通络涤痰汤联合桃红四物汤治疗痰瘀阻络型缺血性脑卒中的临床疗效及对BDNF、Fib、NSE的影响  

Decoction in Treating Phlegm-Stasis Obstructing Collaterals Type Ischemic Stroke and Its Effects on BDNF,Fib,and NSE

作　　者：周晓鹏 詹远玲 ZHOU Xiaopeng;ZHAN Yuanling(Department of Traditional Chinese Medicine,Xi'an Qinghua Hospital,Xi'an 710025,China;Department of Traditional Chinese Medicine,Xi'an Hospital of Traditional Chinese Medicine for Cerebral Diseases,Xi'an 710032,China)

机构地区：[1]西安庆华医院中医内科,陕西西安710025 [2]西安中医脑病医院中医内科,陕西西安710032

出　　处：《中医药学报》2025年第3期72-76,共5页Acta Chinese Medicine and Pharmacology

基　　金：陕西省重点研发计划项目(2020SF-150)。

摘　　要：目的:探讨通络涤痰汤联合桃红四物汤治疗痰瘀阻络型缺血性脑卒中的临床疗效及对BDNF、Fib、NSE的影响。方法:研究纳入2020年2月—2023年2月西安庆华医院接收的98例痰瘀阻络型缺血性脑卒中患者,通过随机数字表法分为对照组与观察组,每组49例,对照组予以常规西医治疗,观察组予以通络涤痰汤联合桃红四物汤治疗,比较两组患者的临床疗效、治疗前后的神经功能[美国国立卫生研究院卒中量表(NIHSS)]、痰瘀阻络证症状评分、神经细胞因子[脑源性神经营养因子(BDNF)、纤维蛋白原(Fib)、神经特异性烯醇化酶(NSE)]、血清炎性因子[白细胞介素-8(IL-8)、内皮素-1(ET-1)、一氧化氮(NO)]、脑血流动力学[脉动指数(PI)、阻力指数(RI)、血流速度(Vs)、脑血管阻力(CVR)]。结果:治疗前,两组神经功能、痰瘀阻络证症状评分、神经细胞因子、血清炎性因子、脑血流动力学差异无统计学意义(P>0.05);治疗后,观察组治疗有效率为97.96%(48/49),较对照组85.71%(42/49)高(P<0.05);观察组NIHSS评分、痰瘀阻络证症状评分较对照组低(P<0.01);神经细胞因子方面,观察组BDNF水平较对照组高(P<0.01),Fib、NSE水平较对照组低(P<0.01);血清炎性因子方面,两组IL-8、ET-1均呈下降趋势(P<0.05),观察组下降更显著(P<0.01),NO呈上升趋势(P<0.05),观察组较对照组高(P<0.01);脑血流动力学方面,观察组PI、RI较对照组低(P<0.01),Vs、CVR较对照组高(P<0.01)。结论:通络涤痰汤联合桃红四物汤治疗痰瘀阻络型缺血性脑卒中效果显著,能有效改善患者的神经功能、症状评分,提高BDNF水平,降低Fib、NSE水平,并对血清炎性因子及脑血流动力学产生积极影响。Objective:To investigate the clinical efficacy of Tongluo Ditan Decoction combined with Taohong Siwu Decoction in treating phlegm-stasis obstructing collaterals type ischemic stroke and its effects on brain-derived neurotrophic factor(BDNF),fibrinogen(Fib),and neuron-specific enolase(NSE).Methods:A total of 98 patients diagnosed with phlegm-stasis obstructing collaterals type ischemic stroke from February 2020 to February 2023 at Xi'an Qinghua Hospital were randomly divided into two groups:the control group(49 cases)and the observation group(49 cases).The control group received conventional Western medical treatment,while the observation group was treated with Tongluo Ditan Decoction combined with Taohong Siwu Decoction.The clinical efficacy,neurological function(National Institutes of Health Stroke Scale,NIHSS),phlegm-stasis obstructing collaterals syndrome scores,neurotrophic factors(BDNF,Fib,NSE),serum inflammatory factors(interleukin-8(IL-8),endothelin-1(ET-1),nitric oxide(NO)),and cerebrovascular hemodynamics(pulsatility index(PI),resistance index(RI),blood flow velocity(Vs),cerebrovascular resistance(CVR))were compared before and after treatment.Results:Before treatment,there were no significant differences in neurological function,syndrome scores,neurotrophic factors,serum inflammatory factors,or cerebrovascular hemodynamics between the two groups(P>0.05).After treatment,the observation group showed a higher effective treatment rate(97.96%,48/49)compared to the control group(85.71%,42/49)(P<0.05).The observation group had lower NIHSS and syndrome scores than the control group(P<0.01).Regarding neurotrophic factors,the observation group had higher BDNF levels(P<0.01)and lower Fib and NSE levels(P<0.01)compared to the control group.For serum inflammatory factors,both groups showed a decrease in IL-8 and ET-1(P<0.05),with a more significant decrease in the observation group(P<0.01).NO levels increased,with the observation group showing higher levels than the control group(P<0.05).In terms of cerebrovascular h

关 键 词：通络涤痰汤 桃红四物汤 痰瘀阻络型缺血性脑卒中 临床疗效 神经细胞因子 

分 类 号：R255.2[医药卫生—中医内科学]