑血管病学术会议纪要[J].卒中与神经疾病,1997,4(2):3-8.
[9]郑莜萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:68-73.
[10]朱东碧.自拟益气通脉活血汤结合西药治疗急性脑梗死120例[J].浙江中医杂志,2016,51(9):638-638.
[11]曹盼盼,吴明华.中西医结合治疗急性脑梗死痰瘀阻络证40例临床研究[J].江苏中医药,2017,49(6):26-29.
[12]王艳旭,李世举,王芳,等.天麻钩藤饮对风阳上扰型急性脑梗死患者血脂,CAT水平的影响[J].中国实验方剂学杂志,2016,13(9):139-142.
[13]王军红.补阳还五汤联合天麻钩藤饮治疗脑梗死的效果观察[J].河南医学研究,2016,25(7):1271-1272.
[14]顾峰.补阳还五汤联合天麻钩藤饮治疗脑梗死的临床效果[J].中国当代医药,2016,23(33):156-158.
[15]张文静,朱涛,张永,等.血管内皮功能与急性脑梗死患者梗死类型及颈动脉斑块性质的相关性[J].现代生物医学进展,2016,16(30):5886-5889.
[16]张阿宁,王剑.急性脑梗死患者血管内皮功能及同型半胱氨酸水平的变化[J].中国微生态学杂志,2017,29(9):1059-1062.
[17]贾二娟.血清Hcy、hs-CRP、IL-6和TNF-α水平与急性脑梗死严重程度的关系[J].实验与检验医学,2017,35(3):382-384.
[18]王伦善,贾建安,黄其峰,等.FDP和D-二聚体在急性脑梗塞和深静脉血栓中的诊断价值[J].临床输血与检验,2016,18(2):133-136.
[19]钱文忠,张富山,杨小旺,等.血浆D-二聚体与急性脑梗死的相关性研究[J].现代临床医学,2017,43(2):127-128.
[20]李冬松,王世君,郜锦英,等.血清hs-CRP水平与急性脑梗死病情程度及近期预后的相关性分析[J].河北医学,2017,23(6):1005-1008.