镇肝熄风汤对急性脑出血阴虚风动证的影响
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摘要
目的:
本文从理论和临床研究出发探讨了镇肝熄风汤对出血性中风急性期阴虚风动证的临床疗效,并进一步分析了血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)在其中的作用,旨在为镇肝熄风汤治疗出血性中风阴虚风动证提供理论依据,为临床决策提供新的思维。
方法:
选取48例急性基底节脑出血阴虚风动患者随机分为治疗组及对照组。治疗组采用西药常规治疗加口服方药镇肝熄风汤,对照组仅采用西药常规治疗。从中西医两方面比较两组治疗前后神经功能缺损评分及中医症候积分变化并进行疗效评定,比较两组治疗前后的头颅CT血肿体积变化。另选正常健康者12例为正常对照组,将治疗组与对照组于入院时(24小时内)、7天、14天采取空腹静脉血和正常对照组静脉空腹静脉血用ELISA法测定血清MMP-9浓度。理论部分探讨了气化理论,提出气机升降异常,阴阳失衡易发中风,选用滋养肝肾潜阳熄风,沉降浊邪之镇肝熄风汤治疗阴虚风动之急性脑出血以平复气机升降异常调整阴阳失衡。
结果:
1.治疗后治疗组与对照组组在神经功能缺损评分、中医症候积分、疗效评定及头颅CT测定血肿体积等观察项目均较治疗前均有明显改善(各P值均＜0.05),但治疗组更优于对照组(P＜0.05)。
2.治疗组与对照组血浆MMP-9表达在入院时(发病24小时内)均升高,并与血肿周围水肿带体积正相关(r=0.286,P＜0.05),一周后达到高峰,两周后下降。但治疗组在治疗后一周及两周时血浆MMP-9表达均低于对照组(P＜0.05)。
结论:
镇肝熄风汤对脑出血急性期阴虚风动证有明显疗效,并可通过降低血浆MMP-9的表达以减轻脑水肿与炎症反应从而保护脑细胞。
Objectives : To observe the therapeutic efficacy of Liver-Wind Suppressing Decoction on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage and further to study the role of matrix metalloproteinase-9 (MMP-9) in the treatment.
Methods: In clinical research part, 48 patients of acute cerebral hemorrhage were randomly divided into treatment group and control group. The treatment group took Liver-Wind Suppressing Decoction orally besides receiving conventional therapy, but the control group was only received conventional therapy. Nervous Function Defect Scores, Traditional Chinese Syndrome Medicine Accumulated Points, Clinical Efficiency and head CT were evaluated after treatment comparing to pretherapy. Plasma MMP-9 levels were measured with ELISA in 24 hours, the 7~(th) day and the 14~(th) days after the onste of the disease. In theoretical research part, an overview was done on Chinese medicine treating stroke. Based on gasification theory, a hypothesis was proposed that losing balance between YIN and YANG is the main pathogenesis of stroke, the key treatment of stroke is to balance YIN with YANG Liver-Wind Suppressing Decoction, which represents nourishing liver and kidney, suppressing hyper-YANG to eliminate wind, is applied to treat the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage.
Results: 1. Nervous Function Defect Scores and Traditional Chinese Syndrome Medicine Accumulated Points of post-treatment were improved and hematoma volume was reduced comparing to pretreatment (all the P value are lower than 0.05) with more significance in the treatment group than in the control group(P<0.05).
2. In the 2 groups, plasma MMP-9 levels increased after 24h and reached the peak in the 7~(th) day, then decreased after 2 weeks. Plasma MMP-9 levels were positively correlated with brain edema range (r=0.286, P<0.05). Plasma MMP-9 levels in the treatment group were lower than in the control group (P<0.05 ).
Conclusions: Liver-Wind Suppressing Decoction is effective on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage, and might protect brain cells by lessening brain edema and inflammation by inhibiting MMP-9 expression.
本文从理论和临床研究出发探讨了镇肝熄风汤对出血性中风急性期阴虚风动证的临床疗效,并进一步分析了血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)在其中的作用,旨在为镇肝熄风汤治疗出血性中风阴虚风动证提供理论依据,为临床决策提供新的思维。
方法:
选取48例急性基底节脑出血阴虚风动患者随机分为治疗组及对照组。治疗组采用西药常规治疗加口服方药镇肝熄风汤,对照组仅采用西药常规治疗。从中西医两方面比较两组治疗前后神经功能缺损评分及中医症候积分变化并进行疗效评定,比较两组治疗前后的头颅CT血肿体积变化。另选正常健康者12例为正常对照组,将治疗组与对照组于入院时(24小时内)、7天、14天采取空腹静脉血和正常对照组静脉空腹静脉血用ELISA法测定血清MMP-9浓度。理论部分探讨了气化理论,提出气机升降异常,阴阳失衡易发中风,选用滋养肝肾潜阳熄风,沉降浊邪之镇肝熄风汤治疗阴虚风动之急性脑出血以平复气机升降异常调整阴阳失衡。
结果:
1.治疗后治疗组与对照组组在神经功能缺损评分、中医症候积分、疗效评定及头颅CT测定血肿体积等观察项目均较治疗前均有明显改善(各P值均＜0.05),但治疗组更优于对照组(P＜0.05)。
2.治疗组与对照组血浆MMP-9表达在入院时(发病24小时内)均升高,并与血肿周围水肿带体积正相关(r=0.286,P＜0.05),一周后达到高峰,两周后下降。但治疗组在治疗后一周及两周时血浆MMP-9表达均低于对照组(P＜0.05)。
结论:
镇肝熄风汤对脑出血急性期阴虚风动证有明显疗效,并可通过降低血浆MMP-9的表达以减轻脑水肿与炎症反应从而保护脑细胞。
Objectives : To observe the therapeutic efficacy of Liver-Wind Suppressing Decoction on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage and further to study the role of matrix metalloproteinase-9 (MMP-9) in the treatment.
Methods: In clinical research part, 48 patients of acute cerebral hemorrhage were randomly divided into treatment group and control group. The treatment group took Liver-Wind Suppressing Decoction orally besides receiving conventional therapy, but the control group was only received conventional therapy. Nervous Function Defect Scores, Traditional Chinese Syndrome Medicine Accumulated Points, Clinical Efficiency and head CT were evaluated after treatment comparing to pretherapy. Plasma MMP-9 levels were measured with ELISA in 24 hours, the 7~(th) day and the 14~(th) days after the onste of the disease. In theoretical research part, an overview was done on Chinese medicine treating stroke. Based on gasification theory, a hypothesis was proposed that losing balance between YIN and YANG is the main pathogenesis of stroke, the key treatment of stroke is to balance YIN with YANG Liver-Wind Suppressing Decoction, which represents nourishing liver and kidney, suppressing hyper-YANG to eliminate wind, is applied to treat the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage.
Results: 1. Nervous Function Defect Scores and Traditional Chinese Syndrome Medicine Accumulated Points of post-treatment were improved and hematoma volume was reduced comparing to pretreatment (all the P value are lower than 0.05) with more significance in the treatment group than in the control group(P<0.05).
2. In the 2 groups, plasma MMP-9 levels increased after 24h and reached the peak in the 7~(th) day, then decreased after 2 weeks. Plasma MMP-9 levels were positively correlated with brain edema range (r=0.286, P<0.05). Plasma MMP-9 levels in the treatment group were lower than in the control group (P<0.05 ).
Conclusions: Liver-Wind Suppressing Decoction is effective on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage, and might protect brain cells by lessening brain edema and inflammation by inhibiting MMP-9 expression.
引文
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[44]刑承方,郭立伍.镇肝熄风汤治疗高血压的体会.光明中医.2001,11(1):38
[45]刘晚,贾琳娜.中医治疗高血压病的方药.中国临床医生.1999,27(12):13
[46]赵孟碧.镇肝熄风汤加味治疗高血压36例.实用中医内科杂志.2004,18(5):446-447
[47]甘业崇.镇肝熄风汤治疗轻中度高血压病157例.中国民间疗法.2005,13(13):53-54
[48]屠德敬等.镇肝熄风汤佐治顽固性原发性高血压47例.实用中医药杂志.2005,21(4):220-221
[49]姜坤等.镇肝熄风汤对高血压病人血液流变学的影响.中国血液流变学杂志.2004;14(2):180-239
[50]周志兰.中西医结合治疗原发性高血压200例临床观察.湖南中医杂志.2000,16(2):22
[51]赵智强,陆跃鸣,周仲英.天麻钩藤饮等三方对高血压大鼠模型 降压作用的药效动力学研究.中药药理与临床.1999,15(4):26-29
[52]孟云辉,涂欣,吴艳霞.镇肝熄风汤对自发性高血压大鼠脑保护作用的研究.北京中医药大学学报.2007,(2):101
[53]俞晶华,赵智强,陆跃鸣.镇肝熄风汤与建瓴汤的镇静及催眠作用的实验研究.1999,16(4):44-45
[54]陆智慧,丁琪.辨证治疗腔隙性梗塞51例疗效观察.安徽中医临床杂志.1996,8(2):57-58
[55]刘冬立.腔隙性脑梗塞103例疗效小结.中国医药学报.1994,(4):29-30
[56]邵淑娟.镇肝熄风汤为主治疗急性脑卒中疗效观察.湖北中医杂志.2004,(10):30-31
[57]胡建鹏,韩小祥,王健,程红.3种中药复方对脑缺血再灌注大鼠脑能量代谢相关酶影响的比较研究.中国中西医结合杂志.2007,(3):231-233
[58]刘政等.镇肝熄风汤治疗脑梗死疗效观察.浙江中西医结合杂志.2005,(2):124
[59]周自祥.镇肝熄风汤加减合葛根素注射液治疗肝肾阴虚风阳上扰型脑梗死58例.广西中医药.2006,(1):20
[60]管民俭等.镇肝熄风汤加减治疗出血性脑卒中46例.陕西中医.2006,(7):822-823
[61]夏荣蓉等.镇肝熄风汤对脑出血模型大鼠脑细胞凋亡的影响.山东中医杂志.2005,(12):742
[1]成其国.镇肝熄风汤加减治疗高血压的临床体会.现代医药卫生.2002,18(6):197
[2]刑承方,郭立伍.镇肝熄风汤治疗高血压的体会.光明中医.2001,11(1):38
[3]刘晚,贾琳娜.中医治疗高血压病的方药.中国临床医生.1999,27(12):13
[4]赵孟碧.镇肝熄风汤加味治疗高血压36例.实用中医内科杂志.2004,18(5):446-447
[5]甘业崇.镇肝熄风汤治疗轻中度高血压病157例.中国民间疗法.2005,13(13):53-54
[6]屠德敬等.镇肝熄风汤佐治顽固性原发性高血压47例.实用中医药杂志.2005,21(4):220-221
[7]姜坤等.镇肝熄风汤对高血压病人血液流变学的影响.中国血液流变学杂志.2004;14(2):180-239
[8]周志兰.中西医结合治疗原发性高血压200例临床观察.湖南中医杂志.2000,16(2):22
[9]赵智强,陆跃鸣,周仲英.天麻钩藤饮等三方对高血压大鼠模型降压作用的药效动力学研究.中药药理与临床.1999,15(4):26-29
[10]孟云辉,涂欣,吴艳霞.镇肝熄风汤对自发性高血压大鼠脑保护作用的研究.北京中医药大学学报.2007,(2):101
[11]俞晶华,赵智强,陆跃鸣.镇肝熄风汤与建瓴汤的镇静及催眠作用 的实验研究.1999,16(4):44-45
[12]陆智慧,丁琪.辨证治疗腔隙性梗塞51例疗效观察.安徽中医临床杂志.1996,8(2):57-58
[13]刘冬立.腔隙性脑梗塞103例疗效小结.中国医药学报.1994,(4):29-30
[14]邵淑娟.镇肝熄风汤为主治疗急性脑卒中疗效观察.湖北中医杂志.2004,(10):30-31
[15]胡建鹏,韩小祥,王健,程红.3种中药复方对脑缺血再灌注大鼠脑能量代谢相关酶影响的比较研究.中国中西医结合杂志.2007,(3):231-233
[16]刘政等.镇肝熄风汤治疗脑梗死疗效观察.浙江中西医结合杂志.2005,(2):124
[17]周自祥.镇肝熄风汤加减合葛根素注射液治疗肝肾阴虚风阳上扰型脑梗死58例.广西中医药.2006,(1):20
[18]管民俭等.镇肝熄风汤加减治疗出血性脑卒中46例.陕西中医.2006,(7):822-823
[19]夏荣蓉等.镇肝熄风汤对脑出血模型大鼠脑细胞凋亡的影响.山东中医杂志.2005,(12):742
[2]各类脑血管疾病诊断要点.中华神经精神科杂志.1996,29(6):381-382
[3]Brott T,Broderick J,kothari R,et al.Early hemorrhage growth in patients with intracerebral hemorrhage.Stroke,1997,28:1-5
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[1]成其国.镇肝熄风汤加减治疗高血压的临床体会.现代医药卫生.2002,18(6):197
[2]刑承方,郭立伍.镇肝熄风汤治疗高血压的体会.光明中医.2001,11(1):38
[3]刘晚,贾琳娜.中医治疗高血压病的方药.中国临床医生.1999,27(12):13
[4]赵孟碧.镇肝熄风汤加味治疗高血压36例.实用中医内科杂志.2004,18(5):446-447
[5]甘业崇.镇肝熄风汤治疗轻中度高血压病157例.中国民间疗法.2005,13(13):53-54
[6]屠德敬等.镇肝熄风汤佐治顽固性原发性高血压47例.实用中医药杂志.2005,21(4):220-221
[7]姜坤等.镇肝熄风汤对高血压病人血液流变学的影响.中国血液流变学杂志.2004;14(2):180-239
[8]周志兰.中西医结合治疗原发性高血压200例临床观察.湖南中医杂志.2000,16(2):22
[9]赵智强,陆跃鸣,周仲英.天麻钩藤饮等三方对高血压大鼠模型降压作用的药效动力学研究.中药药理与临床.1999,15(4):26-29
[10]孟云辉,涂欣,吴艳霞.镇肝熄风汤对自发性高血压大鼠脑保护作用的研究.北京中医药大学学报.2007,(2):101
[11]俞晶华,赵智强,陆跃鸣.镇肝熄风汤与建瓴汤的镇静及催眠作用 的实验研究.1999,16(4):44-45
[12]陆智慧,丁琪.辨证治疗腔隙性梗塞51例疗效观察.安徽中医临床杂志.1996,8(2):57-58
[13]刘冬立.腔隙性脑梗塞103例疗效小结.中国医药学报.1994,(4):29-30
[14]邵淑娟.镇肝熄风汤为主治疗急性脑卒中疗效观察.湖北中医杂志.2004,(10):30-31
[15]胡建鹏,韩小祥,王健,程红.3种中药复方对脑缺血再灌注大鼠脑能量代谢相关酶影响的比较研究.中国中西医结合杂志.2007,(3):231-233
[16]刘政等.镇肝熄风汤治疗脑梗死疗效观察.浙江中西医结合杂志.2005,(2):124
[17]周自祥.镇肝熄风汤加减合葛根素注射液治疗肝肾阴虚风阳上扰型脑梗死58例.广西中医药.2006,(1):20
[18]管民俭等.镇肝熄风汤加减治疗出血性脑卒中46例.陕西中医.2006,(7):822-823
[19]夏荣蓉等.镇肝熄风汤对脑出血模型大鼠脑细胞凋亡的影响.山东中医杂志.2005,(12):742