化痰通腑法对急性缺血性中风病痰热腑实证病人ACTH、CORT的影响  

The Influence of Therapy of Resolving Phlegm and Relaxing Bowels on ACTH and CORT Levels in Patients with Syndrome of Phlegm-heat and Fu-organ Excess after Acute Ischemic Stroke

作　　者：陆梦馨 江澜[2] 陈沛 王雅惠 杜钟名 耿花蕾 王月 邹忆怀[2] LU Mengxin;JIANG Lan;CHEN Pei;WANG Yahui;DU Zhongming;GENG Hualei;WANG Yue;ZOU Yihuai(Beijing University of Chinese Medicine,Beijing 100029,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;不详)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东直门医院,北京100700 [3]首都医科大学附属北京安定医院

出　　处：《中西医结合心脑血管病杂志》2020年第3期393-397,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：“十二五”国家科技支撑计划课题——名老中医特色治则治法传承研究(No.2013BAI13B022)。

摘　　要：目的探讨急性缺血性中风病痰热腑实证病人肾上腺皮质激素(ACTH)、皮质醇(CORT)变化及化痰通腑法对其的调节作用。方法筛选符合纳入标准的急性缺血性中风病病人125例,进行临床量表评价,根据痰热腑实证证候积分分为痰热腑实证组(53例)与非痰热腑实证组(72例),两组均依据病情给予常规西医基础治疗,痰热腑实证组又根据治疗方法不同分为化痰通腑法组(37例)及常规西药法组(16例)。痰热腑实证组在常规治疗基础上分别给予星蒌承气汤或常规西药通便,检测治疗前后ACTH、CORT水平的变化。结果痰热腑实证组与非痰热腑实证组美国国立卫生研究院卒中量表(NIHSS)评分、ACTH、CORT比较差异有统计学意义(P<0.05),痰热腑实证组病人在使用化痰通腑法治疗后NIHSS、痰热腑实证积分均较治疗前下降,差异有统计学意义(P<0.05),ACTH、CORT差异无统计学意义(P>0.05),但化痰通腑法组CORT上升幅度小于常规西药法组,其改善痰热腑实证症状亦明显优于常规西药法组。结论急性缺血性中风病后,下丘脑-垂体-肾上腺(HPA)轴应激激活,ACTH、CORT持续升高,但神经功能损伤程度越重在一定程度上抑制HPA轴调节功能,经治疗腑气通下后,神经系统损伤程度及痰热腑实证症状均明显改善,化痰通腑法可降低CORT升高幅度,保护神经功能恢复,故推测化痰通腑法可通过改善症状促进HPA轴调节功能恢复,从而促进中风后神经功能损伤的恢复。Objective To explore the changes of adrenocortical hormone(ACTH),cortisol(CORT)in patients with phlegm-heat and fu-organ excess syndrome after acute ischemic stroke,and to investigate the regulating characteristics of therapy of resolving phlegm and relaxing bowels.Methods A total of 125 patients with acute ischemic stroke that met the inclusion criteria were screened and evaluated on a clinical scale.Patients were divided into phlegm-heat and fu-organ excess syndrome group,and other syndromes group.In addition to conventional treatment,patients in the phlegm-heat and fu-organ excess syndrome group were treated with Xinglog Chengqi decoction or conventional western medicine laxative,respectively.The ACTH and CORT levels were detected before and after treatment.Results There were significant differences in the National Institutes of Health Stroke Scale(NIHSS),ACTH and CORT between the phlegm-heat and fu-organ excess syndrome group and other syndromes group(P<0.05).Compared with before treatment,the scores of NIHSS,and phlegm-heat and fu-organ excess syndrome were significantly decreased(P<0.05),while ACTH and CORT levels showed no obvious difference(P>0.05).However,the increase of CORT in the resolving phlegm and relaxing bowels therapy group was lower than that in the conventional western medicine group.The symptoms of phlegm-heat and fu-organ excess were improved in the resolving phlegm and relaxing bowels therapy group,which was significantly better than that in the conventional western medicine group(P<0.05).Conclusion After acute ischemic stroke,the hypothalamic-pituitary-adrenal(HPA)axis is activated by stress accompanied by an increase in ACTH and CORT,but the greater degree of neurological injury can inhibit HPA axis regulation function to a certain extent.After treatment of resolving phlegm and relaxing bowels,the degree of neurological injury and the symptoms of phlegm-heat and fu-organ excess were obviously improved.The therapy of resolving phlegm and relaxing bowels can reduce the increase of CORT and

关 键 词：急性缺血性中风病 化痰通腑法 痰热腑实证 下丘脑-垂体-肾上腺轴 肾上腺皮质激素 皮质醇 

分 类 号：R749.1[医药卫生—神经病学与精神病学] R255.2[医药卫生—临床医学]