基于Nrf2-ARE通路探讨黄芪桂枝五物汤对急性脑梗死治疗后缺血再灌注损伤的保护效应与机制  

Protective Effect and Mechanism of Huangqi Guizhi Wuwu Decoction on Ischemia Reperfusion Injury After Treatment of Acute Cerebral Infarction Based on Nrf2-ARE Pathway

作　　者：郭新年 口锁堂[1] 刘帮健[2] GUO Xinnian;KOU Suotang;LIU Bangjian(Dept.of Acupuncture Massage,East Hospital of the Sixth People’s Hospital of Shanghai,Shanghai 201306,China;Dept.of Neurology,the Sixth People’s Hospital of Shanghai,Shanghai 201306,China)

机构地区：[1]上海市第六人民医院针推伤科,上海201306 [2]上海市第六人民医院神经内科,上海201306

出　　处：《中国医院用药评价与分析》2023年第10期1190-1194,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：2018-2020上海市中医药三年发展项目[No.ZF(2018-2020)-ZYBZ-33];上海市第六人民医院院级科学研究及基金项目(No.DY2019009)。

摘　　要：目的:基于核因子-E2相关因子2(Nrf2)-抗氧化反应元件(ARE)通路,探讨黄芪桂枝五物汤对急性脑梗死治疗后缺血再灌注损伤的保护效应与机制。方法:选择2020—2021年于该院治疗的急性脑梗死治疗后缺血再灌注损伤患者96例,根据随机数字表法分组,48例患者为常规西医组(西医基础治疗),48例患者为中医治疗组(西医基础治疗+黄芪桂枝五物汤)。治疗前后,检测两组患者ARE、Nrf2、NOD样受体蛋白3(NLRP3)、丙二醛(MDA)、核因子κB(NF-κB)、泛酸羧基末端水解酶1(UCH-L1)、沉默信息调节因子1(SIRT1)、肿瘤坏死因子α(TNF-α)、脑源性神经生长因子(BDNF)和脂蛋白相关磷脂酶A2(Lp-PLA2)水平,检测患者血管临界压力、血管差压和脑血管动态阻力,给予患者中医证候评分、临床神经功能缺损评分量表(CSS)、蒙特利尔认知评估量表(MoCA)和功能综合评定量表(FCA)评价,比较两组患者的临床疗效。结果:治疗后,中医治疗组患者的MDA、NLRP3、NF-κB、Lp-PLA2、TNF-α和UCH-L1水平较常规西医组明显降低,ARE、Nrf2、SIRT1和BDNF水平较常规西医组明显升高,差异均有统计学意义(P<0.05)。中医治疗组患者的血管差压、脑血管动态阻力较常规西医组明显降低,血管临界压力较常规西医组明显升高,差异均有统计学意义(P<0.05)。中医治疗组患者的FCA、MoCA评分较常规西医组升高,CSS、中医证候评分较常规西医组降低,差异均有统计学意义(P<0.05)。中医治疗组患者的总有效率较常规西医组更高[97.92%(47/48)vs. 83.33%(40/48)],差异有统计学意义(P<0.05)。结论:黄芪桂枝五物汤用于急性脑梗死治疗后缺血再灌注损伤患者,可调节Nrf2-ARE通路,抑制机体缺血再灌注损伤产生的氧化应激反应及炎症反应,抑制神经元损伤,改善神经功能及脑微循环,提高患者认知功能、临床疗效及生活质量。OBJECTIVE:To probe into the protective effect and mechanism of Huangqi Guizhi Wuwu decoction on ischemia reperfusion injury after treatment of acute cerebral infarction based on the nuclear factor E2 related factor 2(Nrf2)-antioxidant response element(ARE)pathway.METHODS:Totally 96 patients with ischemia-reperfusion injury after treatment of acute cerebral infarction in this hospital from^(2)020 to 2021 were selected and grouped via random number table,48 patients were the conventional Western medicine group(treated with basic Western medicine)and 48 patients were the Chinese medicine treatment group(treated with basic Western medicine combined with Huangqi Guizhi Wuwu decoction).The ARE,Nrf2,NOD like receptor protein 3(NLRP3),malondialdehyde(MDA),nuclear factorκB(NF-κB),pantothenate carboxyl terminal hydrolase 1(UCH-L1),silence information regulatory factor 1(SIRT1),tumor necrosis factorα(TNF-α),brain derived nerve growth factor(BDNF)and lipoprotein related phospholipase A2(Lp-PLA2)levels of both groups were measured before and after treatment,the vascular critical pressure,vascular differential pressure and cerebrovascular dynamic resistance were measured,the traditional Chinese medicine(TCM)syndrome score,clinical neurological deficit scale(CSS),montreal cognitive assessment scale(MoCA)and functional comprehensive assessment scale(FCA)were evaluated,so that the clinical efficacy of the two groups were compared.RESULTS:After treatment,patients in the Chinese medicine treatment group have lower MDA,NLRP3,NF-κB,Lp-PLA2,TNF-αand UCH-L1 levels than those of the conventional Western medicine group,and the expression levels of ARE,Nrf2,SIRT1 and BDNF were significantly higher than those of the conventional Western medicine group,with statistically significant differences(P<0.05).The vascular differential pressure and cerebrovascular dynamic resistance of the Chinese medicine treatment group were significantly lower than those of the conventional Western medicine group,while the vascular critical pressure was si

关 键 词：黄芪桂枝五物汤 急性脑梗死 Nrf2-ARE通路 氧化应激反应 炎症反应 缺血再灌注损伤 

分 类 号：R932[医药卫生—生药学]