熄风化瘀通络方治疗脑出血急性期风痰瘀阻型患者的疗效及其对相关炎性因子、神经因子和血脑屏障的影响

Therapeutic Effect of Xifeng Huayu Tongluo Prescription for Acute Cerebral Hemorrhage Patients with Wind-phlegm-stasis Obstruction Syndrome and Its Influence on Inflammatory Factors,Neural Factors and Blood-brain Barrier

【目的】探讨熄风化瘀通络方治疗脑出血急性期风痰瘀阻型患者的临床疗效及其对相关炎性因子、神经因子和血脑屏障的影响。【方法】将106例脑出血急性期风痰瘀阻型患者随机分为对照组和观察组,每组各53例。对照组给予西医常规治疗,观察组在对照组基础上联合熄风化瘀通络方治疗,疗程为2周。观察2组患者治疗前后血清同型半胱氨酸(Hcy)、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶9(MMP-9)、基质金属蛋白酶组织抑制剂1(TIMP-1)、神经生长因子(NGF)、脑源性神经营养因子(BDNF)、超氧化物歧化酶(SOD)水平及美国国立卫生研究院卒中量表(NIHSS)神经功能评分的变化情况,评价2组患者的临床疗效和安全性。【结果】(1)治疗2周后,观察组的总有效率为96.23%(51/53),对照组为79.25%(42/53),组间比较,观察组的疗效明显优于对照组(P<0.01)。(2)治疗后,2组患者血清NGF、BDNF、SOD水平均较治疗前明显升高(P<0.05),血清Hcy、TNF-α、MMP-9、TIMP-1水平均较治疗前明显降低(P<0.05),且观察组对血清NGF、BDNF、SOD水平的升高作用及对血清Hcy、TNF-α、MMP-9、TIMP-1水平的降低作用均明显优于对照组(P<0.01)。(3)治疗3 d、7 d和14 d后,2组患者的NIHSS评分均较治疗前明显降低(P<0.05),且观察组在各观察时点对NIHSS评分的降低作用均明显优于对照组(P<0.01)。(4)2组患者的不良反应均以皮疹、肝功能损伤、头痛、恶心呕吐、腹泻为主,其中,观察组的不良反应发生率为13.21%(7/53),对照组为16.98%(9/53),组间比较,差异无统计学意义(P>0.05)。【结论】在西医常规治疗基础上联合熄风化瘀通络方治疗脑出血急性期风痰瘀阻型患者,有助于减轻炎症反应,促进神经功能恢复,保护血脑屏障,提高临床疗效。

Objective To explore the clinical efficacy of Xifeng Huayu Tongluo Prescription for the treatment of acute cerebral hemorrhage(ACH)patients with wind-phlegm-stasis obstruction syndrome,and to observe its influence on inflammatory factors,neural factors and blood-brain barrier.Methods A total of 106 ACH patients with wind-phlegm-stasis obstruction syndrome were randomly divided into control group and observation group,with 53 cases in each group.The control group was given conventional treatment of western medicine,and the observation group was given Xifeng Huayu Tongluo Prescription orally combined with conventional treatment of western medicine.The course of treatment lasted for 2 weeks.The changes of serum levels of homocysteine(Hcy),tumor necrosis factor alpha(TNF-α),matrix metalloproteinase 9(MMP-9),tissue inhibitor of matrix metalloproteinase 1(TIMP-1),nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),and superoxide dismutase(SOD)as well as the scores of neurologic function evaluated with National Institute of Health stroke scale(NIHSS)in the two groups were observed before and after treatment.Meanwhile,the clinical efficacy and safety of two groups were evaluated.Results(1)After 2 weeks of treatment,the total effective rate of the observation group was 96.23%(51/53),and that of the control group was 79.25%(42/53).The intergroup comparison showed that the therapeutic effect of the observation group was significantly superior to that of the control group(P<0.01).(2)After treatment,the serum levels of NGF,BDNF and SOD in the two groups were significantly increased compared with those before treatment(P<0.05),and the levels of serum Hcy,TNF-α,MMP-9 and TIMP-1 were significantly decreased compared with those before treatment(P<0.05).In addition,the effect on improving serum levels of NGF,BDNF and SOD and the effect on lowering serum levels of Hcy,TNF-α,MMP-9 and TIMP-1 in the observation group were significantly superior to those in the control group(P<0.01).(3)After 3,7 and 14 days of treatment,NIHSS scores in the two groups were significantly decreased compared with those before treatment(P<0.05),and the effect on lowering the NIHSS scores in the observation group was significantly superior to that in the control group at each observation time point(P<0.01).(4)The adverse reactions in both groups were mainly manifested as rash,liver function injury,headache,nausea and vomiting,and diarrhea.The incidence of adverse reaction in the observation group was 13.21%(7/53)and that in the control group was 16.98%(9/53),and the difference was not statistically significant between the two groups(P>0.05).Conclusion The combined use of Xifeng Huayu Tongluo Prescription based on the conventional western medicine is effective on reducing the inflammatory response,promoting the recovery of neurologic function,protecting the blood-brain barrier and enhancing the clinical efficacy for the treatment of ACH patients with wind-phlegm-stasis obstruction syndrome.