益气活血汤对脑分水岭梗死急性期多时点NIHSS,中医证候,HSP-70的影响
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摘要
目的:探讨益气活血汤对脑分水岭梗死急性期患者多时点美国国立卫生研究院卒中量表(NIHSS)、中医证候、热休克蛋白-70(HSP-70)的影响,及HSP-70的动态变化与疾病发展和中医证候演变的相关性。方法:脑分水岭梗死发病72 h以内的137例患者随机分为治疗组69例,对照组68例。治疗组在对照组治疗的基础上,口服中药益气活血汤。发病3 d内、第7,14天记录NIHSS评分,进行中医证候评价。采集HSP-70,进行比较及相关性分析。结果:治疗后治疗组NIHSS差值高于对照组(P<0.05),治疗组气虚和血瘀的改善显著优于对照组(P<0.01)。两组发病3~7 d,治疗组HSP-70升高幅度高于对照组(P<0.05)。两组发病7~14 d,治疗组HSP-70下降幅度高于对照组(P<0.05)。3个时点HSP-70与NIHSS,气虚,血瘀均成负相关(P<0.05)。发病3 d内、第7天NIHSS与气虚、血瘀均成显著正相关(P<0.01)。发病第14天NIHSS与气虚成正相关(P<0.05),与血瘀成显著正相关(P<0.01)。结论:益气活血汤有助于改善脑分水岭梗死急性期患者的神经功能缺损情况,对气虚血瘀的中医证候有显著改善作用。益气活血汤可能有利于HSP-70发挥细胞保护功能。因其高度相关性,发病后HSP-70的表达水平在不同时间点的差异与关联能够从微观角度反映脑分水岭梗死急性期患者的神经功能缺损的变化规律及中医证候的演变趋势。
Objective: To investigate the effects of Yiqi Huoxue decoction on National Institute of Health stroke scale( NIHSS),traditional Chinese medicine( TCM) syndromes and heat shock protein-70( HSP-70) scores of acute cerebral watershed infarction patients at several time points, and explore the correlation between dynamic changes of HSP-70 and disease development as well as evolution of TCM syndromes. Method:The 137 patients within 72 h of cerebral watershed infarction were randomly divided into treatment group( 69cases) and control group( 68 cases). Patients in treatment group orally took Yiqi Huoxue decoction on the basis of treatment in control group. NIHSS and TCM Syndrome scores were recorded while HSP-70 data were collected within 3 days and on day 7,day 14 after disease onset. Means were compared and correlation analysis was done.Result: The differential value of NIHSS scores before and after treatment in treatment group was higher than that in control group( P < 0. 05). The differential values of Qi deficiency score and blood stasis score before and after treatment in the treatment group were significantly higher than those in control group( P < 0. 01). Within 3 days to the day 7 after disease onset,the increased degree of HSP-70 in treatment group was higher than that in control group( P < 0. 05). From day 7 to day 14 after onset,the decreased degree of HSP-70 in treatment group was higher than that in control group( P < 0. 05). HSP-70 was negatively correlated with NIHSS score,Qi deficiency score and blood stasis score at 3 time points( P < 0. 05). NIHSS score was significantly positively correlated with Qi deficiency score and blood stasis score within 3 days and on day 7 after onset( P < 0. 01). NIHSS score was positively correlated with Qi deficiency score( P < 0. 05) and significantly positively correlated with blood stasis( P < 0. 01) on day 14 after onset. Conclusion: Yiqi Huoxue decoction can help to improve the neurologic deficits,and significantly improve Qi deficiency and blood stasis of the patients with acute cerebral watershed infarction. Yiqi Huoxue decoction possibly beneficial to the cells protection effect of HSP-70. Because of the high correlation,the difference and relevance of HSP-70 expression level at different time points after onset can reflect the change rule of neurologic deficits and the evolution trend of TCM syndromes in patients with acute cerebral watershed infarction from micro perspective.
Objective: To investigate the effects of Yiqi Huoxue decoction on National Institute of Health stroke scale( NIHSS),traditional Chinese medicine( TCM) syndromes and heat shock protein-70( HSP-70) scores of acute cerebral watershed infarction patients at several time points, and explore the correlation between dynamic changes of HSP-70 and disease development as well as evolution of TCM syndromes. Method:The 137 patients within 72 h of cerebral watershed infarction were randomly divided into treatment group( 69cases) and control group( 68 cases). Patients in treatment group orally took Yiqi Huoxue decoction on the basis of treatment in control group. NIHSS and TCM Syndrome scores were recorded while HSP-70 data were collected within 3 days and on day 7,day 14 after disease onset. Means were compared and correlation analysis was done.Result: The differential value of NIHSS scores before and after treatment in treatment group was higher than that in control group( P < 0. 05). The differential values of Qi deficiency score and blood stasis score before and after treatment in the treatment group were significantly higher than those in control group( P < 0. 01). Within 3 days to the day 7 after disease onset,the increased degree of HSP-70 in treatment group was higher than that in control group( P < 0. 05). From day 7 to day 14 after onset,the decreased degree of HSP-70 in treatment group was higher than that in control group( P < 0. 05). HSP-70 was negatively correlated with NIHSS score,Qi deficiency score and blood stasis score at 3 time points( P < 0. 05). NIHSS score was significantly positively correlated with Qi deficiency score and blood stasis score within 3 days and on day 7 after onset( P < 0. 01). NIHSS score was positively correlated with Qi deficiency score( P < 0. 05) and significantly positively correlated with blood stasis( P < 0. 01) on day 14 after onset. Conclusion: Yiqi Huoxue decoction can help to improve the neurologic deficits,and significantly improve Qi deficiency and blood stasis of the patients with acute cerebral watershed infarction. Yiqi Huoxue decoction possibly beneficial to the cells protection effect of HSP-70. Because of the high correlation,the difference and relevance of HSP-70 expression level at different time points after onset can reflect the change rule of neurologic deficits and the evolution trend of TCM syndromes in patients with acute cerebral watershed infarction from micro perspective.
引文
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[13]王增义.益气活血方治疗分水岭脑梗死20例[J].中国中医药现代远程教育,2010,8(11):214-215.
[14]曹学乾.加味补阳还五汤治疗脑分水岭梗死60例[J].湖北中医杂志,2011,33(3):30-31.
[15]骆磊,何晓茵,彭海丽,等.补阳还五汤加减方联合基础疗法治疗早期脑分水岭梗死疗效观察[J].中国中西医结合杂志,2014,34(10):1275-1277.
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[17]查鹏洲,刘荣丽,林海,等.补气养阴通络法治疗分水岭性脑梗死36例[J].陕西中医,2010,31(2):156-158.
[18]朱俊英.中西医结合治疗分水岭性脑梗死临床观察[J].现代中西医结合杂志,2008,17(36):5607-5608.
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[20]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国医学前沿杂志:电子版,2010,2(4):50-59.
[21]高颖,马斌,刘强,等.缺血性中风证候要素诊断量表编制及方法学探讨[J].中医杂志,2011,52(24):2097-2101.
[22]朱大栩,马更生.热休克蛋白的生物学功能[J].国外医学分子生物学杂志,1993,15(6):275-278.
[23]谷文萍.热休克蛋白70研究进展[J].国外医学:神经病学,1999,26(2):57-59.
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[25]刘璐,高颖,马斌.缺血性中风急性期证候特征与生物学指标的关系[J].中华中医药杂志,2011,26(5):1086-1090.
[2]文洁.中西医结合治疗脑分水岭梗塞56例疗效观察[J].海南医学,2009,20(9):42-43.
[3]汤永国.参麦注射液治疗急性分水岭脑梗死35例疗效观察[J].浙江中医杂志,2011,46(4):238-239.
[4]王连心,谢雁鸣,艾青华,等.参麦注射液上市后临床安全性主动监测与被动监测大数据综合评估[J].中国中药杂志,2015,40(24):4752-4756.
[5]王瑜.中西医结合治疗脑分水岭梗死26例观察[J].实用中医内科杂志,2007,21(3):53-54.
[6]胡荣鑫,张贺,王政琨.中西医结合治疗分水岭脑梗死临床分析[J].实用中医内科杂志,2008,22(12):59-60.
[7]翟永超.参附针治疗脑分水岭梗死疗效观察[J].中国实用神经疾病杂志,2010,13(9):64-66.
[8]邓孝纯,许斌,李强.丹红注射液治疗脑分水岭梗死临床疗效分析[J].西部医学,2010,22(6):1059-1060.
[9]郭联,柳波.706代血浆联合灯盏生脉胶囊治疗脑分水岭梗死的临床观察[J].广东医学,2009,30(8):1178-1179.
[10]庞啸虎,高丽,陈士军,等.通心络胶囊治疗分水岭脑梗死疗效观察[J].中国现代药物应用,2011,5(23):80-81.
[11]程宇.针刺联合养血清脑颗粒治疗分水岭脑梗死30例临床观察[J].山东医药,2008,48(31):35.
[12]张利平.中西医结合治疗脑分水岭梗死的临床研究[J].中国医药指南,2013,11(12):681-682.
[13]王增义.益气活血方治疗分水岭脑梗死20例[J].中国中医药现代远程教育,2010,8(11):214-215.
[14]曹学乾.加味补阳还五汤治疗脑分水岭梗死60例[J].湖北中医杂志,2011,33(3):30-31.
[15]骆磊,何晓茵,彭海丽,等.补阳还五汤加减方联合基础疗法治疗早期脑分水岭梗死疗效观察[J].中国中西医结合杂志,2014,34(10):1275-1277.
[16]胡茂宏.加味补中益气汤联合西药治疗脑分水岭梗死40例疗效观察[J].白求恩军医学院学报,2012,10(6):524-525.
[17]查鹏洲,刘荣丽,林海,等.补气养阴通络法治疗分水岭性脑梗死36例[J].陕西中医,2010,31(2):156-158.
[18]朱俊英.中西医结合治疗分水岭性脑梗死临床观察[J].现代中西医结合杂志,2008,17(36):5607-5608.
[19]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-383.
[20]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中国医学前沿杂志:电子版,2010,2(4):50-59.
[21]高颖,马斌,刘强,等.缺血性中风证候要素诊断量表编制及方法学探讨[J].中医杂志,2011,52(24):2097-2101.
[22]朱大栩,马更生.热休克蛋白的生物学功能[J].国外医学分子生物学杂志,1993,15(6):275-278.
[23]谷文萍.热休克蛋白70研究进展[J].国外医学:神经病学,1999,26(2):57-59.
[24]金醒昉,杨莉,陈明,等.老年脑梗死患者热休克蛋白70及其抗体的研究[J].中国老年保健医学杂志,2003,1(2):24-29.
[25]刘璐,高颖,马斌.缺血性中风急性期证候特征与生物学指标的关系[J].中华中医药杂志,2011,26(5):1086-1090.