灯银脑通胶囊联合阿加曲班治疗脑梗死的效果及机制研究

Therapeutic effect and mechanism of Dengyin Naotong capsule combined with agatroban in the treatment of cerebral infarction

目的探讨灯银脑通胶囊联合阿加曲班在急性脑梗死中的治疗效果及机制。方法选取中国人民武装警察部队特色医学中心脑科中心2017年12月至2018年12月收治的急性脑梗死患者100例,根据随机数字表法分为对照组(50例)和观察组(50例)。对照组采用静脉滴注阿加曲班加口服阿司匹林肠溶片治疗,观察组在对照组基础上联合灯银脑通胶囊治疗。比较2组患者临床疗效,治疗前后中医证候积分、血清血管内皮细胞生长因子(VEGF)、人纤溶酶原、环磷酸腺苷、β-内啡肽水平,并观察2组不良反应发生情况。结果治疗后,观察组治愈19例,显效23例,好转6例,无效2例;对照组治愈15例,显效14例,好转18例,无效3例,观察组临床疗效优于对照组,差异有统计学意义(Z=-2.014,P=0.044)。治疗2周和3个月后,对照组和观察组患者的中医证候积分均明显低于治疗前[(17.9±1.1)、(14.6±1.1)分比(21.2±2.2)分,(16.7±1.6)、(12.2±1.3)分比(21.9±2.3)分],且观察组明显低于对照组,差异均有统计学意义(均P <0.05)。治疗后2组患者血清VEGF、β-内啡肽水平明显低于治疗前,人纤溶酶原、环磷酸腺苷水平明显高于治疗前,且观察组治疗后血清VEGF、β-内啡肽水平低于对照组[(341±28) ng/L比(361±20) ng/L、(29±3) ng/L比(35±3) ng/L],人纤溶酶原、环磷酸腺苷水平高于对照组[(1 075±25)μg/L比(1 025±28)μg/L、(33.6±1.6) ng/L比(30.2±1.5) ng/L],差异均有统计学意义(均P <0.05)。2组患者皮疹、发热、食欲不振、恶心、呕吐发生率比较差异均无统计学意义(均P> 0.05)。结论急性脑梗死患者采用灯银脑通胶囊联合阿加曲班治疗,可通过对神经递质的调节提高临床疗效,且安全性较高。

Objective To explore the therapeutic value and mechanism of Dengyin Naotong Capsule combined with agatroban in acute cerebral infarction. Methods Totally 100 patients with acute cerebral infarction admitted to Brain Center of Characteristic Medical Center of Chinese People’s Armed Police Forces from December2017 to December 2018 were divided into control group( 50 cases) and observation group( 50 cases) according to random number table method. The control group was treated with intravenous drip of agatroban;the observation group was treated with Dengyin Naotong capsule on the basis of the control group. The clinical efficacy of the2 groups was compared before and after treatment,traditional Chinese medicine( TCM) syndrome score,serum levels of human vascular growth factor( VEGF),human plasminogen,β-endorphin and cyclic adenosine were observed. Results After treatment,19 cases were cured,23 cases were effective,6 cases improved,2 cases were ineffective in the observation group;15 cases were cured,14 cases were effective,18 cases improved,3 cases were ineffective in the control group;there was statistically significant difference between the two groups in clinical efficacy( Z =-2. 014,P = 0. 044). After 2 weeks and 3 months of treatment,the TCM syndrome scores of both groups were significantly lower than those before treatment [( 17. 9 ± 1. 1),( 14. 6 ± 1. 1) vs( 21. 2 ± 2. 2);( 16. 7 ± 1. 6),( 12. 2 ± 1. 3) vs( 21. 9 ± 2. 3) ];the TCM syndrome scores of the observation group after treatment for three months were significantly lower than those in the control group( all P < 0. 05). After treatment,the levels of VEGF and β-endorphin in the serum of the two groups were significantly lower than those before treatment;the levels of human plasminogen and adenosine cyclophosphate were significantly higher than those before treatment;the levels of VEGF and β-endorphin in the observation group were lower than those in the control group[( 341 ± 28) ng/L vs( 361 ± 20) ng/L,( 29 ± 3) ng/L vs( 35 ± 3) ng/L];the levels of human plasminogen and adenosine cyclophosphate were higher than those in the control group[( 1 075 ± 25) μg/L vs( 1 025 ± 28) μg/L,( 33. 6 ± 1. 6) ng/L vs( 30. 2 ± 1. 5) ng/L]( all P < 0. 05). There was no significant difference in the incidence of rash,fever,anorexia,nausea and vomiting between the two groups( P > 0. 05). Conclusion The treatment of Dengyin Naotong capsule combined with agatroban is safe in patients with acute cerebral infarction.