导痰通络方对急性脑梗死伴高同型半胱氨酸血症患者血管内皮功能和凝血功能的影响  

Effect of“eliminating phlegm and opening meridians and collaterals”on vascular endothelium and coagulation function in acute cerebral infarction patients with hyperhomocysteinemia

作　　者：杜江强 田云军 张焕 詹国强 马慧青 DU Jiang-qiang;TIAN Yun-jun;ZHANG Huan;ZHAN Guo-qiang;MA Hui-qing(Department of Neurology,Weishan Branch,Dongyang People's Hospital,Dongyang,Zhejiang 322109,China)

机构地区：[1]东阳市人民医院巍山分院神经内科,浙江东阳322109

出　　处：《环境与健康杂志》2025年第2期177-181,共5页Journal of Environment and Health

摘　　要：目的分析导痰通络方联合西医常规治疗对急性脑梗死伴高同型半胱氨酸血症患者血管内皮和凝血功能的影响。方法选取东阳市人民医院巍山分院2021年1月至2023年1月收治的113例高同型半胱氨酸血症型急性脑梗死患者作为回顾性研究对象,按治疗方法分为两组,其中48例采用常规疗法(对照组),65例采用常规疗法+导痰通络方联合叶酸治疗(观察组)。统计分析两组治疗前后高同型半胱氨酸(Hcy)、C反应蛋白(CRP)、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活活动能力Barthel指数评分、血管内皮功能指标[一氧化氮(NO)、内皮素-1(ET-1)和血管内皮生长因子(VEGF)]水平及炎性因子指标。结果两组治疗后血清Hcy及CRP水平均明显下降,差异有统计学意义(P<0.01);观察组治疗后血清Hcy及CRP水平明显低于对照组,差异有统计学意义(P<0.01)。两组治疗后NIHSS评分明显降低,Barthel指数评分均明显升高,差异有统计学意义(P<0.01);观察组与对照组治疗后NIHSS评分及Barthel指数评分相比差异有统计学意义(P<0.01)。两组治疗后NO水平明显升高,ET-1及VEGF水平明显降低,差异有统计学意义(P<0.01);观察组与对照组治疗后NO、ET-1及VEGF水平相比差异有统计学意义(P<0.01)。治疗后观察组白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平均明显低于对照组,差异有统计学意义(P<0.05)。观察组治疗后活化部分凝血活酶时间(aPTT)、凝血酶原时间(PT)和D-二聚体(D-D)水平均高于本组治疗前和同期对照组,纤维蛋白原(fibrinogen,FIB)低于本组治疗前和同期对照组,差异有统计学意义(P<0.05)。结论导痰通络方联合西医常规治疗可有效改善高同型半胱氨酸血症型急性脑梗死患者的神经功能、血管内皮功能、免疫功能和凝血功能,并有效改善患者日常生活活动评分及NIHSS评分。Objective To understand the effect of“eliminating phlegm and opening meridians and collaterals”on vascular endothelium and coagulation function in patients with acute cerebral infarction(ACI)with hyperhomocysteinemia.Methods 113 patients with ACI admitted to our hospital from January 2021 to January 2023 were chosen as the retrospective study objects and divided into two groups according to treatment methods:48 patients received conventional therapy(control group)and 65 patients received conventional therapy plus Chinese traditional medicine Daotan Tongluo prescription combined with folic acid treatment(observation group).Hcy,CRP,National Institutes of Health Stroke Scale(NIHSS)score,activity of daily living Barthel index score,vascular endothelial function indicators[nitric oxide(NO),endothelin-1(ET-1)and vascular endothelial growth factor(VEGF)]and inflammatory factor indicators before and after treatment were compared between the two groups.Results After treatment,compared with the control,in the observation group,serum Hcy and CRP levels were significantly lower(P<0.01),NIHSS score decreased significantly(P<0.001)and Barthel index score increased significantly(P<0.01).After treatment,the levels of NO in the two groups significantly increased(P<0.01),while the levels of ET-1 and VEGF significantly decreased(P<0.01).After treatment,the levels of IL-6,TNF-α in the observation group were significantly lower than those in the control group(P<0.05).The levels of aPTT,PT and D-D in the observation group after treatment were higher than those before treatment and the control group at the same period(P<0.05),and the FIB was lower than that in the control group before treatment and the control group at the same period(P<0.05).Conclusion“Eliminating phlegm and opening meridians and collaterals”of Chinese traditional medicine combined with conventional western medicine treatment can effectively improve the neurological function,vascular endothelial function,immune function and coagulation function in acute cereb

关 键 词：急性脑梗死 导痰通络方 叶酸 维生素B12 神经功能 血管内皮功能 

分 类 号：R45[医药卫生—治疗学]