行气通脉方治疗痰瘀阻络型后循环缺血性眩晕的临床疗效

Evaluation of the Therapeutic Effect of Xingqi Tongmai Decoction in the Treatment of Post Circulation Ischemic Vertigo of Phlegm Stasis and Collaterals Blocking Type

目的通过临床随机对照研究观察行气通脉方治疗痰瘀阻络型后循环缺血性眩晕(PCIV)患者的临床有效性及安全性。方法选取2017年1月—2018年12月期间就诊于上海市嘉定区中医医院内一科病房和门诊的痰瘀阻络型后循环缺血性眩晕患者72例,采用随机数字表法分为对照组和治疗组,每组各36例,对照组在常规西医治疗基础上(包括控制血压血糖、降脂稳斑、抗血小板聚集等)加用甲磺酸倍他司汀治疗,治疗组在常规西医治疗的基础上加用行气通脉方,两组疗程均为14 d。观察并记录患者治疗前和治疗后的总疗效、各中医证候积分、眩晕残障量表积分、血清NO及NOS亚型结果,比较分析两种治法的临床疗效;同时观察治疗前后血、尿、粪三大常规、血清肌酐、尿素氮水平和心电图的改变进行安全性评估以及健康人与两组PCIV患者血清NO和NOS表达比较。结果治疗后中医证候总体疗效方面,治疗组总有效率为87.50%(28/32),对照组总有效率为76.47%(26/34),治疗组总体疗效优于对照组,两组比较,差异有统计学意义(P<0.05)。治疗组治疗后各证候积分较治疗前均有所好转,差异有统计学意义(P<0.05),对照组在眩晕、头重昏蒙、胸闷恶心、头痛等症状较治疗前有明显改善(P<0.05),但在肢体麻木或刺痛、唇甲发绀、肌肤甲错等方面较前无显著好转,差异无统计学意义(P>0.05)。治疗组在改善胸闷心慌、肢体麻木或刺痛、唇甲发绀、肌肤甲错等方面疗效优于对照组,两组比较,差异有统计学意义(P<0.05)。两组患者在改善眩晕残障评分方面具有明显效果,差异有统计学意义(P<0.05),且治疗组疗效优于对照组,两组比较,差异有统计学意义(P<0.05)。治疗期间两组患者安全性相关指标无明显异常。两组PCIV患者较健康人,血清eNOS活性明显降低,NO浓度及nNOS、iNOS明显升高,治疗组可明显升高血清eNOS活性,降低nNOS、iNOS活性及NO浓度,对照组可明显降低iNOS活性及NO浓度,对血清eNOS及nNOS活性有所改善,但差异无统计学意义(P>0.05),治疗组在改善血清NO及NOS各亚型含量方面均优于对照组,两组比较,差异有统计学意义(P<0.05)。结论行气通脉方治疗痰瘀阻络型后循环缺血性眩晕总体临床疗效优于甲磺酸倍他司汀,其机制可能与调节血清NO浓度及NOS亚型活性有关。

To observe the clinical efficacy and safety of Xingqi Tongmai Recipe in treating the patients with post circulation ischemic vertigo(PCIV)of phlegm stasis and collaterals obstruction type.Methods A total of 72 patients with post-circulation ischemic vertigo with phlegm and blood stasis obstructing collateral type were selected from January 2017 to December 2018 in the first ward and outpatient department of the Chinese Medicine Hospital of Jiading District,Shanghai,were divided into two groups with 36 cases in each group.the control group was treated with betahistine mesylate on the basis of conventional western medicine treatment(including blood pressure and blood sugar control,lipid-lowering stabilization,anti-platelet aggregation,etc.).The treatment group was treated with Xingqi Tongmai Decoction on the basis of conventional western medicine treatment.The treatment course of both groups was 14 days.The total effect of the patients before and after treatment,the scores of various TCM syndromes,the scores of the Vertigo Disability Scale,the serum NO and the scores of the patients were observed and recorded.NOS subtype results and clinical efficacy of the two treatments were compared.At the same time the blood,urine,feces,serum creatinine,urea nitrogen levels and electrocardiogram changes in the two groups of PCIV patients before and after treatment were tested for safety assessment and healthy.Serum NO and NOS expression were compared between the two groups of PCIV patients.Results In terms of the overall curative effect of TCM syndromes after treatment,the total effective rate of the treatment group was 87.50%(28/32),and the total effective rate of the control group was 76.47%(26/34).The overall curative effect of the treatment group was better than that of the control group(P<0.05).The scores of all syndromes in the treatment group improved significantly after treatment(P<0.05).The symptoms of dizziness,dizziness,dizziness,chest tightness,nausea,and headache in the control group were significantly improved compared with before treatment(P<0.05).However,there was no significant improvement in limb numbness or tingling,cyanosis of the lips and nails,and faulty skin nails(P>0.05).The treatment group was better than the control group in improving chest tightness,palpitation,numbness or tingling of the limbs,cyanosis of the lips and nails,and faulty skin nails(P<0.05).The two groups of patients had a significant effect in improving the vertigo and disability score(P<0.05),and the treatment group had better efficacy than the control group(P<0.05).During the treatment period,the safety-related indicators of the two groups were not significantly abnormal.The two groups of PCIV patients were compared in healthy people.Serum e NOS activity was significantly reduced,and NO concentration and n NOS and i NOS were significantly increased.The treatment group could significantly increase serum e NOS activity,and reduce n NOS,i NOS activity and NO concentration.And the control group could significantly reduce i NOS activity and NO concentration.Serum e NOS and n NOS activities were improved,but the difference was not statistically significant;the treatment group was better than the control group in improving the levels of serum NO and NOS subtypes(P<0.05).Conclusion The overall clinical effect of Xingqi Tongmai Decoction on the post circulation ischemic vertigo of phlegm stasis and collaterals blocking type is better than betahistine mesylate.The mechanism may be related to the regulation of serum NO concentration and NOS subtypes activity,and there is no obvious adverse reaction.