不同中医治法对脑出血患者神经功能缺损与血清神经元特异性烯醇化酶水平的影响

Effect of various traditional therapies on neurological impairment and levels of serum neuro-specific enolase in patients with cerebral hemorrhage

目的:观察不同中医治法对脑出血患者血清神经元特异性烯醇化酶水平及对症候和神经功能缺损评分的影响,比较不同中医治法对脑出血的疗效差异。方法:选择2002-08/2003-06湘雅医院收治的76例脑出血患者,随机分为6组:①镇肝息风汤组12例。②血府逐瘀汤组11例。③涤痰汤组13例。④大承气汤组11例。⑤平肝息风汤组14例。⑥西药治疗组15例。各中药组分别采用镇肝熄风汤、血府逐瘀汤、涤痰汤、大承气汤、平肝熄风汤治疗,西药组采用甘露醇降颅压,调控血压,对症支持治疗。于入院后1,10d采集血标本,用放射免疫法测定血清神经元特异性烯醇化酶水平,同时进行症候评分(9项,共52分,评分越低症状越轻)和神经功能缺损评分(总分45分,评分越高,神经功能缺陷越重),并进行相关行分析。另设正常对照组8例,测定血清神经元特异性烯醇化酶水平。结果:84例全部进入结果分析。①血清神经元特异性烯醇化酶水平:治疗前各组脑出血患者均高于正常对照组(P<0.01),治疗10d后仍高于正常对照组(P<0.01);与其他各组比较,平肝熄风汤组治疗后下降最明显(P<0.01,0.05)。②各组脑出血患者治疗后神经功能缺损积分和主证积分均较治疗前显著下降(P<0.01或P<0.05),其中平肝熄风汤组治疗前后差值大于其他各组(P<0.01或P<0.05)。③脑出血患者血清神经元特异性烯醇化酶水平与神经功能缺损评分呈正相关(r=0.752,P<0.01)。结论:①采取平肝熄风,清热凉血,涤痰开窍,活血化瘀等治法均能降低脑出血患者血清神经元特异性烯醇化酶水平,提示对脑出血神经元损伤均有保护作用,以风火痰瘀同治(平肝熄风汤)疗效最佳。②血清神经元特异性烯醇化酶水平能较好地反映脑出血后的脑损伤程度和预后。

AIM： To observe effect of variously traditional therapies on levels of serum neuron-specific enolase （NSE）, symptom and scores of neurological impairment of patients with cerebral hemorrhage, and compare effective differences of variously traditional therapies on cerebral hemorrhage. METHODS： The experiment was completed in Xiangya Hospital from August 2002 to June 2003. Totally 76 patients with cerebral hemorrhage were divided randomly into 6 groups： zhenggan xifeng tang group （n=12）, xuefu zhuyu tang group （n=11）, ditan tang group （n=13）, dacheng qitang group （n=1 1）, pinggan xifeng tang group （n=14）, and western medicine group （n=15）. Zhenggan xifeng tang, xuefu zhuyu tang, ditan tang, dacheng qitang and pinggan xifeng tang in Chinese herb groups and manicol in western medicine group were used to decrease cranial pressure and regulate blood pressure, One and ten days after hospitalization, blood samples were selected, and NSE levels were assayed with radio-immunity method. Symptom scores contained 9 items 52 points in total, and the lower scores were, the milder symptom was; meanwhile, scores of neurological impairment contained 45 points in total, and the higher scores were, the severer neurological impairment was. Another 8 cases were regarded as normal control group to assay their NSE levels. RESULTS： Totally 84 patients entered the final analysis, ① NSE levels of patients with cerebral hemorrhage in each group were higher than those in normal control group before treatment （P 〈 0.01）, and still higher 10 days after treatment （P 〈 0.01）. NSE levels in plnggan xlfeng tang group were decreased remarkably as compared with those in other groups after treatment （P 〈 0.01, 0.05）. ②Scores of neurological impairment and integras of inain symptom were decreased obviously in each group after treatment （P 〈 0.01 or P 〈 0.05）. ③ NSE levels were positive correlation with scores of neurological impairment of patients with cerebral hemorrhage （r=0.752, P 〈 0.01）. CONCLUSION：① NSE levels can be decreased through calming liver to suppress wind, removing phlegnl and inducing resuscitation, promoting blood circulation by removing blood stasis, etc., which suggests that it has protective eftect on neuron injury combined with cerebral hemorrhage, especially the effect of pinggan xifeng tang is the best. ② Serum NSE lever can well reflect degree and prognosis of cerebral injury after acute cerebral hemorrhage.