化痰通腑汤治疗急性脑梗死78例临床观察

Clinical observation on effects of Huatan Tongfu decoction on 78 patients with acute cerebral infarction

目的探讨化痰通腑汤对急性脑梗死患者血浆组织型纤溶酶原激活物（t-PA）、组织型纤溶酶原激活物抑制物（PAI）、同型半胱氨酸（Hcy）的影响。方法采用随机对照研究方法，选择2010年至2012年在首都医科大学附属北京朝阳医院中医科住院的患者78例，按随机数字表法分为治疗组40例和对照组38例。对照组采用常规治疗，治疗组在对照组基础上加用化痰通腑汤（组成：全瓜蒌30g，胆南星6g，厚朴10g，炒谷芽15g）治疗；另外将生大黄单独制成汤剂，每20mL含生药量6g。于入组后前1～4d，两组汤剂混合，每日分2次温服；人组后5～12d，每日服用组方汤剂200mL，分2次温服，根据患者排便情况调整生大黄的用量，疗程为12d。观察患者治疗前及治疗7d后t—PA、PAI、Hcy水平，治疗前及治疗12d后中医证候积分（按痰证、火热证及腑实证评分），并用美国国立卫生院卒中量表（NIHSS）评分评价神经功能缺损程度。结果两组治疗前t—PA、PAI、Hcy水平及NIHSS评分和痰证、火热证、腑实证证候积分比较差异均无统计学意义；治疗后所有指标均较治疗前明显改善，且以治疗组变化更显著[t—PA（mg／L）：13．03±2．15比12．95±2．16，PAI（mg／L）：23．64±9．07比26．81±10．00，Hcy（μmol／L）：9．13±1．15比11．52±3．17，痰证（分）：9．16±1．71比11．17±2．89，火热证（分）：7．51±1．59比8．81±2．26，腑实证（分）：0．61±0．87比1．19±1．14，NIHSS评分（分）：5．70±3．16比5．90±2．97]。结论化痰通腑汤治疗痰热腑实证急性脑梗死患者的机制可能是通过降低PAI和Hcy水平，保护血管内皮、促进纤溶的发生，从而提高临床疗效。

Objective To study the influence of resolving phlegm and relaxing bowels decoction （Huatan Tongfu decoction） on plasma tissue type plasminogen activator （t-PA）, plasminogen activator inhibitor （PAl） and homocysteine （Hcy） in patients with acute cerebral infarction. Methods With randomized and controlled clinical research, 78 inpatients from 2010 to 2012 in Traditional Chinese Medicine （TCM） Department of Beijing Chaoyang Hospital, Capital Medical University were chosen, including 40 patients in observation group and 38 patients in control group. The patients in control and observation groups were treated by conventional treatment, and additionally the patients in observation group received Huatan Tongfu decoction （ingredients ： Trichosanthis 30 g, Arisaema with bile 6 g, Magnolia bark 10 g, Fried rice sprout 15 g）, and the rhubarb decoction was made alone, each 20 mL decoction containing crude drug 6 g. 1-4 days after the beginning of the study, the two decoctions were mixed, and the patients took the lukewarm mixture orally twice daily （once 1/2 the dosage） ; 5-12 days after the start of the study, the patients took 200 mL lukewarm mixed decoction daily, being divided into 2 times to administer, and according to the patient defecation situation, the dosage of rhubarb decoction was adjusted individually, the therapeutic course being 12 days. The t-PA, PAI and Hcy were detected before treatment and on the 7th day after treatment. TCM syndrome scores （phlegm syndrome, fire-heat syndrome and sthenic-fu syndrome） were recorded before and on the 12th day after treatment, and the scores of National Institute of Health Stroke Scab （NIHSS） were recorded at the same time. Results Before treatment, the differences in t-PA, PAl, Hcy levels and NIHSS score and phlegm syndrome, fire-heat syndrome and sthenic-fu syndrome scores were not statistically significant ; all the indicators improved significantly after treatment compared with those before treatment, and the changes in observation group were more remarkable [ t-PA （mg/L） ： 13.03 ±2.15 vs. 12.95 ± 2.16, PAI （mg/L） ： 23.64±9.07 vs. 26.81 ± 10.00, Hey （μmol/L） ： 9.13±1.15 vs. 11.52±3.17, phlegm syndrome： 9.16±1.71 vs. 11.17±2.89, fire-heat syndrome： 7.51±1.59 vs. 8.81±2.26, sthenic-fu syndrome： 0.61±0.87 vs. 1.19±1.14, NIHSS score： 5.70±3.16 vs. 5.90± 2.97 ]. Conclusion The mechanism of Huatan Tongfu decoction in treatment of patients with acute cerebral infarction accompanied by TCM syndromes of phlegm heat and sthenie-fu may be related to the reduction of plasma PAI and Hey levels, protection of vascular endothelium and promotion of fibrinolysis, thereby the decoction can improve the clinical efficacy.