化痰通络汤联合丁苯酞氯化钠注射液对急性脑梗死患者侧支循环及脑血流灌注的影响

Effects of Huatan Tongluo Decoction Combined with Butylphthalide Sodium Chloride Injection on Collateral Circulation and Cerebral Blood Perfusion in Patients with Acute Cerebral Infarction

目的探讨化痰通络汤联合丁苯酞氯化钠注射液治疗急性脑梗死(ACI)风痰阻络证的临床疗效,及对侧支循环和脑血流灌注的影响。方法采用随机数字表法将120例患者分为对照组和联合组各60例。2组均进行西医常规治疗。对照组在西医常规治疗基础上予丁苯酞氯化钠注射液,100 mL/次,静脉滴注,2次/d;联合组在对照组基础上予化痰通络汤,每日1剂,每日2次,口服。2组均连续治疗14 d。评价2组临床疗效,观察2组治疗前后美国国立卫生院卒中量表(NIHSS)评分、Barthel指数(BI)评分、蒙特利尔认知评估量表(MoCA)评分、中医症状积分及脑血流动力学指标、脑侧支循环形成情况,检测外周血血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)、脑源性神经营养因子(BDNF)水平,监测2组安全性指标及不良反应。结果对照组剔除3例,联合组脱落2例。联合组总有效率为96.55%(57/58),对照组为85.96%(49/57),联合组疗效优于对照组(P<0.05)。与本组治疗前比较,2组治疗后BI、MoCA评分升高(P<0.01),NIHSS评分、中医症状积分降低(P<0.05,P<0.01);2组治疗后比较,联合组BI、MoCA评分高于对照组(P<0.01),NIHSS评分、中医症状积分低于对照组(P<0.01)。与本组治疗前比较,2组治疗后大脑前、中、后动脉平均血流速度增高(P<0.01);2组治疗后比较,联合组上述脑血流动力学指标优于对照组(P<0.01)。联合组治疗后脑侧支循环形成效果优于对照组(P<0.05)。与本组治疗前比较,2组治疗后VEGF、IGF-1、BDNF水平升高(P<0.01);2组治疗后比较,联合组VEGF、IGF-1、BDNF水平高于对照组(P<0.01)。2组均未见不良反应,安全性指标未见明显异常。结论在常规西医治疗的基础上,化痰通络汤联合丁苯酞氯化钠注射液可更好地促进ACI风痰阻络证患者VEGF、IGF-1及BDNF的分泌,促进脑梗死后侧支循环形成,增加脑血流灌注,从而改善神经功能缺损,增强认知功能,提升日常生活能力。

Objective To investigate the clinical efficacy of Huatan Tongluo Decoction combined with butylphthalide in the treatment of patients with acute cerebral infarction(ACI) with wind-phlegm blockage syndrome and its effects on collateral circulation and cerebral blood perfusion. Methods Totally 120 patients were divided into control group and combination group according to random number table method, with 60 cases in each group. Both groups received routine Western therapy. The control group was given butylphthalide sodium chloride injection, 100 mL/time, intravenous drip, twice per day, on the basis of routine Western medicine treatment;combination group was treated with Huatan Tongluo Decoction on the basis of the treatment of the control group, one dosage per day, twice a day, orally. The treatment for both groups lasted for 14 weeks. Clinical efficacy of both groups was evaluated. National Institutes of Health Stroke Scale(NIHSS) score, Barthel Index(BI) score, Montreal Cognitive Assessment Scale(MoCA) score, TCM symptom score and cerebral hemodynamic indicators, cerebral collateral circulation formation of both groups before and after treatment were observed. The levels of peripheral blood vascular endothelial growth factor(VEGF), insulin-like growth factor-1(IGF-1) and brain-derived neurotrophic factor(BDNF) were detected. The safety indicators and adverse reactions of the two groups were monitored. Results 3 cases in the control group were eliminated and 2 cases in the combination group were dropped. The total effective rate of the combination group was 96.55%(57/58), and the control group was 85.96%(49/57). The combination group had better efficacy than the control group(P<0.05). Compared with before treatment, BI and MoCA scores increased after treatment in the two groups(P<0.01), and NIHSS scores and TCM symptom scores decreased(P<0.05, P<0.01). After treatment, the BI and MoCA scores of the combination group were higher than those of the control group(P<0.01), and the NIHSS score and TCM symptom score were lower than those of the control group(P<0.01). Compared with before treatment, the average blood flow velocity of the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery in the two groups increased(P<0.01);after treatment, the above-mentioned cerebral hemodynamic indexes of the combination group were better than those of the control group(P<0.01). The effect of cerebral collateral circulation formation after treatment in the combination group was better than that in the control group(P<0.05). Compared with before treatment, the level of VEGF, IGF-1 and BDNF increased after treatment in the two groups(P<0.01);after treatment, the level of VEGF, IGF-1 and BDNF in the combination group were higher than those in the control group(P<0.01). There were no adverse reactions in the two groups, and no obvious abnormalities in safety indicators. Conclusion On the basis of routine Western medicine treatment, Huatan Tongluo Decoction combined with butylphthalide sodium chloride injection can better promote the secretion of VEGF, IGF-1 and BDNF in patients with ACI of phlegm blocking collateral syndrome, promote the formation of collateral circulation after cerebral infarction, and increase cerebral blood perfusion, thereby improving neurological deficits, enhancing cognitive function, and enhancing the ability of daily living.