通窍活血汤化裁对急性脑梗死静脉溶栓后同型半胱氨酸、脂蛋白a及预后的影响

Effect of Modified Tongqiao Huoxue Decoction(通窍活血汤化裁)on Hcy,Lipoprotein a and Prognosis after Intravenous Thrombolysis in Acute Cerebral Infarction

目的观察通窍活血汤化裁对急性脑梗死静脉溶栓后高同型半胱氨酸(Hcy)、脂蛋白a[LP(a)]及预后的影响。方法研究总计纳入120例急性脑梗死患者(2022年6月—2023年6月收治),将纳入患者采取随机数字表法分为溶栓组(60例)与中药组(60例),溶栓组患者均采取阿替普酶溶栓治疗,中药组患者在溶栓组治疗基础上结合通窍活血汤化裁治疗,观察各组患者临床数据情况:疗效、治疗前后中医证候积分(偏瘫、口眼歪斜、头部刺痛、乏力)与Hcy及LP(a)水平变化、血清超敏C反应蛋白(hs-CRP)及白介素-6(IL-6)水平变化、红细胞聚集指数(EAI)及红细胞沉降率(ESR)、红细胞比容(HCT)及血浆黏度(PV)等血液流变学参数变化、卒中量表(NIHSS)及Barthel指数(BI)、中风病患者生存质量量表(QOLISP)评分变化。结果中药组患者治疗总有效率显著高于溶栓组患者,P<0.05;各组患者治疗前中医证候积分(偏瘫、口眼歪斜、头部刺痛、乏力)、Hcy及LP(a)水平、hs-CRP及IL-6水平、血液流变学参数(EAI、ESR、HCT、PV)、NIHSS及BI、QOLISP评分比较,P>0.05,经治疗后两组患者的中医证候积分(偏瘫、口眼歪斜、头部刺痛、乏力)、Hcy及LP(a)水平、hs-CRP及IL-6水平、血液流变学参数(EAI、ESR、HCT、PV)、NIHSS及BI、QOLISP评分等指标均改善,而中药组患者治疗后中医证候积分(偏瘫、口眼歪斜、头部刺痛、乏力)、Hcy及LP(a)水平、hs-CRP及IL-6水平、血液流变学参数(EAI、ESR、HCT、PV)、NIHSS及BI、QOLISP评分等指标均明显优于溶栓组,P<0.05。结论通窍活血汤化裁有助于降低急性脑梗死患者Hcy及LP(a)水平,可缓解患者症状,改善患者神经功能,提升患者生活质量,值得应用。

Objective To observe the effect of Modified Tongqiao Huoxue Decoction(通窍活血汤化裁)on high homocysteine(Hcy),lipoprotein a[LP(a)]and prognosis of acute cerebral infarction after intravenous thrombolysis.Methods A total of 120 patients with acute cerebral infarction(admitted from June 2022 to June 2023)were included and divided into the thrombolysis group(60 cases)and the traditional Chinese medicine group(60 cases)by random number table method.All patients in the thrombolytic group received alteplase thrombolytic therapy,while those in the traditional Chinese medicine group were treated with Modified Tongqiao Huoxue Decoction on the basis of thrombolytic therapy.The efficacy,changes in TCM symptom scores(hemiplegia,mouth and eye distortion,head stabbing pain,weakness),the levels of Hcy and LP(a),the levels of serum hypersensitive C-reactive protein(hs-CRP)and interleukin-6(IL-6),the hemorheological parameters such as erythrocyte aggregation index(EAI)and erythrocyte sedimentation rate(ESR),erythrocyte specific volume(HCT)and plasma viscosity(PV),National Institute of Health stroke scale(NIHSS)and Barthel index(BI),Stroke Patient Quality of Life Scale(QOLISP)score changes before and after treatment of two groups were observed.Results The total effective rate of the traditional Chinese medicine group was significantly higher than that of the thrombolysis group(P<0.05).Before treatment,TCM syndrome scores(hemiplegia,mouth and eye distortion,head stabbing pain,weakness),the levels of Hcy and LP(a),the levels of hs-CRP and IL-6,the values of hemorheological parameters(EAI,ESR,HCT,PV),the scores of NIHSS,BI and QOLISP were not significant in both groups(P>0.05).After treatment,these indexes were improved in both groups.After treatment,the above indexes in the traditional Chinese medicine group were significantly better than those in the thrombolytic group(P<0.05).Conclusion Tongqiao Huoxue Decoction can reduce the levels of Hcy and LP(a),alleviate the symptoms,improve the neurological function and the quality of life of patients with acute cerebral infarction,and is worthy of application.