熄风通络颗粒对前循环脑梗死患者外周血可溶性白细胞分化抗原40配体表达的影响

The effects of Xifeng Tongluo Granula （熄风通络颗粒） on peripheral blood expression of soluble CD40 ligand in patients with acute anterior circulation infarction

目的观察熄风通络颗粒对风痰瘀阻型急性前循环脑梗死（AACI）患者外周血可溶性白细胞分化抗原40配体（sCD40L）表达的影响。方法68例发病72h内的风痰瘀阻型AACI患者被随机分为治疗组（熄风通络颗粒＋基础治疗，35例）和对照组（基础治疗，33例），采用酶联免疫吸附法（ELISA）检测两组治疗前和治疗后7d血sCD40L水平；同时用Barthel指数（MBI）、急性脑卒中评定表（NIHSS）评分法评价两组治疗前和治疗后14d神经功能缺损程度的变化。并以23例健康体检者sCD40L值作为正常参照值。结果治疗组与对照组患者血清sCD40L水平（pg／L）治疗前（7．463±2．899、7．854±3．652），治疗后7d（5．273±1．698、7．349±2．113）均显著高于健康对照组（1．746±1．012，均P〈0．05）；治疗后7d治疗组sCD40L水平显著低于对照组P〈0．05）；大梗死灶组sCD40L水平（10．312±1．975）明显高于中小梗死灶组（6．843±2．984，P〈0．05）。治疗后14d，治疗组NIHSS评分（分：3．428±1．034）较对照组（5．897±1．653）明显降低（P〈0．05）；治疗组MBI（87．356±12．429）则较对照组（69．139±14．572）明显增高（P〈0．05）。治疗组显著进步率（54．3％）明显高于对照组（33．3％，P〈0．05）；脑梗死体积与MBI呈显著负相关（r=0．633，P〈0．01）。结论熄风通络颗粒促进风痰瘀阻型AACI患者神经功能恢复的作用可能与其下调促炎因子sCD40L水平、减轻脑缺血继发的炎症损伤等机制密切相关。

Objective To observe the effect of Xifeng Tongluo granula （熄风通络颗粒） on peripheral blood expression of soluble CD40 ligand （sCD40L） in patients with acute anterior circulation infarction （AACI） and obstruction of collateral due to wind-phlegm syndrome （风痰瘀阻型）. Methods Sixty-eight cases of AACI with obstruction of collateral due to wind-phlegm syndrome who admitted within 72 hours were randomly divided into treatment group （35 cases） and control group （33 cases）. The patients in treatment group were treated with Xifeng Tongluo granula and conventional therapy, while the patients in control group exclusively with conventional treatment. The levels of blood expression of sCD40L in two groups were respectively detected by enzyme linked immunosorbent assay （ELISA） before treatment and on the 7th day after treatment. The expression in both groups was compared with that of 23 healthy people. In the mean time, the degrees of neurologic impairment in the two groups were respectively evaluated by Barthel index （MBI） and National Institutes of Health Stroke Scale （NIHSS） before treatment and on the 14th day after treatment. Results The expression of sCD40L （gg/L） in AACI patients in both groups was significantly increased before treatment （7. 4635=2. 899, 7. 8545= 3. 652） and on the 7th day after treatment （5. 273± 1. 698, 7. 349±2. 113） compared to that in healthy people （1. 746 ± 1. 012, all P 〈 0. 05）. However, the expression of sCD40L in treatment group （5. 273±1. 698） was markedly decreased compared to that in control group （7. 349±2. 113, P〈0. 05） on the 7th day after treatment. The expression of sCD40L in larger cerebral infarction volume （CIV） group （10. 3125=1. 975） was higher than that in middle ＆small CIV group （6. 843± 2. 184, P〈0.01） on the 7th day after treatment. NIHSS in treatment group （3. 428±1. 034） was lower than that in control group （5. 897 ± 1. 653） on the 14th day after treatment （P〈0. 05）. The MBI （87. 356 ± 12. 429） was markedly increased in treatment group on the 14th day after treatment with significant difference compared to that in control group （69. 139± 14. 572, P〈0. 05）. The significant improvement rate was markedly increased in treatment group （54.3%） on the 14th day after treatment with significant difference compared to that in control group （33.3%, P〈0.05）. Volume of cerebral infarction was negatively correlated to MBI （γ=-0. 633, P〈0.01）. Conclusion The action of Xifeng Tongluo Granula to promote the recovery of neurological function in patients with AACI and collateral obstruction due to wind-phlegm syndrome is possibly closely related to the mechanism of down-regulating the level of sCD40L inflammatory factor, which may ameliorate the inflammatory injury secondary to cerebral ischemia.