从MMP-9水平研究芪棱汤对动脉粥样硬化性脑梗死患者的影响

Investigation of Effects of Qileng Decoction on Patients with Atherosclerotic Cerebral Infarction Based on Serum MMP-9 Level

【目的】探讨芪棱汤对动脉粥样硬化性脑梗死患者血清基质金属蛋白酶9(MMP-9)水平、颈动脉粥样硬化及神经缺损程度的影响。【方法】选取180例急性脑梗死患者,根据颈动脉彩超结果分为无动脉粥样硬化组(A)、稳定斑块组(B)、不稳定斑块组(C),检测每组患者发病时血清MMP-9水平;进一步将B、C组的患者随机分为常规组和芪棱汤组进行治疗:常规组采用脑梗死的基础方案治疗,芪棱汤组在常规组的基础上加用芪棱汤治疗,分别于治疗前和治疗15 d、90 d、180 d后对患者的MMP-9水平、颈动脉内膜中层厚度(IMT)进行测定,并采用美国国立卫生研究院脑卒中评定量表(NIHSS)进行神经功能缺损评分。【结果】(1)发病时,B组和C组的MMP-9水平明显高于A组,且C组MMP-9水平较B组明显升高,3组比较,差异均有统计学意义(P<0.05)。(2)治疗后,B组及C组各时间段MMP-9水平的过度表达和NIHSS评分均明显下降(P<0.05),且各组内芪棱汤组均优于常规组(P<0.05)。(3)疗程结束后,B组、C组中的IMT均较治疗前明显改善,差异有统计学意义(P<0.05),且各组内芪棱汤组均优于常规组(P<0.05)。【结论】芪棱汤能降低动脉粥样硬化性脑梗死患者MMP-9水平的高表达,改善本病动脉粥样硬化程度,有效恢复神经功能缺损状态。

Objective To explore the effects of Qileng Decoction on the serum level of matrix metalloproteinase 9（MMP-9）, the degree of carotid atherosclerosis and nerve defect in patients with atherosclerotic cerebral infarction. Methods One hundred and eighty cases of patients with acute cerebral infarction were classified as non-atherosclerosis group（A）,stable plaque group（B）and unstable plaque group（C） according to the results of carotid color Doppler uitrasound,and the serum level of MMP-9 of onset patients in each group was detected. And then group B and group C were randomly assigned to conventional treatment group and Qileng Decoction group. The conventional treatment group and Qileng Decoction group received the basic regimen for acute atherosclerotic cerebral infarction,and additionally,Qileng Decoction group received oral use of Qileng Decoction. The serum level of MMP-9 and carotid artery intima-media thickness（IMT）were measured,and the neurological deficit score was calculated by National Institutes of Health Stroke Scale（NIHSS）before treatment and after treatment for 15,90,180 d. Results（1）During the onset,the serum level of MMP-9 in group B and group C was significantly higher than that in group A（P〈0.05）,and the serum level of MMP-9 in group C was significantly higher than that in group B（P〈0.05）,the difference among the 3 groups being significant（P〈0.05）.（2）After treatment,the over-expression level of MMP-9 and the NIHSS scores at various time points in group B and group C were significantly decreased（P〈0.05）,the effect of Qileng Decoction groups in above both groups being significantly superior to that in the conventional treatment groups（P〈0.05）.（3）After the whole treatment course,IMT in group B and group C was significantly improved as compared with that before treatment, the difference being significant（P〈0.05）,and the effect of Qileng Decoction groups was better than that in the conventional treatment group（P〈0.05）. Conclusion Qileng Decoction can reduce the high expressed level of serum MMP-9,decrease the degree of carotid atherosclerosis in patients with atherosclerotic cerebral infarction,so as to improve the state of nerve function defect.