【作者】 朱磊；

【导师】 刘茂才；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2010， 博士

【摘要】 临床部分目的评估中医综合治疗对合并高血压与非合并高血压的急性缺血中风患者神经功能缺损程度、残障水平、生活能力、生存质量和中医症候的影响以及高血压对中医综合方案干预缺血中风疗效的影响。内容与方法通过分析“十五”课题后期“急性缺血中风疗效评价RCT临床试验方案”数据库资料,比较中医综合疗法与西医常规治疗不同干预对合并高血压急性缺血中风患者在不同时点NIHSS评分、mRS评分、BI指数、GOS评分、SS-QOL积分、中医症征积分的影响,以期全面评价中医综合方案对高血压性及非高血压性急性缺血中风疾病的干预作用。通过比较有高血压与无高血压缺血中风患者分别接受中医综合治疗后各水平量表评分上的差异,以评估高血压因素对疾病预后及干预方案疗效的影响。结果对于合并高血压的缺血中风患者,控制糖尿病史因素,中医综合治疗与西医对照治疗比较,患者在NIHSS、BI、SSQOL上两组之间差异无统计学意义(P>0.05)；在mRS、GOS、SSTCM上两组之间差异有统计学意义(P<0.05；P<0.01)。两组在第60天mRS、GOS,第0天、7天、60天SSTCM上差异有统计学意义(P<0.05)。对于非合并高血压的缺血中风患者,中医综合治疗与西医对照治疗比较,患者在NIHSS、GOS、BI、SSQOL、SSTCM上两组之间差异无统计学意义(P>0.05)。在mRS上两组之间差异有统计学意义(P<0.05)。两组在第60天、90天mRS,第21天、60天、90天GOS,第90天SSQOL,第60天、90天SSTCM上差异有统计学意义(P<0.05)。在控制脑卒中史、高胆固醇史,高血压因素对中医综合治疗后患者的NIHSS、BI、SSQOL、SSTCM改变无影响(P>0.05)；对中医综合治疗后患者的mRS、GOS改变有影响(P<0.05)。结论中医综合治疗方案能有效减轻合并高血压的缺血中风患者第60天残障水平,改善第7天、第60天中医症状；降低非合并高血压缺血中风患者第21天、60天、90天残障水平,提高第90天生存质量,改善60天、90天中医症状；高血压因素对中医综合治疗缺血中风患者的残障水平有影响,中医综合治疗对降低非高血压性缺血中风患者残障水平疗效更好。实验部分目的通过观察益脑康胶囊干预对动脉粥样硬化性急性缺血中风大鼠行为学、病理学、生化学、组织学相关指标的改变,以客观评价中药益脑康胶囊对动脉粥样硬化性急性缺血中风的防治作用。内容与方法观察中药益脑康胶囊对动脉粥样硬化性急性缺血中风大鼠血液及组织中N0、VEGF、PDGF-BB、vWF、TM等动脉硬化及内皮损伤相关因子的影响,以探讨益脑康胶囊发挥缺血中风防治作用的可能机制。结果益脑康预防组、益脑康治疗组、立普妥治疗组大鼠脑组织含水量低于AS+ACI模型组,差异有显著统计学意义(P<0.01)。益脑康预防组、立普妥治疗组与AS+ACI模型组比较,血清NO水平增高,差异有统计学意义(P<0.01,P<0.05)；益脑康治疗组与AS+ACI模型组比较,NO水平差异无统计学意义(P>0.05)；益脑康预防组与立普妥治疗组比较,NO水平差异无统计学意义(P>0.05)。三个干预组与AS+ACI模型组比较,血清VEGF、PDGF-BB水平下降,差异有统计学意义(P<0.01,P<0.05)；三个干预组之间比较,血清VEGF、PDGF-BB水平差异无统计学意义(P>0.05)。AS模型组和AS+ACI模型组大鼠脑组织可见vWF中等强度阳性、血管可见强阳性和非常强阳性表达,药物干预后比较,益脑康预防组和立普妥治疗组脑组织未见明显vWF表达,而益脑康治疗组为vWF弱阳性表达。在三个干预组血管中均表现为vWF中等强度阳性表达。AS造模组和ACI造模组大鼠脑组织可见TM中等强度阳性表达,在AS模型组和AS+ACI模型组大鼠脑组织未见TM阳性表达,益脑康预防组脑组织仍未见TM阳性表达,而益脑康治疗组和立普妥治疗组脑组织观测到TM弱阳性表达。结论益脑康胶囊预防或治疗性用药能够提高血清NO水平及增强TM表达,降低VEGF、PDGF-BB含量和减弱vWF表达,降低脑水肿,可以减轻血管内皮损伤、纠正内皮功能紊乱、延缓动脉粥样硬化和抗血栓形成,可能对于动脉粥样硬化和急性缺血中风具有防治作用。更多还原

【Abstract】 Clinical ResearchObjectiveTo evaluate the effect of integrated TCM therapy on ischemic stroke w ith/without hypertension patients’neural function deficits, levels of di sabilities, viabilities, qualities of lives and symptoms of Traditional C hinese Medicine and to evaluate the effect of hypertension on the efficac y of intervention in ischemic stroke with integrated TCM therapeutic prot ocol.MethodsBy analyzing the database information of the Tenth Five-Year Project Late Stage (named evaluation of acute ischemic stoke RCT clinical trial p rotocol), it is compared integrated TCM therapy protocol with Western con trol protocol, two different therapies treating ischemic stroke with/with out hypertension patients, from the aspects of NIHSS, mRS, BI, GOS, SS-QO L and SSTCM, to comprehensively evaluate the effect of integrated TCM the rapy protocol intervening the patients mentioned above.By comparing differences of various levels’scale score between hyper tensive and non-hypertensive ischemic stroke treated with integrated TCM therapy, it is assessed the effect of hypertension factors on the prognos is of diseases and the efficacy of intervention protocol.ResultsFor ischemic stroke patients with hypertension, integrated TCM therap y compared with western control treatment after diabetes history factors controlled. It is found that there are no significant differences between the two groups in NIHSS, BI, SSQOL (P>0.05); whereas there are significa nt differences in mRS, GOS, SSTCM between the two groups (P<0.05;P<0.01). The two groups in the 60th day’s mRS, GOS, the 7th,60th day’s SSTCM there are significant differences (P<0.05).For ischemic stroke patients without hypertension, integrated TCM the rapy compared with western control treatment. It is found that there are no significant differences between the two groups in NIHSS, GOS, BI, SSQO L and SSTCM (P>0.05); whereas there is significant difference in mRS betw een the two groups (P<0.05). Between the two groups in the 60th,90th days’ mRS, the 21st,60th,90th days’GOS, the 90th day’s SSQOL and the 60th,90th days’SSTCM there are significant differences (P<0.05).After histories of stroke and high cholesterol controlled, patients r eceiving integrated TCM therapy, their mRS, GOS change (P<0.05), but not their NIHSS, BI, SSQOL and SSTCM change (P>0.05), were influenced by fact ors of hypertension.ConclusionsIntegrated TCM protocol can effectively reduce ischemic stroke patien ts with hypertension the 60th day’s disability level, to improve the 7th an d 60th day’s clinical symptoms; reduce the ischemic stroke patients withou t hypertension the 21th,60th,90th days’levels of disabilities, to improve the 90th day’s quality of life and the 60th,90th days’clinical symptoms of TCM. Treated by integrated TCM therapy, ischemic stroke patients’leve ls of disabilities were affected by factors of hypertension. Integrated T CM therapy has better efficacy to reduce non-hypertensive ischemic stroke patients’levels of disabilities.Animals StudyObjectiveBy observing changes of concerning indicators, involving praxiology, pathology, biochemistry and histology, after Yinaokang capsule intervenin g atherosclerotic acute cerebral ischemic rats, the effect of preventing and treating atherosclerotic acute ischemic stroke is objectively evaluat ed.MethodsBy observing atherosclerosis and endothelial injury relative factors, i.e. NO, VEGF, PDGF-BB, vWF and TM, which are in the bloods and tissues of atherosclerotic acute cerebral ischemic rats intervened by Yinaokang c apsule, it is investigated Yinaokang capsule’s potential mechanism about preventing and curing ischemic stroke.ResultsYinaokang prevention group, Yinaokang treatment group and Lipitor tre atment group comparing with AS+ACI model group, brain water content decre ased and there were significant difference (P<0.05). Yinaokang prevention group, Lipitor treatment group comparing with AS+ACI model group, serum NO level increased and there were significant difference (P<0.05). Yinao kang treatment group comparing with AS+ACI model group, there was no sign ificant differences on NO levels(P>0.05); Yinaokang prevention group an d Lipitor treatment group, there was no significant differences on NO lev els (P>0.05). The three intervention group comparing with AS+ACI model g roup, serum VEGF, PDGF-BB level decreased and there were significant diff erence (P<0.01, P<0.05); between the three intervention group, there wa s no significant difference (P>0.05). In AS model group and AS+ACI model group, it was visible that vWF was moderately expressed in the brain tis sues, strongly and very strongly expressed in the blood vessels. Compared after medicines intervention, in the brain tissues there was no signific ant vWF expression in Yinaokang prevention group and Lipitor treatment gr oup, but in Yinaokang treatment group vWF was weakly expressed. In the th ree intervention groups, it were showed moderate vWF expression in blood vessels. In the AS modeling group and AS+ACI modeling group, moderate TM expression could be seen in the brain tissues. In the AS model group and AS+ACI model group, there were no TM expression in the brain tissues; TM expression was not seen in Yinaokang prevention group yet. While in Yinao kang treatment group and Lipitor treatment group, TM weak expression was observed in the brain tissues.ConclusionsAfter atherosclerotic acute cerebral ischemic rats intervened by Yina okang capsule, their NO levels in the serum could be increased and vWF’s expression in the tissues could be enhanced, their VEGF, PDGF-BB content in the serum could be decreased and TM’ expression in the tissues could b e weakened. Cerebral edema was reduced as well. It can alleviate vascular endothelial injury, mend endothelial dysfunction and inhibit atheroscler osis as well as thrombosis. Hence, for Yinaokang capsule, there is preven tional and curative function in treating atherosclerotic acute cerebral i schemia in rats.更多还原