瘀热方对急性缺血性卒中(瘀热阻窍证)患者炎性反应及肠道菌群的影响  

Effects of Yure Decoction on Inflammatory Response and Gut Microbiota in Patients with Acute Ischemic Stroke(Syndrome of Blood Stasis and Heat Obstructing the Orifices)

作　　者：张俊 张从 倪炯臣 刘红权[4] Zhang Jun;Zhang Cong;Ni Jiongchen;Liu Hongquan(Zhenjiang Affiliated Hospital of Nanjing University of Chinese Medicine,Zhenjiang Hospital of Traditional Chinese Medicine,Jiangsu,Zhenjiang 212003,China)

机构地区：[1]南京中医药大学镇江附属医院,镇江市中医院,江苏镇江212003 [2]安徽省宿松县中医院,安徽宿松246500 [3]陕西省商南县医院,陕西商南726300 [4]江苏省中西医结合医院,江苏南京210028

出　　处：《中国中医急症》2025年第3期429-434,442,共7页Journal of Emergency in Traditional Chinese Medicine

基　　金：江苏省第六期“333人才”培养支持资助项目(重点项目-苏人才办[2022]10号)。

摘　　要：目的探究瘀热方治疗急性缺血性卒中(AIS)相关炎性通路及肠道微生态机制。方法收集60例AIS(瘀热阻窍证)患者,按随机化原则分为对照组与治疗组各30例。两组患者均接受西医的常规治疗方案,治疗组在常规治疗的基础上加用瘀热方口服,持续7 d后进行中医证候积分、NIHSS评分以及相关炎性分子[LPS、Zonulin、TLR4、核转录因子-κB(NF-κB)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]的检测;采用高通量测序检测两组治疗后肠道菌群。结果1)治疗后瘀热方组较对照组NIHSS评分和中医证候积分下降更显著(P<0.001);2)治疗后LPS、IL-1β、IL-6和TNF-α水平瘀热方组较对照组下降更显著(P<0.001);3)治疗后Zonulin、TLR4、NF-κB水平瘀热方组较对照组下降更显著(P<0.001);4)肠道菌群检测:多样性结果显示,瘀热方组Observed species指数、Chao1指数、Shannon指数和Simpson指数与对照组均存在显著差异性(P<0.001);治疗后瘀热方组在门水平上,拟杆菌门、变形菌门及未分类的细菌门的丰度出现了下降,而厚壁菌门和疣微菌门的丰度则相对有所增加;属水平上瘀热方组拟杆菌属、unclassified_d_Bacteria和普雷沃氏菌的丰度下降,阿克曼氏菌属和费氏杆菌属的占比有所提高;结合LEfSe分析发现嗜黏蛋白阿克曼氏菌在瘀热方组富集,可能是瘀热方调控的特异性生物标志物。结论瘀热方可显著降低NIHSS评分、中医证候积分,抑制缺血性卒中患者早期炎性反应,机制可能与修复肠道屏障损伤、减轻内毒素及抑制神经炎性通路有关。Objective:To investigate the effects of the Yure Decoction on inflammatory pathways and gut microbiota in patients with acute ischemic stroke(AIS)(syndrome of blood stasis and heat obstructing the orifices).Methods:A total of 60 patients with AIS(syndrome of blood stasis and heat obstructing the orifices)were recruited and randomly divided into a control group and a treatment group,with 30 patients in each group.Both groups received conventional western medicine treatments.The treatment group additionally received oral administration of the Yure Decoction for 7 days.After treatment,TCM syndrome scores,NIHSS scores,and concentrations of inflammatory molecules(including LPS,Zonulin,TLR4,NF-κB,IL-1β,IL-6,and TNF-α)were measured.Highthroughput sequencing was used to analyze gut microbiota composition after treatment.Results:1)After treatment,the NIHSS scores and TCM syndrome scores decreased significantly more in the Yure Decoction group compared with the control group(P<0.001).2)After treatment,levels of LPS,IL-1β,IL-6,and TNF-αwere significantly lower in the Yure Decoction group than in the control group(P<0.001).3)Concentrations of Zonulin,TLR4,and NF-κB decreased significantly more in the Yure Decoction group compared with the control group(P<0.001).4)Gut microbiota analysis revealed significant differences in diversity indices(Observed species,Chao1,Shannon,and Simpson indices)between the Yure Decoction group and the control group(P<0.001).At the phylum level,the abundance of Bacteroidetes,Proteobacteria,and unclassified bacterial phyla decreased in the Yure Decoction group,while the abundance of Firmicutes and Verrucomicrobia increased relatively.At the genus level,the abundance of Bacteroides,unclassified_d_Bacteria,and Prevotella decreased in the Yure Decoction group,while the proportions of Akkermansia and Faecalibacterium increased.LEfSe analysis showed that Akkermansia muciniphila was enriched in the Yure Decoction group,potentially serving as a specific biomarker regulated by the Yure Decoction.Conc

关 键 词：缺血性卒中 瘀热方 肠道菌群 炎性反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学]