加味承气汤联合肠内营养乳剂通过调节BDNF/TrkB信号通路治疗ICU脑卒中患者的作用研究  

Effect of Jiawei Chengqi decoction combined with enteral nutrition emulsion on intensive care unit stroke patients by regulating brain-derived neurotrophic factor/tyrosine kinase receptor B signaling pathway

作　　者：杨秀荣 刘洁 王岚 Yang Xiurong;Liu Jie;Wang Lan(Critical Care Medicine,Xingtai Third Hospital,Xingtai 054000,Hebei,China)

机构地区：[1]邢台市第三医院重症医学科,河北邢台054000

出　　处：《中国中西医结合急救杂志》2024年第2期173-177,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省邢台市重点研发计划项目(2022ZC252)。

摘　　要：目的加味承气汤联合肠内营养乳剂通过调节脑源性神经营养因子/酪氨酸激酶受体B(BDNF/TrkB)信号通路治疗脑卒中的机制研究。方法选择2020年1月至2022年10月在邢台市第三医院重症监护病房(ICU)进行治疗的200例脑卒中患者作为研究对象,将患者按随机原则分为观察组与对照组,每组100例。对照组采用肠内营养乳剂进行治疗,观察组在此基础上给予加味承气汤进行治疗〔药物组成:生大黄10 g(后下),生麦芽30 g,元明粉6 g(冲),代赭石30 g(先下),厚朴10 g,炒莱菔子15 g,炒枳实15 g,旋覆花10 g(包煎),全瓜蒌30 g。水煎取汁约100~200 mL,分2次服用,每日1剂〕。比较两组治疗后临床疗效、营养指标〔总蛋白(TP)、血红蛋白(Hb)、前白蛋白(PA)、白蛋白(ALB)〕、肠黏膜屏障功能指标〔二胺氧化酶(DAO)、降钙素原(PCT)、D-乳酸〕、中医症状积分、TrkB、BDNF、降钙素基因相关肽(CGRP)水平的差异。结果观察组治疗后临床总有效率明显高于对照组〔92.00%(92/100)比81.00%(81/100),P<0.05〕;两组治疗后营养指标TP、Hb、ALB和肠黏膜屏障功能指标、中医症状积分、TrkB、BDNF、CGRP水平均较治疗前明显降低,观察组治疗后营养指标TP、Hb、PA均明显高于对照组〔TP(g/L):68.09±10.28比64.53±9.81,Hb(g/L):133.48±33.38比121.38±30.72,PA(mg/L):231.29±22.75比219.73±20.48,均P<0.05〕,营养指标ALB和黏膜屏障功能指标、中医症状积分、TrkB、BDNF、CGRP水平均明显低于对照组〔ALB(g/L):36.78±5.32比39.49±5.48,DAO(kU/L):3.19±0.53比3.91±0.59,PCT(μg/L):5.05±0.68比6.14±0.89,D-乳酸(mmol/L):0.14±0.03比0.22±0.03,腹痛腹泻积分(分):1.34±0.62比2.45±0.73,腹部冷痛积分(分):1.63±0.63比2.38±1.03,腰膝酸软积分(分):0.96±0.41比1.75±0.52,不思饮食积分(分):1.14±0.41比1.58±0.69,形寒肢冷积分(分):0.97±0.42比1.68±0.54,TrkB(ng/L):285.02±28.15比375.84±36.12,BDNF(ng/L):1306.84±244.83比1718.84±378.83,CGRP(ng/L):79.68Objective To study the mechanism of Jiawei Chengqi decoction combined with enteral nutrition emulsion in the treatment of stroke patients by regulating brain-derived neurotrophic factor/tropomyosin kinase receptor B(BDNF/TrkB)signaling pathway.Methods A total of 200 stroke patients treated in the intensive care unit(ICU)of Xingtai Third Hospital from January 2020 to October 2022 were selected as the study objects,and the patients were randomly divided into observation group and control group,with 100 cases in each group.The control group was treated with enteral nutrition emulsion,and the observation group was treated with Jiawei Chengqi decoction on this basis[drug composition:Raw Rhubarb 10 g(bottom),Raw Malt 30 g,Sodium Powder 6 g(flush),Substitute Ochre 30 g(first),Magnolia Officinalis 10 g,Stir-fried Raphanus Japonicus 15 g,Stir-fried Fructus Aurifolius 15 g,Spiral Flower 10 g(pan-fried),whole Trichosanthes 30 g.100-200 mL of juice in water was consumed in 2 separate doses,once daily].The clinical efficacy,nutritional indexes[total protein(TP),hemoglobin(Hb),prealbumin(PA),albumin(ALB)],intestinal mucosal barrier indexes[diamine oxidase(DAO),procalcitonin(PCT),D-lactic acid],traditional Chinese medicine(TCM)syndrome score,TrkB,BDNF,and calcitonin gene-related peptide(CGRP)level differences were compared between the two groups after treatment.Results The total clinical effective rate of the observation group was significantly higher than that of the control group[92.00%(92/100)vs.81.00%(81/100),P<0.05].The levels of nutritional indexes TP,Hb,ALB,intestinal mucosal barrier,TCM syndrome score,TrkB,BDNF and CGRP in the two groups after treatment were significantly lower than those before treatment,and the nutritional indexes TP,Hb and PA in the observation group were significantly higher than those in the control group after treatment[TP(g/L):68.09±10.28 vs.64.53±9.81,Hb(g/L):133.48±33.38 vs.121.38±30.72,PA(mg/L):231.29±22.75 vs.219.73±20.48,all P<0.05],the levels of nutrition index ALB,mucosal barrier ind

关 键 词：加味承气汤 脑卒中 肠内营养乳剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]