半夏白术天麻汤加减联合丁苯酞治疗风痰瘀阻型急性脑梗死的临床研究

Clinical Study of Modified Banxia Baizhu Tianma Decoction Combined with Butylphthalide in the Treatment of Acute Cerebral Infarction with Wind-phlegm Stasis Type

目的:探讨半夏白术天麻汤加减联合丁苯酞治疗风痰瘀阻型急性脑梗死的临床效果及对同型半胱氨酸(Hcy)、血管内皮生长因子(VEGF)、神经元特异性烯醇化酶(NSE)的影响。方法:将2020年1月—2022年1月福州市中医院收治的100例急性脑梗死风痰瘀阻型患者按随机数表法分为对照组和观察组,各50例。对照组给予丁苯酞治疗,观察组在对照组基础上给予半夏白术天麻汤加减方汤剂,两组均治疗2周。两组在治疗前后进行中医症候积分评判(肢体麻木、头晕目眩、苔白腻),采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能评定量表(FMMS)、日常生活能力Barthel指数评分分别评价两组神经功能损伤、肢体运动功能及日常生活能力恢复情况,进行血清VEGF、Hcy、NSE检测,治疗后评价两组临床疗效,记录不良反应发生情况。结果:治疗后,两组肢体麻木、头晕目眩、苔白腻评分较治疗前均降低,且观察组均低于对照组(P<0.05)。治疗后,两组NIHSS、FMMS、Barthel指数评分较治疗前均改善,且观察组NIHSS评分低于对照组,上肢FMMS、下肢FMMS、Barthel评分均高于对照组(P<0.05)。治疗后,两组VEGF、Hcy、NSE较治疗前均改善,且观察组Hcy、NSE均低于对照组,VEGF高于对照组(P<0.05)。观察组总有效率为84.00%,明显高于对照组的64.00%(χ^(2)=8.157,P<0.05)。两组治疗过程中均未见明显不良反应。结论:丁苯酞治疗风痰瘀阻型急性脑梗死的基础上口服半夏白术天麻汤加减方汤剂效果确切,能更好地改善中医临床症候,减轻神经功能缺损,提高肢体运动功能及日常生活能力,其作用机制可能与促进VEGF表达、下调NSE表达及降低Hcy水平有关。

Objective: To investigate the clinical efficacy of Modified Banxia Baizhu Tianma Decoction combined with Butylphthalide in the treatment of acute cerebral infarction with wind-phlegm stasis type and its influence on homocysteine(Hcy), vascular endothelial growth factor(VEGF) and neuron-specific enolase(NSE). Method: A total of 100 patients with acute cerebral infarction with wind-phlegm stasis type who admitted to Fuzhou Hospital of Traditional Chinese Medicine from January 2020 to January 2022 were divided into the control group and the observation group according to random number table, 50 cases in each group. The control group was given Butylphthalide treatment, the observation group was given Modified Banxia Baizhu Tianma Decoction Decoction on the basis of the control group, two groups were treated for 2 weeks. Before and after treatment, two groups were evaluated by traditional Chinese medicine symptom score(limb numbness, dizziness, white and greasy fur), the National Institutes of Health stroke scale(NIHSS), Fugl-Meyer motor function scale(FMMS), and Barthel index score of daily living ability were used to evaluate the recovery of neurological function injury,limb motor function and daily living ability of two groups, respectively, serum serum VEGF, Hcy and NSE were detected, and the clinical efficacy was evaluated after treatment, and the occurrence of adverse reactions was recorded. Result: After treatment, the scores of limb numbness, dizziness and white and greasy fur of two groups were lower than those before treatment, and the observation group were lower than those in the control group(P<0.05). After treatment, the NIHSS, FMMS and Barthel index scores of two groups were improved than those before treatment, and the NIHSS score of the observation group was lower than that in the control group, but the FMMS of upper limb, FMMS of lower limb and Barthel scores were higher than those in the control group(P<0.05). After treatment, the VEGF, Hcy and NSE of two groups were improved than those before treatment, and the Hcy and NSE of the observation group were lower than those in the control group, but the VEGF was higher than that in the control group(P<0.05). The total effective rate of the observation group was 84.00%, which was significantly higher than 64.00% of the control group( χ^(2)=8.157, P<0.05). No obvious adverse reactions were observed in two groups during treatment. Conclusion: Modified Banxia Baizhu Tianma Decoction combined with Butylphthalide is effective in the treatment of acute cerebral infarction with wind-phlegm stasis type, and it can better improve clinical symptoms of traditional Chinese medicine, reduce neurological deficit, and improve limb motor function and daily living ability. Its mechanism of action may be it is related to promoting the expression of VEGF, down-regulating NSE and reducing the level of Hcy.