基于DCE-MRI评价协定方通脑饮改善急性缺血性脑卒中患者血脑屏障损伤的疗效  

Evaluation of Effect of Tongnaoyin on Blood-brain Barrier Injury in Acute Ischemic Stroke Patients Based on Dynamic Contrast-enhanced Magnetic Resonance Imaging

作　　者：夏杨静怡 李姗珊 厉励 唐晓刚 王欣彤 朱清 蒋辉 袁翠平 刘永康 陈兆耀 李文磊 朱元 吴明华 XIA Yangjingyi;LI Shanshan;LI Li;TANG Xiaogang;WANG Xintong;ZHU Qing;JIANG Hui;YUAN Cuiping;LIU Yongkang;CHEN Zhaoyao;LI Wenlei;ZHU Yuan;WU Minghua(Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院/江苏省中医院,南京210029

出　　处：《中国实验方剂学杂志》2025年第2期140-146,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：江苏省研究生培养创新工程研究生科研与实践创新计划项目(SJCX23-0871)。

摘　　要：目的:运用动态对比增强磁共振成像(DCE-MRI)技术评估协定方通脑饮对痰瘀阻络型急性缺血性脑卒中患者血脑屏障状况和神经功能缺损的改善作用。方法:纳入2022年10月至2023年12月在江苏省中医院神经内科住院的中风痰瘀阻络证的患者共63例。根据随机数字表法将患者分为两组,对照组32例,观察组31例。对照组予符合指南的基础西医治疗,观察组在对照组基础上加用协定方通脑饮水煎剂,早晚饭后温服200 mL,每日2次,入院第2天起连续服用7 d后行DCE-MRI检查。对两组患者治疗前的基线资料进行比较;对两组患者治疗前及治疗90 d后美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin量表(mRS)评分进行比较;通过梗死区感兴趣区(ROI)/镜面区ROI得出r参数(r)容积转运常数(Ktrans)、r返流速率常数(Kep)及r血管外容积分数(Ve)值,并对两组患者的rKtrans、rKep和rVe行比较。结果:治疗前两组患者NIHSS评分、mRS评分差异无统计学意义。与本组治疗前比较,治疗90 d后,观察组及对照组患者治疗前后NIHSS评分、mRS评分均明显降低(P<0.05)。与对照组治疗后比较,观察组患者NIHSS评分、mRS评分降低更明显(P<0.05)。观察组患者治疗后rKtrans和rVe均显著低于对照组(P<0.01)。结论:通脑饮联合西医基础治疗相较于西医基础治疗更有助于加快AIS患者卒中后血脑屏障的修复,显著减轻急性缺血性脑卒中患者神经功能缺损症状,从而改善功能结局。Objective:To evaluate the effects of Tongnaoyin on the blood-brain barrier status and neurological impairment in acute ischemic stroke(AIS)patients with the syndrome of phlegm-stasis blocking collaterals by dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI).Methods:A total of 63 patients diagnosed with AIS in the Jiangsu Province Hospital of Chinese Medicine from October 2022 to December 2023 were enrolled in this study.According to random number table method,the patients were assigned into a control group(32 cases)and an observation group(31 cases).The control group received conventional Western medical treatment,and the observation group took 200 mL Tongnaoyin after meals,twice a day from day 2 of admission on the basis of the treatment in the control group.After 7 days of treatment,the patients were examined by DCE-MRI.The baseline data for two groups of patients before treatment were compared.The National Institute of Health Stroke Scale(NIHSS)score and modified Rankin Scale(mRS)score were recorded before treatment and after 90 days of treatment for both groups.The rKtrans,rKep,and rVe values were obtained from the region of interest(ROI)of the infarct zone/mirror area and compared between the two groups.Results:There was no significant difference in the NIHSS or mRS score between the two groups before treatment.After 90 days of treatment,the NIHSS and mRS scores declined in both groups,and the observation group had lower scores than the control group(P<0.05).After treatment,the rKtrans and rVe in the observation group were lower than those in the control group(P<0.01).Conclusion:Compared with conventional Western medical treatment alone,conventional Western medical treatment combined with Tongnaoyin accelerates the repair of the blood-brain barrier in AIS patients,thereby ameliorating neurological impairment after AIS to improve the prognosis.

关 键 词：急性缺血性卒中 通脑饮 痰瘀阻络证 血脑屏障 动态对比增强磁共振成像(DCE-MRI) 

分 类 号：R259[医药卫生—中西医结合] R255.2[医药卫生—中医内科学] R743.3[医药卫生—中医学]