高压氧配合中药汤剂治疗中青年脑卒中患者的效果及对TLR4/NF-κB信号通路与免疫炎症因子的影响

Effect of Hyperbaric Oxygen Combined with Traditional Chinese Medicine Decoction on Young and Middle-Aged Stroke Patients and Influence on TLR4/NF-κB Signaling Pathway and Immune Inflammatory Factors

目的 探讨高压氧配合中药汤剂治疗中青年脑卒中患者的临床疗效,并分析其对免疫炎症因子、Toll样受体4(TLR4)/核转录因子-κB(NF-κB)信号通路的影响。方法 选取2021年2月至2023年2月郑州颐和医院收治的80例中青年脑卒中患者为研究对象,遵循随机单双数分配原则分为单一组、联合组,每组40例。单一组接受中药汤剂治疗,联合组接受高压氧配合中药汤剂治疗。统计对比两组临床疗效、中医证候积分、不良反应发生情况及神经功能[美国国立卫生研究院卒中量表(NIHSS)]、日常生活能力[Barthel指数(BI)]、肢体运动功能[Fugl-Meyer运动功能量表(FMA)]。对比两组治疗前后血清免疫炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)、红细胞C3b受体花环率(RBC-C3bRR)、红细胞免疫复合物花环率(RBC-ICR)]、Toll样受体4(TLR4)/核转录因子-κB(NF-κB)信号通路相关因子(TLR4 mRNA、NF-κB p65 mRNA)水平。结果 联合组总有效率高于单一组(P<0.05);治疗后,联合组中医证候积分、NIHSS评分低于单一组,BI、FMA评分高于单一组(P<0.05);治疗后,联合组血清TNF-α、hs-CRP水平及RBC-ICR低于单一组,RBC-C3bRR高于单一组(P<0.05);治疗后,联合组外周血单核细胞中TLR4 mRNA、NF-κB p65 mRNA水平低于单一组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 高压氧配合中药汤剂治疗中青年脑卒中患者的效果确切且具有一定安全性,可改善临床症状,减轻神经功能损伤,促进肢体功能、日常生活能力恢复,并可抑制炎症反应,改善免疫功能,可能与抑制TLR4/NF-κB信号通路活化有关。

Objective To investigate the clinical efficacy of hyperbaric oxygen combined with traditional Chinese medicine decoction in the treatment of middle-aged and young stroke patients,and to analyze its effects on immune inflammatory factors,Toll-like receptor 4(TLR4)/nuclear transcription factor-κB(NF-κB)signaling pathway.Methods A total of 80 middle-aged and young stroke patients admitted to Zhengzhou Yihe Hospital from February 2021 to February 2023 were selected as the study objects,and were divided into single group and combined group according to the random odd-even number allocation principle,with 40 cases in each group.The single group was treated with Chinese herbal decoction,and the combined group was treated with hyperbaric oxygen combined with Chinese herbal decoction.Clinical efficacy,traditional Chinese medicine syndrome score,occurrence of adverse reactions,neurological function[National Institutes of Health stroke scale(NIHSS)],ability of daily living[Barthel index(BI)]and limb motor function[Fugl-Meyer assessment of motor function(FMA)]of the two groups were statistically compared.Serum immunoinflammatory factors[tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein(hs-CRP),red blood cell C3b receptor chaplet rate(RBC-C3bRR),red blood cell immunocomplex receptor chaplet rate(RBC-ICR)],Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway related factors(TLR4 mRNA,NF-κB p65 mRNA)levels before and after treatment were compared between the two groups.Results The total effective rate of combined group was higher than that of single group(P<0.05).After treatment,traditional Chinese medicine syndrome score and NIHSS score of combined group were lower than those of single group,BI and FMA scores were higher than those of single group(P<0.05).After treatment,the serum levels of TNF-α,hs-CRP and RBC-ICR in combination group were lower than those in single group,and RBC-C3bRR were higher than those in single group(P<0.05).After treatment,the levels of TLR4 mRNA and NF-κB p65 mRNA in peripheral blood mononuclear cells in combination group were lower than those in single group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Hyperbaric oxygen combined with traditional Chinese medicine decoction is effective and safe in the treatment of middle-aged and young stroke patients.It can improve clinical symptoms,reduce nerve function injury,promote the recovery of limb function and daily living ability,inhibit inflammatory response and improve immune function,which may be related to inhibiting the activation of TLR4/NF-κB signaling pathway.