化痰通络颗粒对LAA型脑梗死患者白三烯B4表达的影响
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摘要
【目的】观察化痰通络颗粒对风痰瘀阻型大动脉粥样硬化型(LAA)急性脑梗死(ACI)患者血清白三烯B4(LTB4)表达的影响。【方法】将69例发病3 d内的风痰瘀阻型ACI患者随机分为观察组35例和对照组34例。2组患者均给予西医基础治疗,观察组同时给予口服化痰通络颗粒(由法半夏、天麻、白术、三七粉、丹参、香附、酒大黄等组成)治疗,对照组同时给予灯盏细辛注射液静脉滴注治疗。治疗前及治疗7 d、14 d后对2组患者进行神经功能学评分(包括简化Fugl-Meyer法、Barthel指数、NIHSS评分)和疗效评定,用酶联免疫吸附法(ELISA)检测2组患者血清LTB4水平,并与25例健康体检者(正常对照组)作比较。【结果】(1)经2个疗程治疗后,观察组的显效率和总有效率分别为60.0%和94.3%,对照组分别为32.4%和73.5%;组间比较,观察组的显效率、总有效率和总体疗效均优于对照组,差异均有统计学意义(P<0.05)。(2)治疗7 d和14 d后,2组患者Barthel指数和Fugl-Meyer评分均较治疗前升高(P<0.05),NIHSS评分均较治疗前降低(P<0.05),且观察组对Barthel指数和Fugl-Meyer评分的升高作用和对NIHSS评分的降低作用均优于对照组(P<0.05)。(3)治疗前,2组患者血清LTB4水平均明显高于正常对照组(P<0.05)。治疗7 d后2组血清LTB4水平仍较治疗前升高(P<0.05),治疗14 d后2组血清LTB4水平开始降低(P<0.05),但仍明显高于正常对照组水平(P<0.05)。【结论】化痰通络颗粒对风痰瘀阻型ACI患者的神经功能恢复具有较好的促进作用,这可能与其下调LTB4水平,减轻ACI后的炎症反应等有关。
Objective To observe the effect of Huatan Tongluo Granules on the expression of serum leukotriene B4(LTB4)in acute cerebral infarction(ACI)patients due to large-artery atherosclerosis(LAA)with wind-phlegmand blood-stasis blockage type. Methods Sixty-nine cases of LAA-ACI patients with wind-phlegm and blood-stasis blockage type within 3 days after the attack were randomly divided into two groups, 35 cases in theobservation group and 34 cases in the control group. The two groups were given fundamental treatment of westernmedicine, and additionally the observation group was given oral use of Huatan Tongluo Granules(mainlycomposed of Rhizoma Pinelliae,Rhizoma Gastrodiae,Rhizoma Atractylodis Macrocephalae,Radix Notoginsengpowder,Radix Salviae Miltiorrhizae,Rhizoma Cyperi,and Radix et Rhizoma Rhei prepared with wine)and thecontrol group was given intravenous injection of Dengzhan Xixin Injection. Seven days constituted one treatmentcourse,and the treatment lasted for 2 courses. Before treatment and after treatment for 7,14 days,the neurologicfunction in the two groups was evaluated with simplified Fugl-Meyer scores,Barthel index and National Instituteof Health Stroke Scale(NIHSS)scores, the therapeutic effect was observed, and the serum LTB4 level was detected with enzyme-linked immunosorbent assay(ELISA). The serum LTB4 level in the two groups wascompared with that of the 25 healthy volunteers. Results(1)After treatment for 2 courses,the markedly effectiverate and the total effective rate in the observation group were 60.0% and 94.3%,and were 32.4% and 73.5% in thecontrol group respectively,the difference being significant(P<0.05).(2)Compared with those before treatment,Barthel index and Fugl-Meyer scores in the two groups after treatment for 7,14 days were increased(P<0.05),and NIHSS scores were decreased(P<0.05);the effects of the observation group on increasing Barthel index andFugl-Meyer scores as well as on decreasing NIHSS scores were superior to those of the control group(P<0.05).(3)Before treatment, serum LTB4 level in the two groups was higher than that of the healthy volunteers(P<0.05).After treatment for 7 days,serum LTB4 level in the two groups was higher than that before treatment(P<0.05),and began to decrease after treatment for 14 days(P<0.05 compared with that after treatment for 7 days),but thelevel was still much higher than that of the healthy volunteers(P<0.05). Conclusion Huatan Tongluo Granulesexert certain effects on promoting the recovery of neurologic function of LAA-ACI patients with wind-phlegm andblood-stasis blockage type,and the mechanism may be related with the down-regulation of serum LTB4 level andwith the reduction of inflammatory response after ACI.
Objective To observe the effect of Huatan Tongluo Granules on the expression of serum leukotriene B4(LTB4)in acute cerebral infarction(ACI)patients due to large-artery atherosclerosis(LAA)with wind-phlegmand blood-stasis blockage type. Methods Sixty-nine cases of LAA-ACI patients with wind-phlegm and blood-stasis blockage type within 3 days after the attack were randomly divided into two groups, 35 cases in theobservation group and 34 cases in the control group. The two groups were given fundamental treatment of westernmedicine, and additionally the observation group was given oral use of Huatan Tongluo Granules(mainlycomposed of Rhizoma Pinelliae,Rhizoma Gastrodiae,Rhizoma Atractylodis Macrocephalae,Radix Notoginsengpowder,Radix Salviae Miltiorrhizae,Rhizoma Cyperi,and Radix et Rhizoma Rhei prepared with wine)and thecontrol group was given intravenous injection of Dengzhan Xixin Injection. Seven days constituted one treatmentcourse,and the treatment lasted for 2 courses. Before treatment and after treatment for 7,14 days,the neurologicfunction in the two groups was evaluated with simplified Fugl-Meyer scores,Barthel index and National Instituteof Health Stroke Scale(NIHSS)scores, the therapeutic effect was observed, and the serum LTB4 level was detected with enzyme-linked immunosorbent assay(ELISA). The serum LTB4 level in the two groups wascompared with that of the 25 healthy volunteers. Results(1)After treatment for 2 courses,the markedly effectiverate and the total effective rate in the observation group were 60.0% and 94.3%,and were 32.4% and 73.5% in thecontrol group respectively,the difference being significant(P<0.05).(2)Compared with those before treatment,Barthel index and Fugl-Meyer scores in the two groups after treatment for 7,14 days were increased(P<0.05),and NIHSS scores were decreased(P<0.05);the effects of the observation group on increasing Barthel index andFugl-Meyer scores as well as on decreasing NIHSS scores were superior to those of the control group(P<0.05).(3)Before treatment, serum LTB4 level in the two groups was higher than that of the healthy volunteers(P<0.05).After treatment for 7 days,serum LTB4 level in the two groups was higher than that before treatment(P<0.05),and began to decrease after treatment for 14 days(P<0.05 compared with that after treatment for 7 days),but thelevel was still much higher than that of the healthy volunteers(P<0.05). Conclusion Huatan Tongluo Granulesexert certain effects on promoting the recovery of neurologic function of LAA-ACI patients with wind-phlegm andblood-stasis blockage type,and the mechanism may be related with the down-regulation of serum LTB4 level andwith the reduction of inflammatory response after ACI.
引文
[1]方美凤,谭峰.细胞因子信号转导抑制因子-3与缺血性脑损伤[J].中华神经医学杂志,2009,8(5):532.
[2]方美凤,谭峰.化痰通络颗粒对脑梗死患者外周血细胞因子信号转导抑制因子-3及肿瘤坏死因子-α的影响[J].中国中西医结合杂志,2010,30(11):1142.
[3]Wu L,Miao S,Zou L B,et al.Lipoxin A4 inhibits 5-lipoxygenase translocation and leukotrienes biosynthesis to exert a neuroprotective effect in cerebral ischemia/reperfusion injury[J].JMol Neurosci,2012,48(1):185.
[4]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[5]Pullicino P,Nelson R F,Kendall B E,et al.Small deep infarcts diagnosed on computed tomograhy[J].Neurology,1980,30(10):1090.
[6]国家中医药管理局脑病急症科研协作组.中风病辨证诊断标准(试行)[J].北京中医药大学学报,1991,17(3):64.
[7]Bamford J,Dennis M,Sandercock P,et al.The frequency,causes and timing of death within 30 days of a first stroke:the Oxfordshire Community Stroke Project[J].J Neurol Neurosurg Psychiatry,1990,53(10):824.
[8]Adams H P Jr,Bendixen B H,Kappelle L J,et al.Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial.TOAST.Trial of org 10172 in Acute Stroke Treatment[J].Stroke,1993,24:35.
[9]饶明俐.中国脑血管病防治指南(试行版)[M].北京:人民卫生出版社,2007.
[10]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(12):381.
[11]Brott T,Adams H P,Olinger C P,et al.Measurements of acute cerebral Infarction:a clinical examination scale[J].Stroke,1989,20:864.
[12]王拥军.卒中单元[M].北京:科学技术文献出版社,2004:490-494,496-497.
[13]詹杰,谭峰.中风病“气-血-痰”轴及益气活血化痰法初探[J].辽宁中医杂志,2016,43(8):163.
[14]雍胜海,谢涛,何旭明,等.中经Ⅱ号治疗缺血性中风风痰阻络证100例[J].广西中医药,2002,25(1):26.
[15]张慧,黄帆.脑梗塞患者外周血LTB4的动态变化[J].热带医学杂志,2005,5(3):297.
[16]Barone F C,Hillegass L M,Tzimas M N,et al.Time-related changes in myeloperoxidase activity and leukotriene B4 receptor binding reflect leukocyte influx in cerebral focal stroke[J].Mol Chem Neuropathol,1995,24(1):13.
[17]李健业,李军荣.白三烯B4与大动脉粥样硬化型脑梗死患者的临床研究[J].卒中与神经疾病,2017,24(6):540.
[2]方美凤,谭峰.化痰通络颗粒对脑梗死患者外周血细胞因子信号转导抑制因子-3及肿瘤坏死因子-α的影响[J].中国中西医结合杂志,2010,30(11):1142.
[3]Wu L,Miao S,Zou L B,et al.Lipoxin A4 inhibits 5-lipoxygenase translocation and leukotrienes biosynthesis to exert a neuroprotective effect in cerebral ischemia/reperfusion injury[J].JMol Neurosci,2012,48(1):185.
[4]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379.
[5]Pullicino P,Nelson R F,Kendall B E,et al.Small deep infarcts diagnosed on computed tomograhy[J].Neurology,1980,30(10):1090.
[6]国家中医药管理局脑病急症科研协作组.中风病辨证诊断标准(试行)[J].北京中医药大学学报,1991,17(3):64.
[7]Bamford J,Dennis M,Sandercock P,et al.The frequency,causes and timing of death within 30 days of a first stroke:the Oxfordshire Community Stroke Project[J].J Neurol Neurosurg Psychiatry,1990,53(10):824.
[8]Adams H P Jr,Bendixen B H,Kappelle L J,et al.Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical trial.TOAST.Trial of org 10172 in Acute Stroke Treatment[J].Stroke,1993,24:35.
[9]饶明俐.中国脑血管病防治指南(试行版)[M].北京:人民卫生出版社,2007.
[10]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(12):381.
[11]Brott T,Adams H P,Olinger C P,et al.Measurements of acute cerebral Infarction:a clinical examination scale[J].Stroke,1989,20:864.
[12]王拥军.卒中单元[M].北京:科学技术文献出版社,2004:490-494,496-497.
[13]詹杰,谭峰.中风病“气-血-痰”轴及益气活血化痰法初探[J].辽宁中医杂志,2016,43(8):163.
[14]雍胜海,谢涛,何旭明,等.中经Ⅱ号治疗缺血性中风风痰阻络证100例[J].广西中医药,2002,25(1):26.
[15]张慧,黄帆.脑梗塞患者外周血LTB4的动态变化[J].热带医学杂志,2005,5(3):297.
[16]Barone F C,Hillegass L M,Tzimas M N,et al.Time-related changes in myeloperoxidase activity and leukotriene B4 receptor binding reflect leukocyte influx in cerebral focal stroke[J].Mol Chem Neuropathol,1995,24(1):13.
[17]李健业,李军荣.白三烯B4与大动脉粥样硬化型脑梗死患者的临床研究[J].卒中与神经疾病,2017,24(6):540.