痰瘀同治对脑梗死急性期t-PA、PAI影响的临床观察

Effect of simultaneous treatment of phlegm and blood stasis on plasma t-PA and PAI in patients with acute cerebral infarct

目的观察化痰祛瘀汤对脑梗死急性期患者临床神经功能缺损评分、血浆组织型纤溶酶原激活物(t-PA)及血浆组织型纤溶酶原激活物抑制物(PAI)水平的影响,以及对中医证候的影响。方法42例脑梗死急性期患者随机分为2组,对照组22例,采用中西医常规治疗;治疗组20例,在对照组治疗的基础上加口服中药汤剂化痰祛瘀汤。治疗前后行神经功能评分及中医证候评定,并测定治疗前后血浆t-PA、PAI水平。结果治疗组总有效率达75%,对照组为41%,组间比较有显著性差异(P<0.05)。神经功能评分有明显改善,明显提高t-PA水平,降低PAI水平(P<0.05),对中医证候的改善具极显著意义。结论化痰祛瘀汤可显著改善神经功能缺损,作为脑梗死急性期联合用药可明显提高临床疗效,其作用机制可能与其影响t-PA、PAI活性有关。

Objective To observe the effect of Huatanquyu Decoction （HD） on neurofunctional impairment score, tissue type plasminogen activator （t-PA）, tissue type plasminogen activator inhibitor （PAI） and on traditional Chinese medicine （TCM） syndrome in patients with acute cerebral infarct. Methods Forty-two patients with acute cerebral infarct were randomly divided into two groups. The control group （ n = 22 ） were treated with the conventional treatment. On the basis of conventional treatment, the HD was given to the treated group （n = 20） additionally. The neurofunctjonal impairment score, TCM syndrome grade, t-PA and PAI were determined before and after treatment. Results There was a significant difference in the total effective rate of TCM syndrome score between the treated group （75%） and the control group （41%） （P 〈0.05）. There was a significant improvement in the neurofunctional impairment scores, t-PA and PAI（ P 〈 0.05 ）. Conclusion HD has the significant effects of improving neurofunctional impairment score, increasing t-PA and decreasing PAI. HD markedly improves the therapeutic effects when combined with the conventional treatment in the patients with acute cerebral infarct. The mechanism could be related mainly to its effects on t-PA and PAI activation.