葛根总黄酮与丹参酮ⅡA治疗缺血性脑卒中的随机对照临床研究  

Flavonoids of puerarin versus tanshinoneⅡA for ischemic stroke:a randomized controlled trial

作　　者：陈蕾[1] 毕晓莹[1] 朱立勋[1] 仇一青[1] 丁素菊[1] 邓本强[1] 

机构地区：[1]第二军医大学长海医院神经内科,上海200433

出　　处：《中西医结合学报》2011年第11期1215-1220,共6页Journal of Chinese Integrative Medicine

基　　金：上海市卫生局中医药基金青年基金项目(No.2008Q013L)

摘　　要：背景:总黄酮类药物正广泛用于缺血性卒中的治疗,其治疗效果及作用机制受到越来越多的关注。目的:探讨葛根总黄酮对缺血性脑卒中的神经保护作用及其机制。设计,场所,对象和干预措施:选择在上海长海医院神经科住院的经头颅核磁共振成像证实为新发脑梗死的患者67人,随机分为治疗组和对照组。两组均使用阿司匹林抗血小板凝集,控制血压、血脂,营养神经,维持水电解质平衡等常规治疗,治疗组同时加用葛根素葡萄糖注射液静脉滴注,对照组同时加用丹参酮ⅡA(不含黄酮)静脉滴注。每天1次,连续14 d。主要结局指标:发病第1天时按美国国立卫生研究院神经功能缺损量表(National Institutesof Health Stroke Scale,NIHSS)评分进行神经功能缺损评价,第2天测定患者血清乳酸脱氢酶(lactatc dehydrogenase,LDH)、白细胞介素6(interleukin-6,IL-6)和脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)水平。治疗14 d后再次测定血清LDH、IL-6和BDNF水平,进行NIHSS评分;对两组患者行头颅灌注CT检查,通过灌注软件分析比较病变区及对侧相应部位局部脑血流量、局部脑血容量及平均通过时间。结果:发病第2天两组的LDH和IL-6水平差异无统计学意义(P>0.05)。治疗14 d后,治疗组血清LDH、IL-6水平较对照组低(P<0.05),且治疗组NIHSS评分较对照组低(P<0.05)。治疗组血清BDNF水平较对照组高,但两者差异无统计学意义(P>0.05)。两组患者灌注CT结果差异有统计学意义(P<0.05)。结论:葛根总黄酮使急性缺血性卒中后血清中增多的IL-6明显降低,并显著减轻脑卒中后缺血再灌注所致的LDH升高,通过抗炎症反应及抗缺血再灌注损伤促进神经功能恢复及血供的恢复。Background： Flavonoids are widely used today in the treatment of ischemic stroke. The therapeutic effects and functions of flavonoids are, therefore, generating more and more interest. Objective： To investigate the therapeutic effects and functions of flavonoids of puerarin in treating patients with ischemic stroke. Design, setting, participants and interventions： A total of 67 inpatients suffering from ischemic stroke from the Department of Neurology, Changhai Hospital in China were divided into two groups randomly, the treatment group, which was treated with flavonoids of puerarin, and the control group, administered with tanshinone Ⅱ A sulfate instead. Main outcome measures： Defects in neurological function of Health Stroke Scale （NIHSS） on the first day of onset. were evaluated according to the National Institutes Lactate dehydrogenase （LDH）, serum interleukin-6 （IL-6） and brain-derived neurotrophic factor （BDNF） levels were determined by radioimmunoassay on the second trial day. After a 14-day treatment, LDH, serum IL-6 and BDNF levels and NIHSS score were also detected, and CT perfusion imaging was used to measure and analyze the regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV） and mean transit time （MTT）. Results： On the first day, NIHSS scores of the two groups were similar. On the second day there was no significant difference in LDH and IL-6 levels between the treatment group and the control group. After a 14-day treatment, LDH and IL-6 levels and the NIHSS score in the treatment group were lower than those in the control group （P〈0.05）. There was no significant difference in BDNF levels in the two groups. After 14 d, the CT perfusion imaging demonstrated that the treatment group showed more effective blood perfusion than the control group. Conclusion： Flavonoids of puerarin can restrain the increase of IL-6 after acute ischemic stroke, and depress the LDH raised by reperfusion after cerebral ischemia. It can also enhance blood pe

关 键 词：葛根素 黄酮 丹参酮 脑缺血 卒中 乳酸脱氢酶 白细胞介素6 脑源性神经营养因子 

分 类 号：R277.7[医药卫生—中医学]