Efficacy of Guhong injection versus Butylphthalide injection for mild ischemic stroke: A multicenter controlled study

BACKGROUND Most studies on Guhong injection have involved a single center with a small sample size,and the level of clinical evidence is low.AIM To assess the safety and efficacy of Guhong injection for mild ischemic stroke(IS).METHODS A total of 399 IS patients treated at six hospitals from August 2018 to August 2019 were retrospectively analyzed.The patients were given Guhong injection(experimental group)or Butylphthalide injection(control group).Changes in National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS)scores were observed before treatment and at 1,2,and 3 wk after treatment in each group.The efficacy and safety of Guhong injection for IS were assessed.Other medications taken by the patients were confounding factors for efficacy assessment.These factors were controlled by propensity score matching,and the results were further analyzed based on the matching.RESULTS The marked response rates at three follow-up visits were 64.64%,74.7%,and 66.7%in the experimental group,and 48.26%,45.4%,and 22.2%in the control group.The marked response rates increased significantly in the experimental group compared with the control group(P<0.05).The overall response rate at the first visit(days 7±2)did not differ significantly between the two groups,but differed significantly at the second(days 14±2)and third visits(days 21±3)(P<0.05).The proportion of patients without any symptoms in the experimental group was significant different at the first visit(P<0.05),but not significantly different at the second visit.The two groups showed no significant difference in the baseline distribution of mRS scores.At the first and second visits,the change in mRS scores was-2 and-1 in the experimental and control groups,respectively,which were significantly different(P<0.05).After propensity score matching,the overall response rate and marked response rate were 97.29%and 100%in the experimental group(P>0.05)and 64.0%and 47.7%in the control group(P<0.05)at the first visit,respectively.The decreased NIHSS scores in the two groups were significant different(P<0.05).The overall response rate and marked response rate differed significantly between the two groups at the second visit(P<0.05).There was no significant difference in the incidence of adverse events between the two groups.No severe adverse events occurred in either group.CONCLUSION Guhong injection is safe and more effective than Butylphthalide injection for treatment of IS.

Effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke

Objective:To investigate the effect of Shuxuetong injection on platelet function, hemorheology and cerebral blood flow in patients with ischemic stroke.Methods: One hundred cases of ischemic stroke admitted in our hospital from February 2015 to January 2017 were randomly divided into control group and observation group. The control group was given routine treatment. The observation group was given Shuxuetong injection on the basis of the control group. The changes of platelet function, hemorheology and cerebral blood flow before and after treatment were detected in both groups.Results: After treatment, the whole blood viscosity, plasma viscosity and fibrinogen level in both groups were significantly lower than those before treatment. The whole blood viscosity, plasma viscosity and fibrinogen level in the observation group were (4.18±0.05) mPa?s, (1.66±0.12) mPa?s and (3.45±0.08) g/L, respectively, which were significantly lower than the control group;After treatment, the levels of MCA, ACA and PCA in both groups were significantly increased. MCA, ACA and PCA levels in the observation group were (70.82±4.13) cm/s, (60.62±3.55) cm/s and (54.11±2.36) cm/s, which were significantly higher than those in the control group;After treatment, the maximum platelet aggregation rate, PLT, MPV and PDW levels in the two groups significantly decreased. The maximum platelet aggregation rate, PLT, MPV and PDW levels in the observation group were (27.93±1.44)% and (155.32±13.46)×109/L, (9.42±0.32) fL and (9.12±0.24) fL, respectively, which were significantly lower than those in the control group. Conclusions: Shuxuetong injection can effectively improve the patient's hemorheology and platelet function, improve the level of cerebral blood flow in patients with significant effect, it is worth further clinical application.

Clinical Study of Xingnaojing Injection Combined with Craniocerebral Hypothermia Apparatus in the Treatment of Acute Hemorrhagic Stroke

Objective:To investigate the clinical effect of Xingnaojing injection combined with craniocerebral hypothermia apparatus in the treatment of acute hemorrhagic stroke.Methods:Seventy-two patients with acute hemorrhagic stroke admitted to our hospital from March 2018 to September 2019 were randomly divided into two groups,with 36 cases in each group.The control group(n=36)was treated with craniocerebral hypothermia apparatus,and the observation group(n=36)was treated with Xingnaojing injection combined with craniocerebral hypothermia apparatus.The clinical efficacy,the National Institutes of Health Stroke Scale(NIHSS)score and the activity of daily living(MBI score)after 1 month of treatment were compared.Results:The effective rate of treatment in the observation group was higher than that in the control group(P<0.05);NIHSS score was decreased in both groups(P<0.05);MBI score was increased in both groups,and the change range of the observation group was greater than that of the control group,showing statistically significant differences(P<0.05).Conclusion:Xingnaojing injection combined with craniocerebral hypothermia apparatus can improve the clinical efficacy,the neurological impairment and activity of daily living in the treatment of acute hemorrhagic stroke,which is worthy of clinical application.

Neuroprotective Effect and Mechanism of Tanreqing Injection on Ischemic Stroke:Insights from Network Pharmacology and in vivo Experiments

Objective To explore the neuroprotective effects and mechanism of Tanreqing Injection(TRQ)on treating ischemic stroke based on network pharmacology and in vivo experimental validation.Methods The chemical compounds of TRQ were retrieved based on published data,with targets retrieved from PubChem,Therapeutic Target Database and DrugBank.Network visualization and analysis were performed using Cytoscape,with protein-protein interaction networks derived from the STRING database.Enrichment analysis was performed using Kyoto Encyclopedia of Genes Genomes pathway and Gene Ontology analysis.In in vivo experiments,the middle cerebral artery occlusion(MCAO)model was used.Infarct volume was determined by 2,3,5-triphenyltetrazolium hydrochloride staining and protein expressions were analyzed by Western blot.Molecular docking was performed to predict ligand-receptor interactions.Results We screened 81 chemical compounds in TRQ and retrieved their therapeutic targets.Of the targets,116 were therapeutic targets for stroke.The enrichment analysis showed that the apelin signaling pathway was a key pathway for ischemic stroke.Furthermore,in in vivo experiment we found that administering with intraperitoneal injection of 2.5 mL/kg TRQ every 6 h could significantly reduce the infarct volume of MCAO rats(P<0.05).In addition,protein levels of the apelin receptor(APJ)/phosphatidylinositol 3-kinase(PI3K)/protein kinase B(AKT)pathway were increased by TRQ(P<0.05).In addition,41 chemical compounds in TRQ could bind to APJ.Conclusions The neuroprotective effect of TRQ may be related to the APJ/PI3K/AKT signaling pathway.However,further studies are needed to confirm the findings.

Danshen-Chuanxiongqin Injection attenuates cerebral ischemic stroke by inhibiting neuroinflammation via the TLR2/ TLR4-MyD88-NF-κB Pathway in tMCAO mice

Danshen-Chuanxiongqin Injection(DCI)is a commonly used traditional Chinese medicine for the treatment of cerebral ischemic stroke in China.However,its underlying mechanisms remain completely understood.The current study was designed to explore the protective mechanisms of DCI against cerebral ischemic stroke through integrating whole-transcriptome sequencing coupled with network pharmacology analysis.First,using a mouse model of cerebral ischemic stroke by transient middle cerebral artery occlusion(tMCAO),we found that DCI(4.10 mL·kg−1)significantly alleviated cerebral ischemic infarction,neurological deficits,and the pathological injury of hippocampal and cortical neurons in mice.Next,the whole-transcriptome sequencing was performed on brain tissues.The cerebral ischemia disease(CID)network was constructed by integrating transcriptome sequencing data and cerebrovascular disease-related genes.The results showed CID network was imbalanced due to tMCAO,but a recovery regulation was observed after DCI treatment.Pathway analysis of the key genes with recovery efficiency showed that the neuroinflammation signaling pathway was highly enriched,while the TLR2/TLR4-MyD88-NF-κB pathway was predicted to be affected.Consistently,the in vivo validation experiments confirmed that DCI exhibited protective effects against cerebral ischemic stroke by inhibiting neuroinflammation via the TLR2/TLR4-MyD88-NF-κB pathway.More interestingly,DCI markedly suppressed the neutrophils infiltrated into the brain parenchyma via the choroid plexus route and showed anti-neuroinflammation effects.In conclusion,our results provide dependable evidence that inhibiting neuroinflammation via the TLR2/TLR4-MyD88-NF-κB pathway is the main mechanism of DCI against cerebral ischemic stroke in mice.

The Chinese herbal formula Tongluo Jiunao promotes expression of brain-derived neurotrophic factor/tropomyosin-related kinase B pathways in a rat model of ischemic brain injury

The neurotrophin-Trk receptor pathway is an intrinsic pathway to relieve damage to the central nervous system. The present study observed the effects of Tongluo Jiunao （TLJN）, which comprises Panax Notoginseng and Gardenia Jasminoides, on expression of brain-derived neurotrophic factor （BDNF） and tropomyosin-related kinase B （TrkB） in a rat model of focal cerebral ischemic injury. Xue Sai Tong （XST）, comprising Panax Notoginseng, served as the positive control. Mechanisms of neuroprotection were analyzed following TLJN injection. Following establishment of the middle cerebral artery occlusion models, TLJN and XST were intraperitoneally injected, and 2, 3 5-triphenyltetrazolium chloride staining results revealed that TLJN injection reduced infarct volume, suggesting that TLJN exerted a neuroprotective effect. Enzyme-linked immunosorbent assay results showed that TLJN elevated BDNF and growth associated protein-43 expression in ischemic brain tissues, as well as serum BDNF levels. Reverse-transcription polymerase chain reaction and western blot results showed that TLJN injection did not affect TrkB expression in the ischemic brain tissues of rats. These results suggested that TLJN injection reduced damage to ischemic brain tissues and increased BDNF expression. In addition, TLJN injection resulted in better promoting effects on neurotrophic factor expression compared with XST.

血栓通注射液联合奥拉西坦对老年缺血性脑卒中的作用

目的探讨血栓通注射液联合奥拉西坦对老年缺血性脑卒中(ischemic stroke,IS)的作用。方法选取106例老年IS患者作为研究对象,随机分为观察组和对照组,每组53例。对照组用奥拉西坦治疗,观察组在对照组治疗的基础上联合血栓通注射液治疗,比较2组的临床疗效、神经功能[用美国国立卫生研究院卒中量表评分(national institute of health stroke scale,NIHSS)评估]、运动功能(用日常生活活动能力(activities of daily living,ADL)量表评估)、颈动脉狭窄程度(颈动脉内中膜厚度和狭窄率)、血流动力学(全血黏度、血流速度和血流阻力)、神经损伤因子[神经胶质原纤维酸性蛋白(glial fibrillary acidic protein,GFAP)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)和脑源性神经生长因子(brain-derived neurotrophic factor,BDNF)]和氧化应激指标[丙二醛(malondialdehyde,MDA)和超氧化物歧化酶(superoxide dismutase,SOD)]水平。结果观察组的总有效率为98.11%,高于对照组的86.79%(P<0.05);治疗后,观察组的NIHSS评分为(10.14±1.91)分,低于对照组的(12.43±2.12)分,P<0.05;观察组的ADL评分为(64.49±8.30)分,高于对照组的(58.37±7.26)分,P<0.05;观察组颈动脉内中膜厚度和狭窄率分别为(1.27±0.11)mm、(74.84%±5.14%),低于对照组[(1.33±0.13)mm、(78.92%±5.95%)],P<0.05;观察组(高切和低切)全血黏度和血流阻力分别为(4.72±0.91)mPa·s、(10.99±2.25)mPa·s、(1.52±0.24)Pa·s·L^(-1),低于对照组[(5.86±1.17)mPa·s、(13.40±2.77)mPa·s、(1.64±0.27)Pa·s·L^(-1)],血流速度为(18.33±3.85)cm·s^(-1),高于对照组[(16.51±3.61)cm·s^(-1)],P<0.05;观察组的GFAP和NSE分别为(5.62±1.11)、(23.88±4.25)ng·mL^(-1),低于对照组[(6.57±1.30)、(27.17±4.76)ng·mL^(-1)],BDNF为(3.06±0.77)ng·mL^(-1),高于对照组[(2.38±0.52)ng·mL^(-1)],P<0.05;观察组的MDA为(3.62±0.63)μmol·L^(-1),低于对照组[(4.05±0.78)μmol·L^(-1)],SOD为(105.20±15.63)U·mL^(-1),高于对照组[(93.42±13.27)U·mL^(-1)],P<0.05。结论血栓通注射液联合奥拉西坦对老年IS患者疗效显著,可通过调节神经损伤因子和氧化应激因子水平及改善血流动力学,提高患者的神经功能和运动功能,改善颈动脉狭窄。

236例巴曲酶注射液治疗血管闭塞性疾病的警示医嘱用药分析

目的:回顾性分析巴曲酶注射液用于治疗血管闭塞性疾病的警示医嘱,为临床合理使用巴曲酶注射液提供参考。方法:基于PASS医嘱审核结果数据库,导出2020年9月至2023年6月河北省人民医院巴曲酶注射液所有警示级别的医嘱236例,进行统计分析。利用Excel软件辅助作图,计数资料采用频数及百分比描述,计量资料采用分段描述频数和百分比描述。结果:236例巴曲酶注射液治疗血管闭塞性疾病的警示医嘱中,男性患者(136例)、中老年患者(≥60岁,164例)居多;警示医嘱出现最多的科室是血管外科;警示级别中,橙灯问题占25.85%(61例),红灯问题占16.10%(38例),黑灯问题占58.05%(137例),黑灯警示医嘱均因为药物的相互作用。结论:男性、高龄是血管闭塞性疾病的高危因素;医嘱中存在禁忌证、超适应证、超频次及不符合维持剂量范围使用巴曲酶注射液的问题;同属纤维蛋白原溶解药以及巴曲酶注射液与阿司匹林的联合应用,并非绝对的禁忌,在控制好药物剂量、监测凝血-纤溶指标的前提下,上述药物联合应用可以进一步改善患者的临床结局。

阿替普酶静脉溶栓联合丁苯酞氯化钠注射液治疗急性缺血性脑卒中的效果

目的探讨阿替普酶(rt-PA)静脉溶栓联合丁苯酞氯化钠注射液治疗急性缺血性脑卒中(AIS)的效果。方法选择2022年1月至2023年1月吴川市人民医院收治的AIS患者100例作为研究对象,按随机数表法分为观察组和对照组各50例。对照组患者予以rt-PA静脉溶栓治疗,观察组患者在对照组基础上联合丁苯酞氯化钠注射液治疗,两组患者均持续治疗14 d。比较两组患者治疗14 d后的临床疗效,以及治疗前和治疗14 d后的美国国立卫生院卒中量表(NIHSS)评分、改良Rankin评分量表(mRS)评分、脑血流量(CBF)、脑血容量(CBV)和平均通过时间(MTT),比较两组患者出院后随访1年的复发率和再入院率。结果治疗后,观察组患者的临床疗效总有效率为92.00%,明显高于对照组的74.00%,差异有统计学意义(P<0.05);治疗14 d后,观察组患者的NIHSS评分为(10.34±2.27)分,明显低于对照组的(8.15±2.63)分,mRS评分为(72.64±11.40)分,明显高于对照组的(61.21±10.25)分,差异均有统计学意义(P<0.05);治疗14 d后,观察组患者的CBF、CBV分别为(21.43±2.18)mL/(10 g·min)、(2.19±0.23)mL/100 g,明显高于对照组的(19.75±1.85)mL/(10 g·min)、(2.01±0.27)mL/100 g,MTT为(6.34±0.68)s,明显短于对照组的(7.49±0.75)s,差异均有统计学意义(P<0.05);出院后随访1年,观察组患者的再入院率为2.04%,明显低于对照组的14.29%,差异有统计学意义(P<0.05)。结论rt-PA静脉溶栓联合丁苯酞氯化钠注射液治疗AIS患者的疗效显著,且有助于减少短期再入院率,值得临床推广应用。

Screening Safflower Injection for Constituents with Activity against Stroke Using Comprehensive Chemical Profiling Coupled with Network Pharmacology

Objective:This study aimed to explore safflower injection(SI)for constituents with activity against ischemic stroke using a combination of chemical analysis and a network pharmacology strategy.Materials and Methods:The main ingredients of SI were comprehensively identified using ultra-high-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry,and the core targets and pathways associated with stroke were predicted using PharmMapper and Kyoto Encyclopedia of Genes and Genomes analysis.Cytoscape software was used to visualize and analyze the active compound-target-pathway network of SI regulating ischemic stroke.Results:A total of76 chemical compounds were identified from the SI sample,including 63,which regulated 88 targets that were ultimately enriched in 12 key ischemia stroke-related signaling pathways.Kaempferol-3-O-sophoroside,kaempferol-3-O-rutinoside,carthamoside B6,neoeriocitrin,and6-hydroxykaempferol-3-O-rutinoside-6-O-glucoside were determined to be important for stroke treatment because they had a higher degree value in the network than other constituents did.Moreover,the characteristic components isolated from SI showed protective effect mainly by acting on multiple targets including AKT1,epidermal growth factor receptor,transforming growth factor-beta receptor(TGFBR),Ras homolog,mTORC1 binding,caspase 3,and glycogen synthase kinase 3 beta,which were involved in different signaling pathways including phosphoinositide 3-kinase-Akt,mitogen-activated protein kinase,neurotrophin,ErbB,mechanistic target of rapamycin,and tumor necrosis factor.Conclusions:This study proposed a network pharmacology and chemical component profiling strategy for the systematic understanding of the therapeutic material basis of using SI against ischemic stroke.

中药注射剂治疗脑梗死临床研究进展

中药注射剂作为一种中药特色剂型,在药理学理论指导以及现代制药工艺提升的基础上,临床治疗脑梗死发挥着越来越重要的作用。但由于其种类繁杂,中药作用靶点不明确,临床使用时多根据医师经验选择不同注射剂,使得临床使用缺少规范。文章从中药注射剂功效分类,对临床常用中药注射剂进行再次归纳与分析,以期为脑梗死临床用药提供参考。

醒脑静注射液对脑卒中患者炎症因子影响的Meta分析

目的:基于Meta分析,探讨醒脑静注射液对脑卒中患者炎症因子的影响,以明确醒脑静注射液抑制机体整体炎症反应是其治疗脑出血和脑梗死的共同机制。方法:检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库以及Web of Science、PubMed、Embase、the Cochrane Library等数据库(截至2023年2月20日),根据检索策略以及纳入与排除标准,筛选符合条件的醒脑静注射液用于脑卒中患者的随机对照试验[对照组予以依达拉奉注射液或常规脑保护治疗(不包括溶栓治疗),观察组在对照组的基础上加用醒脑静注射液]。采用Cochrane系统评价员手册5.1.0推荐的质量评价方法进行文献质量评价,应用RevMan 5.3软件进行Meta分析、亚组分析,应用Stata 12.0软件进行Meta回归、敏感性分析以及发表偏倚评价。结果:共纳入12项随机对照试验研究,涉及1 206例患者。文献质量整体水平偏低。Meta分析结果提示,联合应用醒脑静注射液能够较常规治疗降低脑卒中后C反应蛋白(SMD=-2.02,95%CI=-2.89~-1.16,P<0.000 01)、肿瘤坏死因子α(SMD=-1.72,95%CI=-2.31~-1.12,P<0.000 01)和白细胞介素6(SMD=-2.14,95%CI=-2.81~-1.46,P<0.000 01)水平,缩小大脑病灶体积(MD=-1.55,95%CI=-1.98~-1.12,P<0.000 01),差异均有统计学意义。Meta回归结果提示,脑卒中类型,对照组患者是否应用依达拉奉,观察组患者醒脑静注射液用量是否为1次20 mL、1日2次,不是造成肿瘤坏死因子α异质性过高的原因(P均>0.05)。结论:与常规治疗相比,联合应用醒脑静注射液能降低脑卒中后外周血中C反应蛋白、肿瘤坏死因子α、白细胞介素6水平,这种作用可能是醒脑静注射液治疗脑出血和脑梗死的共同机制,但由于纳入文献的质量整体偏低,需要更大规模、更严格的临床随机对照试验验证。

丁苯酞氯化钠注射液联合脑栓通胶囊治疗急性缺血性脑卒中合并2型糖尿病的效果

目的 探讨丁苯酞氯化钠注射液联合脑栓通胶囊治疗急性缺血性脑卒中(AIS)合并2型糖尿病(T2DM)的效果。方法 将2021年9月至2023年8月我院收治的110例AIS合并T2DM患者按照奇偶顺序分为两组。对照组采用丁苯酞氯化钠注射液治疗,观察组在对照组基础上采用脑栓通胶囊治疗。比较两组的NIHSS、 BI评分、炎性因子、不良反应。结果 治疗后14d,观察组NIHSS评分低于对照组,BI评分高于对照组(P <0.05)。治疗后14 d,观察组IL-6、 hs-CRP、 Hcy水平低于对照组(P <0.05)。两组的不良反应发生率比较无统计学差异(P>0.05)。结论 丁苯酞氯化钠注射液联合脑栓通胶囊可改善AIS合并T2DM患者的神经功能和日常生活能力,抑制炎性因子表达,且安全性较高。

通脉汤联合丁苯酞注射液对急性缺血性脑卒中阿替普酶静脉溶栓后患者临床疗效分析

目的探讨通脉汤联合丁苯酞注射液对急性缺血性脑卒中阿替普酶静脉溶栓后患者临床疗效。方法选取2022年8月1日—2023年6月30日于沈阳医学院附属第二医院神经内科住院治疗的急性缺血性脑卒中(AIS)且应用阿替普酶静脉溶栓患者70例作为研究对象。应用随机数字法将患者分为观察组及对照组,每组35例。对照组在常规治疗基础上应用丁苯酞注射液,观察组在对照组治疗基础上加用通脉汤,两组疗程均为2周。观察两组治疗前后神经损害标志物、丙二醛(MDA)、内皮素1(ET-1)、载脂蛋白O(APOO)、基质金属蛋白酶-9(MMP-9)、血清炎症因子水平及血清长链非编码RNA(lncRNA)DLX6-AS1、5-脂氧合酶(5-Lox)的相对表达量以及临床疗效。结果治疗后两组血清血红素氧合酶1(HO-1)、神经丝轻链(NFL)、人磷酸化神经丝重链(PNFH)、生长分化因子-15(GDF-15)血清神经损害标志物水平均有明显下降,观察组下降幅度大于对照组,差异有统计学意义(P<0.05);治疗后两组MDA、ET-1、APOO以及MMP-9水平均有明显下降,观察组下降幅度大于对照组,差异有统计学意义(P<0.05);治疗后两组lncRNA DLX6-AS1相对表达量较同组治疗前明显提升,差异有统计学意义(P<0.05),观察组lncRNA DLX6-AS1相对表达量高于对照组,差异有统计学意义(P<0.05);治疗后两组5-Lox相对表达量较同组治疗前明显下降,差异有统计学意义(P<0.05),观察组5-Lox相对表达量低于对照组,差异有统计学意义(P<0.05);观察组治疗总有效率为82.86%,对照组治疗总有效率为60.00%,观察组高于对照组,差异有统计学意义(P<0.05);治疗后两组患者不良反应发生率比较,观察组不良反应总发生率为14.29%,对照组为8.57%,两组比较差异无统计学意义(P>0.05)。结论通脉汤联合丁苯酞注射液可有效改善AIS阿替普酶静脉溶栓患者的神经损伤程度,降低氧化应激反应及血清炎性因子,调节lncRNA DLX6-AS1及5-Lox蛋白的相对表达量,治疗效果确切,值得临床推广。

银杏内酯治疗缺血性脑卒中的临床疗效及作用机制研究

目的观察银杏内酯治疗缺血性脑卒中的临床疗效,并探究其改善大鼠脑缺血再灌注损伤预后的机制。方法临床研究中,收集2022年1月至2023年9月安徽医科大学第一附属医院北区住院部60例缺血性脑卒中患者,按照随机数字表法分为观察组和对照组,各30例。对照组常规使用抗血小板药物、调脂稳斑、降血压、神经功能保护药物,观察组在此基础上联用银杏内酯注射液,疗程为10天。对比两组患者治疗前后神经功能(NIHSS)评分、临床疗效、日常生活活动能力(Barthel)评分及外周血单核细胞(PBMC)中Kelch样ECH关联蛋白1(Keap1)和核因子E2相关因子2(Nrf2)基因及蛋白表达水平。在动物实验中,30只SPF级雄性SD大鼠采用Zea-Longa线栓法建立大鼠脑缺血模型,所有大鼠分为假手术组(NC组)、模型组、银杏内酯组,各10只。以Zea-Longa评分法评估各组大鼠神经功能损伤程度,HE染色检测脑组织病理学改变,TTC染色检测脑梗死体积百分率,ELISA法检测脑组织和血清中白细胞介素(IL)-2和IL-6及肿瘤坏死因子-α(TNF-α)水平,Real-time PCR和Western blot方法分别检测脑组织和PBMC中Keap1和Nrf2基因及蛋白表达水平。结果临床研究中,观察组总有效率(93.33%)高于对照组(70.00%)(P<0.05)。与对照组治疗后相比,观察组治疗后NIHSS评分显著降低(P<0.05),Barthel指数评分显著升高(P<0.01),Keap1蛋白表达水平明显下调(P<0.01),Nrf2mRNA及蛋白水平明显上调(P<0.01)。动物实验中,与模型组比较,银杏内酯组大鼠神经功能评分显著降低(P<0.01);大鼠脑组织病理状况显著改善;脑组织梗死体积缩小(P>0.05);脑组织匀浆及血清中炎性因子TNF-α、IL-2、IL-6表达均明显下调(P<0.01);脑组织及PBMC中Keap1mRNA及蛋白表达水平明显下调(P<0.01),Nrf2mRNA及蛋白表达水平明显上调(P<0.01)。结论银杏内酯可能通过Keap1/Nrf2信号通路,抑制氧化应激和炎症反应,改善脑卒中血脑屏障功能,降低脑损伤,提高神经功能。

疏血通注射液辅助治疗对老年缺血性脑卒中患者认知功能及TGF-β_(1)、Smad1的影响

目的:探讨疏血通注射液辅助治疗对老年缺血性脑卒中患者认知功能及转化生长因子-β_(1)(TGF-β_(1))、Smad同源物1(Smad1)的影响。方法:选择2021年4月—2023年4月昆山市锦溪人民医院收治的82例老年缺血性脑卒中患者作为研究对象。将随机分为观察组、对照组,各41例。对照组采用常规治疗,观察组在对照组基础上采用疏血通注射液辅助治疗。比较两组认知功能、TGF-β_(1)、Smad1、自理能力和神经功能、不良反应发生率。结果:治疗后,两组简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分高于治疗前,临床痴呆评定量表(CDR)评分低于治疗前,且观察组MMSE、MoCA评分高于对照组,CDR评分低于对照组,差异有统计学意义(P<0.05)。治疗后,两组TGF-β_(1)低于治疗前,Smad1高于治疗前,且观察组TGF-β_(1)低于对照组,Smad1高于对照组,差异有统计学意义(P<0.05)。治疗后,两组日常生活能力量表(ADL)评分高于治疗前,美国国立卫生研究院卒中量表(NIHSS)评分低于治疗前,且观察组ADL评分高于对照组,NHISS评分低于对照组,差异有统计学意义(P<0.05)。观察组不良反应总发生率为7.32%,低于对照组的14.63%,但两组间比较,差异无统计学意义(P>0.05)。结论:疏血通注射液辅助治疗能够有效改善老年缺血性脑卒中患者的认知功能、TGF-β_(1)、Smad1,提高患者自理能力及神经功能,具有较高的安全性。

丹参酮ⅡA磺酸钠注射液联合尼莫地平治疗急性缺血性脑卒中的临床效果

目的分析丹参酮ⅡA磺酸钠注射液(STSI)联合尼莫地平治疗急性缺血性脑卒中(AIS)的临床效果。方法选取2022年3月至2023年3月我院收治的71例AIS患者,按不同治疗方法分为两组。在常规对症处理下,对照组(34例)予以尼莫地平单药口服,观察组(37例)在对照组基础上予以STSI静脉滴注,对比两组的用药效果。结果治疗后,观察组神经功能缺损评分低于对照组,疗效高于对照组(P<0.05)。治疗后,观察组全血粘度、血浆粘度、红细胞聚集指数与红细胞压积低于对照组(P<0.05)。治疗后,观察组TNF-α、IL-6水平低于对照组(P<0.05)。结论STSI联合尼莫地平治疗AIS患者的效果较好,可改善其神经功能,有效调节机体血液流变学,促进炎性因子清除。

活血化瘀类中药注射剂治疗缺血性脑卒中不良反应分析

目的研究活血化瘀类中药注射剂在缺血性脑卒中治疗中的不良反应(ADR)发生状况。方法选取南昌三三四医院神经内科2020年1月—2021年12月收治的缺血性脑卒中患者400例作为研究对象,记录患者的ADR分级、临床表现、涉及中药注射剂品种等,分析ADR发生的特点。结果400例患者的ADR发生率为20.50%(82/400),其中仅有4.88%(4/82)的ADR为2级,其余95.12%(78/82)的ADR均为3~4级,ADR的临床表现以胸闷、皮疹、恶心呕吐、局部水肿等为主。应用注射用灯盏花素、注射用血塞通、丹红注射液和丹参注射液治疗患者的ADR发生率差异无统计学意义(P>0.05);4种中药注射液的不合理用药发生率均偏高,组间差异有统计学意义(P<0.05);4种中药注射液均以超适应证使用引起的ADR发生率最高,高于超剂量使用和超疗程使用的ADR发生率(P<0.05);而在同类不合理用药中,4种中药注射液的ADR发生率差异无统计学意义(P>0.05)。结论临床用药时应加强对医嘱的审核管理,严格把控,减少不合理用药现象,减少ADR发生,保证患者用药的安全性。

川芎嗪类注射液辅助治疗急性缺血性脑卒中疗效的贝叶斯网状Meta分析

背景急性缺血性脑卒中(AIS)是一种严重的脑血管疾病,给社会和患者造成了沉重的负担。川芎嗪类注射液已被广泛用于AIS的治疗,且疗效明显,但目前还缺乏川芎嗪类注射液之间直接或间接比较。目的系统评价川芎嗪类注射液辅助治疗72 h内AIS的疗效性和安全性。方法计算机检索中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)、PubMed、Cochrane Library、Embase和Web of Science数据库中有关川芎嗪类注射液治疗AIS的随机对照试验,检索时限从建库至2023年4月。由2位研究员独立筛选文献、提取资料并用Cochrane评价工具对文献进行质量评价,采用RevMan 5.3、Stata 17、Addis及RStudio软件进行统计分析,比较不同川芎嗪类注射液的疗效及安全性差异并进行排序。结果共纳入71篇文献,总样本量7304例,干预措施包括:丹参川芎嗪注射液(DSCXQ)、参芎葡萄糖注射液(SXPTT)、杏芎氯化钠注射液(XXLHN)、磷酸川芎嗪注射液(LSCXQ)和盐酸川芎嗪注射液(YSCXQ)分别联合常规西医治疗(CT)及单独CT。直接Meta分析结果显示:川芎嗪类注射液联合CT的总有效率、美国国立卫生研究院卒中量表(NIHSS)评分、纤维蛋白原水平、不良反应发生率均优于单独CT(P<0.05)。网状Meta分析结果显示:在总有效率方面,累积概率排序为:SXPTT+CT(0.60)>YSCXQ+CT(0.20)>LSCXQ+CT(0.15)>DSCXQ+CT(0.03)>XXLHN+CT(0.02)>CT(0);在降低NIHSS评分方面,累积概率排序为:SXPTT+CT(0.55)>XXLHN+CT(0.26)>YSCXQ+CT(0.12)>DSCXQ+CT(0.07)>CT(0);在降低纤维蛋白原水平方面,累积概率排序为:XXLHN+CT(0.32)>LSCXQ+CT(0.22)>DSCXQ+CT(0.17)>SXPTT+CT(0.15)>YSCXQ+CT(0.14)>CT(0);在安全性方面,累积概率排序为:SXPTT+CT(0.79)>XXLHN+CT(0.13)>CT(0.04)>DSCXQ+CT(0.03)>YSCXQ+CT(0.01)。结论川芎嗪类注射液辅助治疗AIS疗效显著、安全性好,其中参芎葡萄糖注射液在总有效率方面和改善NIHSS评分方面最佳、不良反应最少;杏芎氯化钠注射液在降低纤维蛋白原水平方面最有优势。

注射用单唾液酸四己糖神经节苷脂钠联合醒脑静注射液对脑卒中患者神经功能和炎症的影响

目的观察注射用单唾液酸四己糖神经节苷脂钠联合醒脑静注射液对脑卒中患者神经功能和炎症的影响。方法选取2020年1月—2023年6月高安市中医院收治的62例脑卒中患者作为研究对象,按照电脑随机法分为醒脑静组31例(患者采用醒脑静注射液)和联合用药组31例(患者在醒脑静组基础上给予注射用单唾液酸四己糖神经节苷脂钠),2组患者均持续治疗1个月。比较2组临床疗效,治疗前后美国国立卫生研究院卒中量表(NIHSS)、简易精神状态检查量表(MMSE)、格拉斯哥昏迷量表(GCS)、改良Rankin量表(mRS)评分及实验室指标[C反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)、红细胞沉降率(ESR)、中性粒细胞与淋巴细胞比值(NLR)、白细胞计数(WBC)],不良反应。结果联合用药组治疗总有效率高于醒脑静组(96.77%vs.70.97%,χ^(2)=7.631,P=0.006)。治疗1个月后,2组NIHSS、mRS评分,血清CRP、IL-6、PCT水平及ESR、NLR、WBC降低,MMSE、GCS评分升高,且联合用药组上述指标低/高于醒脑静组(P<0.01)。联合用药组与醒脑静组不良反应总发生率比较,差异无统计学意义(9.68%vs.22.58%,χ^(2)=1.908,P=0.167)。结论注射用单唾液酸四己糖神经节苷脂钠联合醒脑静注射液治疗脑卒中患者的效果显著,可有效改善神经功能,提高认知功能,减轻机体炎症,且安全性较高。