基于比率低频振幅探讨疏血通注射液联合西医常规疗法对急性缺血性脑卒中的疗效及机制研究

Study on Clinical Efficacy and Mechanism of Shuxuetong Injection Combined with Conventional Therapy in Acute Ischemic Stroke Based on Fractional Amplitude of Low-frequency Fluctuation

目的运用静息态功能磁共振成像(rs-fMRI)方法,观察疏血通注射液联合西医常规疗法对急性缺血性脑卒中的疗效,以及大脑神经元活动比率低频振幅(fALFF)的变化,探讨其潜在的疗效机制。方法选择急性缺血性脑卒中患者及健康对照者各20例。患者行西医常规治疗,并予疏血通注射液6 mL加生理盐水250 mL静脉滴注,每日1次,治疗14 d,随访至发病30 d。健康对照组无干预措施。随访时评价患者临床疗效。于治疗前、随访时评价患者美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)、日常生活活动能力量表(BI)评分。于治疗前、随访时对患者行rs-fMRI,健康对照组行1次rs-fMRI,比较患者2次fALFF差异及与健康对照组的差异。结果临床疗效总有效率为95%(19/20)。随访时NIHSS、mRS评分明显降低,BI评分明显升高(P<0.01)。与健康对照组比较,患者治疗前左侧额中回和左侧顶下小叶fALFF值明显降低(P<0.05),患者随访时左侧额中回和右侧枕上回fALFF值明显降低(P<0.05);与治疗前比较,患者随访时左侧额中回fALFF值有增高趋势,但差异无统计学意义(P>0.05)。结论疏血通注射液联合西医常规疗法对急性缺血性脑卒中疗效显著,其机制可能是通过调节左侧额中回神经元内在活动实现。

Objective To observe the clinical efficacy of Shuxuetong Injection combined with conventional therapy in the treatment of acute ischemic stroke by resting state functional magnetic resonance imaging(rs-fMRI);To explore the change of fractional amplitude of low-frequency fluctuation(fALFF);To reveal the potential therapeutic mechanism.Methods Totally 20 patients with acute ischemic stroke and 20 healthy persons were selected.The patients received conventional western medicine treatment,and were given 6 mL of Shuxuetong Injection and 250 mL of normal saline,intravenous drip,once a day,for 14 days,and followed up for 30 days.The healthy control group had no intervention.The clinical efficacy was evaluated during follow-up.The National Institutes of Health stroke scale(NIHSS),modified Rankin scale(mRS),and Barthel ADL index(BI)scores were evaluated before treatment and during follow-up.Before treatment and during follow-up,rs-fMRI was performed on patients,and rs-fMRI was performed on healthy control group once.The difference of fALFF between patients before treatment and during follow-up and the difference with healthy control group were compared.Results The total effective rate was 95%(19/20).During the follow-up,NIHSS and mRS scores significantly decreased,and BI score significantly increased(P<0.01).Compared with the healthy control group,the fALFF of the left middle frontal gyrus and left inferior parietal lobule of the patients significantly decreased before treatment(P<0.05),and the fALFF of the left middle frontal gyrus and the right superior occipital gyrus of the patients significantly decreased during the follow-up(P<0.05).Compared with before treatment,the fALFF value of left middle frontal gyrus of the patients showed an increasing trend during follow-up,without statistical significance(P>0.05).Conclusion Shuxuetong Injection combined with conventional therapy have evident clinical efficacy on acute ischemic stroke,and its efficacy mechanism may be achieved by regulating the intrinsic activity of neurons in the left middle frontal gyrus.