通窍化栓汤联合长春西汀及阿司匹林治疗急性脑梗死的疗效及对血液流变学和血清S100B、MMP-9的影响

Therapeutic Effect of Tongqiao Huashuan Decoction Combined with Vinpocetine and Aspirin on Acute Cerebral Infarction and Its Influence on Levels of Hemorheology and Serum Calcium-binding Protein S100B and Matrix Metalloproteinase 9

【目的】探讨通窍化栓汤(由大血藤、见血飞和血三七等中药组成)联合长春西汀及阿司匹林治疗急性脑梗死的疗效及对血液流变学、血清钙结合蛋白(S100B)和基质金属蛋白酶9(MMP-9)水平的影响。【方法】将116例急性脑梗死气虚血瘀证患者随机分为对照组和观察组,每组各58例。2组患者入院后均给予对症及维持生命体征平稳、控制血压、降颅内压等常规治疗。在此基础上,对照组患者给予阿司匹林肠溶片联合长春西汀治疗,观察组在对照组的基础上给予通窍化栓汤治疗,疗程为14 d。观察2组患者治疗前后中医证候积分、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力(ADL)评分、血液流变学指标、血小板功能指标和血清S100B、MMP-9水平的变化情况,并评价2组患者的临床疗效。【结果】(1)临床疗效方面,治疗14 d后,观察组的总有效率为91.38%(53/58),对照组为77.59%(45/58),组间比较(χ2检验),观察组的疗效明显优于对照组(P<0.05)。(2)量表评分方面,治疗后,2组患者的中医证候积分、NIHSS评分均较治疗前明显降低(P<0.05或P<0.01),ADL评分均较治疗前明显升高(P<0.05),且观察组对中医证候积分、NIHSS评分的降低幅度和对ADL评分的升高幅度均明显优于对照组(P<0.01)。(3)血液流变学指标方面,治疗后,2组患者的全血高切黏度、全血低切黏度、血浆黏度和纤维蛋白原水平均较治疗前明显降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.05或P<0.01)。(4)血小板功能指标方面,治疗后,2组患者的血小板聚集率(PAgT)、血小板黏附率(PAdT)水平均较治疗前明显降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.01)。(5)血清S100B和MMP-9水平方面,治疗后,2组患者的血清S100B和MMP-9水平均较治疗前明显降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.01)。【结论】通窍化栓汤联合长春西汀和阿司匹林治疗急性脑梗死效果显著,可有效改善患者血液流变学指标和血小板功能,降低血清S100B和MMP-9表达水平,提高患者日常生活能力。

Objective To investigate the therapeutic effect of Tongqiao Huashuan Decoction(mainly composed of Sargentodoxae Caulis,Toddalae Radix and Polygoni Amplexicaulis Rhizoma)combined with Vinpocetine and Aspirin in treating acute cerebral infarction and to observe its effect on the levels of hemorheology and serum calcium-binding protein S100B and matrix metalloproteinase 9(MMP-9).Methods A total of 116 patients with acute cerebral infarction of qi deficiency and blood stasis type were randomly divided into the control group and the observation group,with 58 patients in each group.The patients in the two groups were given symptomatic treatment and conventional treatment for keeping stable vital signs,controlling blood pressure,and lowering intracranial pressure after admission to the hospital.Moreover,patients in the control group were given Aspirin Enteric-Coated Tablets combined with Vinpocetine,and patients in the observation group were given Tongqiao Huashuan Decoction together with the treatment for the control group.Both groups were treated for 14 days.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine syndrome score,National Institutes of Health Stroke Scale(NIHSS)score,activities of daily living(ADL)score,hemorheological indicators,platelet function indicators,and serum levels of S100B and MMP-9.After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 14 days of treatment,the total effective rate of the observation group was 91.38%(53/58)and that of the control group was 77.59%(45/58),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the observation group was significantly superior to that of the control group(P<0.05).(2)After treatment,the TCM syndrome scores and NIHSS scores in the two groups were significantly lower(P<0.05 or P<0.01),and the ADL scores were significantly higher than those before treatment(P<0.05),and the decrease of TCM syndrome scores and NIHSS scores and the increase of the ADL scores in the observation group were significantly superior to those in the control group(P<0.01).(3)After treatment,the levels of hemorheological indicators of whole blood high-shear viscosity,whole blood low-shear viscosity,plasma viscosity and fibrinogen in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the levels of platelet function indicators of platelet aggregation rate(PAgT)and platelet adhesion rate(PAdT)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(5)After treatment,the serum S100B and MMP-9 levels of the two groups were significantly decreased compared with those before treatment(P<0.05),and the decrease in the observation group was significantly superior to that of the control group(P<0.01).Conclusion Tongqiao Huashuan Decoction combined with Vinpocetine and Aspirin exerts certain effect for the treatment of acute cerebral infarction.The combined therapy is effective on improving the hemorheological indicators and platelet function,decreasing the expression level of serum S100B and MMP-9,and improving the ADL of the patients.