苦碟子注射液联合果糖二磷酸钠片治疗急性脑梗死的临床研究

Clinical study of Kudiezi injection combined with fructose diphosphate sodium tablets in the treatment of acute cerebral infarction

目的探讨苦碟子注射液联合果糖二磷酸钠片治疗急性脑梗死(ACI)的疗效及对患者microRNA-124(miR-124)、miR-210表达的影响。方法选取2016年3月~2019年3月我院93例ACI患者为研究对象,随机分为三组,每组31例:对照A组静脉滴注苦碟子注射液,每次40 m L,每天1次;对照B组口服果糖二磷酸钠片,每次1.0 g,每天3次;观察组予以苦碟子注射液联合果糖二磷酸钠片注射液治疗,用法同对照组。三组均连续治疗14 d。统计对比三组临床疗效、不良反应发生率及治疗前后血清血栓调节蛋白(s TM)、脂联素(APN)、血管性血友病因子(v WF)、炎性因子[白细胞介素19(IL-19)、C反应蛋白(CRP)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]、miR-124、miR-210表达水平和美国国立卫生院卒中量表(NIHSS)评分。结果治疗后观察组总有效率明显高于对照A、B组(90.32%vs. 64.52%,61.29%),差异有统计学意义(P <0.05);观察组s TM(μg/L:23.74±2.67 vs. 30.41±2.94,31.84±3.06)、v WF(%:110.27±15.67 vs. 134.27±16.25,136.74±17.85)低于对照A、B组,APN(mg/L:13.52±3.16 vs. 8.41±2.38,9.97±2.37)高于对照A、B组(P <0.05);观察组IL-19(pg/m L:22.69±4.49 vs. 32.41±5.69,37.49±8.24)、CRP(mg/L:4.38±1.56 vs. 6.89±1.74,8.25±1.92)低于对照A、B组(P <0.05);观察组MDA(mmol/L:2.31±0.52 vs. 3.37±0.65,3.04±0.68)低于对照A、B组,SOD(U/m L:96.47±10.25 vs. 82.97±10.26,87.54±10.31)、GSHPx(U:124.94±9.84 vs. 102.39±9.46,107.69±9.15)高于对照A、B组(P <0.05);观察组miR-124(1.15±0.53 vs. 1.48±0.61,1.84±0.82)低于对照A、B组,miR-210(2.01±0.12 vs. 1.63±0.10,1.42±0.11)高于对照A、B组(P <0.05);观察组NIHSS评分低于对照A、B组(分:9.84±1.03 vs. 12.35±1.22,13.14±1.27,P <0.05);观察组不良反应发生率为19.35%,对照A、B组不良反应发生率为12.90%、9.68%,三组比较差异无统计学意义(P>0.05)。结论苦碟子注射液联合果糖二磷酸钠片治疗ACI疗效确切,能显著降低ACI患者炎症反应,减轻氧化应激,改善血管内皮细胞功能,调节miR-124、miR-210表达水平,缓解神经功能缺损。

Objective To investigate the efficacy of Kudiezi injection combined with fructose diphosphate sodium tablets in the treatment of acute cerebral infarction( ACI) and the effect on microRNA-124( miR-124) and microRNA-210( miR-210) expression in the patients. Methods From March 2016 to March 2019,93 cases of ACI in our hospital were selected as the research objects,and they were simply randomized into three groups with 31 cases in each. Control group A was given Kudiezi injection,40 m L/time,1 time/day,intravenously;control group B was given fructose diphosphate sodium tablets,1. 0 g/time,3 times/day,orally;observation group was given fructose diphosphate sodium tablets combined with Kudiezi injection,the usage was the same as the control group. All three groups were treated continuously for 14 days. The clinical efficacy,the incidence of adverse reactions,and serum thrombomodulin( s TM),adiponectin( APN),von Willebrand factor( v WF),and inflammatory factors[interleukin-19( IL-19),C-reactive protein( CRP) ],oxidative stress indicators[malondialdehyde( MDA),superoxide dismutase( SOD),glutathione peroxidase( GSH-Px) ],miR-124,miR-210 expression levels,and National Institutes of Health Stroke Scale( NIHSS)scores before and after the treatment were statistically compared in three groups. Results After the treatment,the total effective rate of the observation group( 90. 32%) was significantly higher than that of the control group A( 64. 52%) and the control group B( 61. 29%),and the difference was statistically significant( P < 0. 05). After the course of treatment,s TM( 23. 74 ± 2. 67) μg/L and v WF( 110. 27 ±15. 67) % were lower in the observation group than in the control group A( 30. 41 ± 2. 94) μg/L,( 134. 27 ± 16. 25) %,and in the control group B( 31. 84 ± 3. 06) μg/L,( 136. 74 ± 17. 85) %. The APN( 13. 52 ± 3. 16) mg/L was higher than in the control group A( 8. 41 ± 2. 38) mg/L and in the control group B( 9. 97 ± 2. 37) mg/L( P < 0. 05). After the course of treatment,IL-19( 22. 69 ±4. 49) pg/m L and CRP( 4. 38 ± 1. 56) mg/L of the observation group were lower than those of the control group A( 32. 41 ± 5. 69) pg/m L,( 6. 89 ± 1. 74) mg/L,control group B( 37. 49 ± 8. 24) pg/m L,( 8. 25 ± 1. 92) mg/L( P < 0. 05). The MDA( 2. 31 ± 0. 52) mmol/L was lower in the observation group than in the control group A( 3. 37 ± 0. 65) mmol/L,and in the control group B( 3. 04 ± 0. 68) mmol/L,SOD( 96. 47 ± 10. 25) U/m L,GSH-Px( 124. 94 ± 9. 84) U were higher than in the control group A( 82. 97 ± 10. 26) U/m L,( 102. 39 ± 9. 46) U,and in the control group B( 87. 54 ± 10. 31) U/m L,( 107. 69 ± 9. 15) U( P < 0. 05). After the course of treatment,miR-124( 1. 15 ± 0. 53) in the observation group was lower than that in the control group A( 1. 48 ± 0. 61) and the control group B( 1. 84 ± 0. 82). miR-210( 2. 01 ± 0. 12) was higher than in the control group A( 1. 63 ± 0. 10) and the control group B( 1. 42 ± 0. 11)( P < 0. 05). After the course of treatment,the NIHSS( 9. 84 ±1. 03) scores of the observation group was lower than that of the control group A( 12. 35 ± 1. 22) scores and the control group B( 13. 14 ± 1. 27) scores( P < 0. 05). During the treatment period,the incidence of adverse reactions in the observation group was 19. 35%,and the incidence of adverse reactions in the control groups A and B was 12. 90% and 9. 68%. There was no significant difference among the three groups( P > 0. 05). Conclusions Kudiezi injection combined with fructose diphosphate sodium tablets for the ACI treatment has a definite therapeutic effect. It can significantly reduce the inflammatory response in the patients with ACI,reduce oxidative stress,improve the function of vascular endothelial cells,regulate the expression levels of miR-124 and miR-210,and relieve neurological deficits.