犀角地黄汤联合常规治疗对瘀热证急性脑梗死患者临床疗效及对血脂水平的影响

Clinical Efficacy of Xijiao Dihuang Decoction Combined with Conventional Treatment on Acute Cerebral Infarction Patients with Stasis Heat Syndrome and Its Impact on Blood Lipid Levels

目的:观察犀角地黄汤联合常规疗法治疗瘀热证急性脑梗死(acute cerebral infarction,ACI)的临床效果及对患者血脂水平的影响。方法:前瞻性纳入本院神经内科在2021年1月至2022年12月收治的100例瘀热证型ACI患者,分为对照组和观察组,各50例。给予对照组患者常规内科治疗,在此基础上给予观察组患者加用犀角地黄汤,两组均连续治疗14 d。比较两组患者临床疗效、治疗后改良Rankin量表(m RS)评分以及治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、瘀热证候积分、血清脂蛋白相关磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)、D-二聚体(DD)、纤维蛋白原(FIB)和血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平。结果:(1)两组患者治疗结束时的NIHSS评分、瘀热证候评分和m RS评分均显著降低,观察组患者下降幅度更显著(P<0.05)。(2)观察组患者治疗总有效率显著高于对照组(98.00%vs. 92.00%,P<0.05)。(3)治疗结束时,观察组患者血清Lp-PLA2、Hcy、DD和FIB水平以及对照组患者血清Lp-PLA2、Hcy和FIB均显著降低(P<0.05),对照组患者治疗前后DD水平无显著差异(P>0.05)。观察组患者治疗结束时的血清Lp-PLA2、Hcy、DD和FIB水平均显著低于对照组(P<0.05)。(4)治疗结束时,观察组患者血清TC、TG、LDL-C水平以及对照组患者血清TC和LDL-C显著低于治疗前(P<0.05),两组患者其他指标治疗前后无显著差异(P>0.05)。观察组患者治疗结束时的血清TC、TG、LDL-C水平均显著低于对照组(P<0.05),两组治疗结束时血清HDL-C比较无显著差异(P>0.05)。结论:犀角地黄汤能够显著提高瘀热证ACI患者临床疗效,减轻神经功能缺损和瘀热征象,提高生活能力,这可能与犀角地黄汤进一步改善患者脂代谢和异常血凝,减轻血管内皮损伤等有关。

Objective:To observe the clinical effect of Xijiao Dihuang Decoction combined with conventional therapy in the treatment of acute cerebral infarction(ACI)with blood stasis heat syndrome and its impact on blood lipid levels in patients.Methods:A prospective study was conducted on 100 ACI patients with blood stasis heat syndrome admitted to the Department of Neurology at the our hospital from January 2021 to December 2022.They were divided into a control group and an observation group using a random number table method,with 50 patients in each group.Patients in the control group were given routine internal medicine treatment,and on this basis,patients in the observation group were given additional treatment with Xijiao Dihuang Decoction.Both groups were treated continuously for 14 days.Compare the clinical efficacy,modified Rankin Scale(mRS)score after treatment,and the National Institutes of Health Stroke Scale(NIHSS)score,blood stasis heat syndrome score,serum lipoprotein associated phospholipase A2(Lp-PLA2),homocysteine(Hcy)score before and after treatment between two groups of patients D-dimer(DD),fibrinogen(FIB),and blood lipids[total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C)]levels.Results:(1)The NIHSS score,stasis heat syndrome score,and mRS score of the two groups of patients at the end of treatment were reduced,while the observation group had a more significant decrease(P<0.05).(2)The total effective rate of treatment in the observation group was higher than that in the control group(98.00%vs.92.00%,P<0.05).(3)At the end of treatment,the serum levels of Lp-PLA2,Hcy,DD,and FIB in the observation group patients and the serum levels of Lp-PLA2,Hcy,and FIB in the control group patients were reduced(P<0.05).There was no difference in DD levels before and after treatment in the control group patients(P>0.05).At the end of treatment,the serum levels of Lp-PLA2,Hcy,DD,and FIB in the observation group were lower than those in the control group(P<0.05).(4)At the end of treatment,the levels of serum TC,TG,and LDL-C in the observation group and the control group were lower than before treatment(P<0.05).There was no difference in other indicators between the two groups before and after treatment(P>0.05).The levels of serum TC,TG,and LDL-C at the end of treatment in the observation group were lower than those in the control group(P<0.05),and there was no difference in serum HDL-C between the two groups at the end of treatment(P>0.05).Conclusion:Xijiao Dihuang Decoction can significantly improve the clinical efficacy of ACI patients with blood stasis and heat syndrome,alleviate neurological deficits and signs of blood stasis and heat,and improve living ability.This may be related to the further improvement of lipid metabolism and abnormal blood coagulation in patients with Xijiao Dihuang Decoction and the reduction of vascular endothelial damage.