活血化痰通络方早期治疗风痰瘀阻证急性小动脉闭塞型脑梗死的临床研究

Clinical study on the auxiliary treatment of acute arterioles occluded cerebral infarction of wind-phlegm and stasis syndrome with Huoxue Huatan Tongluo decoction

目的观察活血化痰通络方早期治疗风痰瘀阻证急性小动脉闭塞型脑梗死的临床疗效。方法将2018年8月1日—2019年9月30日在湖北省中西医结合医院神经内科住院的240例风痰瘀阻证急性小动脉闭塞型脑梗死患者随机分成治疗组和对照组,每组120例。对照组给予常规西药治疗,治疗组在西药治疗基础上给予活血化痰通络方治疗2周。观察2组治疗前及治疗2周后神经功能(NIHSS评分、MRS评分、BI,随访3个月后再次评估)、中医证候要素积分、血黏度[血浆黏度、全血黏度、纤维蛋白原(FIB)]、血脂指标[三酰甘油(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)],分析NIHSS评分、血黏度及血脂水平与中医证候要素的相关性,统计2组治疗2周后临床疗效及不良反应发生情况。结果2组治疗2周后及治疗3个月后NIHSS评分、MRS评分均显著降低(P均<0.05),BI均显著升高(P均<0.05);且2组治疗3个月后NIHSS、MRS评分均明显低于治疗2周后(P均<0.05),BI明显高于治疗2周后(P均<0.05);与对照组比较,治疗组治疗2周后及治疗3个月后NIHSS评分、MRS评分更低(P均<0.05),BI更高(P均<0.05)。2组治疗后内风、痰湿、血瘀积分及总积分,血浆黏度、全血黏度及FIB、TC、TG、LDL-C水平均显著降低(P均<0.05),且治疗组均明显低于对照组(P均<0.05);治疗组治疗后HDL-C水平明显高于治疗前及对照组(P均<0.05)。NIHSS评分、全血黏度均与内风、痰湿、血瘀积分及总积分呈正相关(P均<0.05),血浆黏度与痰湿、血瘀积分及总积分呈正相关(P均<0.05),TC与痰湿积分呈正相关(P<0.05),HDL-C与内风、痰湿积分及总积分呈负相关(P均<0.05)。治疗组总有效率为85.0%(102/120),对照组为76.7%(92/120),2组比较差异有统计学意义(P<0.05)。2组均无明显不良反应发生。结论NIHSS评分、血黏度及血脂与风痰瘀阻证急性小动脉闭塞型脑梗死患者中医证候要素相关,活血化痰通络汤可有效减少患者中医症状,降低血黏度,调节血脂代谢,改善患者神经功能,提高生活质量,远期预后更好。

Objective It is to observe the clinical curative effect of early intervention of Huoxue Huatan Tongluo decoction on acute small artery occlusion cerebral infarction of wind-phlegm and stasis syndrome.Methods 240 patients with acute small artery occlusion cerebral infarction of wind-phlegm and stasis syndrome who were hospitalized in the Neurology Department of Hubei Hospital of Integrated Traditional Chinese and Western Medicine from August 1,2018 to September 30,2019 were randomly divided into treatment group and control group,with 120 patients in each group.The control group was treated with normal western medicine,the treatment group was treated with Huoxue Huatan Tongluo decoction based for 2 weeks based on the control group.The neurological function(NIHSS score,MRS score,BI,and reassessment after 3 months of follow-up),scores of TCM syndrome elements,blood viscosity[plasma viscosity,whole blood viscosity,fibrinogen(FIB)],blood lipid indexes[triacylglycerol(TG),cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]were observed before treatment and 2 weeks after treatment in the two groups,the correlation of NIHSS score,blood viscosity and blood lipid level with TCM syndrome elements was analyzed,the clinical efficacy and occurrence of adverse reactions in the 2 groups after 2 weeks of treatment were calculated.Results After 2 weeks of treatment and 3 months after treatment,the NIHSS scores and MRS scores were significantly reduced(P<0.05),and BI were significantly increased in the two groups(P<0.05),and the scores of NIHSS,MRS after treatment for 3 months were significantly lower than those after 2 weeks of treatment(all P<0.05),and BI was significantly higher than that after 2 weeks of treatment(all P<0.05);compared with the control group,the NIHSS score and MRS score of the treatment group after 2 weeks of treatment and 3 months after treatment were lower(all P<0.05),and BI was higher(all P<0.05).The scores of internal wind,phlegm-dampness,blood stasis and total scores,plasma viscosity,whole blood viscosity and the levels of FIB,TC,TG,LDL-C were significantly reduced after treatment in the two groups(all P<0.05),and these indexes in the the treatment group were significantly lower than those in the control group(all P<0.05);the HDL-C level after treatment in the treatment group was significantly higher than that before treatment and in the control group(all P<0.05).NIHSS score and whole blood viscosity were positively correlated with the scores of internal wind,phlegm dampness,blood stasis and total score(all P<0.05),plasma viscosity was positively correlated with the scores of phlegm dampness,blood stasis score and total score(all P<0.05),TC was positively correlated with phlegm-dampness score(P<0.05),and HDL-C was negatively correlated with the scores of internal wind,phlegm-dampness and total score(P<0.05).The total effective rate was 85.0%(102/120)in the treatment group and 76.7%(92/120)in the control group,the difference between the two groups was statistically significant(P<0.05).No obvious adverse reactions occurred in both groups.Conclusion The TCM syndrome elements of acute arteriole occlusion cerebral infarction of of wind-phlegm and stasis syndrome were related to NIHSS score,blood viscosity and blood lipid.Huoxue Huatan Tongluo decoction can effectively reduce the integration of TCM syndromes,reduce blood viscosity,regulate the metabolism of blood lipids,improve the neurological function and quality of life of patients.