益气通窍活血汤对急性脑梗死(气虚血瘀型)患者HIF-1α、MMP-9、Cys-C及神经功能的影响

Effects of Yiqi Tongqiao Huoxue Decoction on HIF-1α,MMP-9,Cys-C and Nerve Function in Patients with Acute Cerebral Infarction of Qi Deficiency and Blood Stasis Type

【目的】探讨益气通窍活血汤对急性脑梗死(气虚血瘀型)患者的临床疗效及相关炎性因子和神经因子的影响。【方法】将126例急性脑梗死(气虚血瘀型)患者随机分为观察组和对照组,每组各63例。对照组给予西医常规治疗,观察组在对照组的基础上联合益气通窍活血汤口服治疗,疗程为2周。观察2组患者治疗前后脑卒中专用生活质量量表(SS-QOL)评分、美国国立卫生院脑卒中量表(NIHSS)神经功能缺损评分、中医症状总积分及血清缺氧诱导因子1α(HIF-1α)、血管内皮生长因子(VEGF)、基质金属蛋白酶9(MMP-9)、超氧化物歧化酶(SOD)、S100B蛋白(S100B)、神经元特异性烯醇化酶(NSE)、胱抑素C(Cys-C)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗2周后,观察组的总有效率为96.83%(61/63),对照组为82.54%(52/63),组间比较,观察组的疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的SS-QOL评分均较治疗前升高(P<0.05),NIHSS评分和中医症状总积分均较治疗前降低(P<0.05),且观察组对SS-QOL评分的升高作用及对NIHSS评分和中医症状总积分的降低作用均明显优于对照组(P<0.05)。(3)治疗后,2组患者血清VEGF、HIF-1α、MMP-9、S100B、NSE、Cys-C水平均较治疗前降低(P<0.05),血清SOD水平均较治疗前升高(P<0.05),且观察组对血清VEGF、HIF-1α、MMP-9、S100B、NSE、Cys-C水平的降低作用及对血清SOD水平的升高作用均明显优于对照组(P<0.05)。【结论】在西医常规治疗基础上联合益气通窍活血汤治疗急性脑梗死(气虚血瘀型)患者疗效显著,有助于减轻缺血再灌注损伤,促进神经功能改善,提高临床疗效。

Objective To investigate the clinical efficacy of Yiqi Tongqiao Huoxue Decoction for patients with acute cerebral infarction of qi deficiency and blood stasis type and to observe its influence on the related inflammatory factors and nerve factors.Methods A total of 126 patients with acute cerebral infarction of qi deficiency and blood stasis type were randomly divided into observation group and control group,with 63 cases in each group.The control group was given conventional western medicine treatment,and the observation group was given oral use of Yiqi Tongqiao Huoxue Decoction on the basis of treatment for the control group,the course of treatment lasting for2 weeks.The outcomes included the pre-and post-treatment scores of Stroke Specific Quality of Life Scale(SSQOL),neurological deficit scores evaluated with National Institutes of Health Stroke Scale(NIHSS),overall traditional Chinese medicine(TCM)symptom scores,and serum levels of hypoxia-inducible factor 1α(HIF-1α),vascular endothelial growth factor(VEGF),matrix metalloproteinase 9(MMP-9),superoxide dismutase(SOD),protein S100B(S100B),neuron specific enolase(NSE)and cystatin C(Cys-C)level in the two groups were observed before and after treatment.After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 2 weeks of treatment,the total effective rate of the observation group was 96.83%(61/63),and that of the control group was 82.54%(52/63).The intergroup comparison showed that the curative effect of the observation group was significantly superior to that of the control group(P<0.05).(2)After treatment,SS-QOL scores of the two groups were increased(P<0.05),and NIHSS scores and the overall TCM symptom scores were decreased compared with those before treatment(P<0.05).The intergroup comparison showed that the effect on increasing the SS-QOL scores and on lowering the NIHSS scores and overall TCM symptom scores in the observation group was significantly superior to that in the control group(P<0.05).(3)After treatment,the serum levels of VEGF,HIF-1α,MMP-9,S100B,NSE and Cys-C in the two groups were decreased compared with those before treatment(P<0.05),and the serum SOD level was increased compared with that before treatment(P<0.05).The intergroup comparison showed that the effect on decreasing the serum VEGF,HIF-1α,MMP-9,S100B,NSE and Cys-C levels and on increasing serum SOD level in the observation group was superior to that in the control group(P<0.05).Conclusion The combination of Yiqi Tongqiao Huoxue Decoction and conventional western medicine exerts significant effect on patients with acute cerebral infarction of qi deficiency and blood stasis type,which is helpful for relieving ischemia-reperfusion injury,promoting the recovery of neurological function and enhancing clinical efficacy.