【作者】 巫祖强；

【导师】 吴宣富；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 急性脑梗死(Acute Cerebral Infarction,ACI)是内科常见的急危重症之一,急性脑梗死的病理基础多数以动脉粥样硬化为主,约占80%左右,阻塞血管引起相应供血区脑组织缺血缺氧,形成缺血中心坏死区和缺血半暗带。及时改善缺血半暗带区的血液供应,是缩小梗塞面积的关键所在。同时,如何减轻炎症反应已成为临床上治疗缺血性脑血管疾病的重要措施之一。急性脑梗死属于祖国医学“中风”病范畴,其临床表现,大体与现代医学中的急性脑血管病相似。从《内经》开始,后世医家特别强调了瘀血在中风发病中的重要地位。本文认为中风发病的病机核心为气血逆乱,其病变关键为血瘀,而活血化瘀法是治疗中风病的根本大法。本课题在既往相关的研究基础上,进一步探讨血瘀证型急性脑梗死患者的血清VEGF、sICAM-1在治疗前后的变化情况,观察灯盏细辛注射液对于血瘀证型急性脑梗死VEGF、sICAM-1的影响,为临床治疗提供理论的依据。目的:观察灯盏细辛注射液对于血瘀证型急性脑梗死患者的血管内皮生长因子、可溶性细胞间黏附分子-1、血瘀证积分、神经功能缺损症状的影响,探讨急性脑梗死(ACI)血瘀证与VEGF、sICAM-1的关系,分析灯盏细辛治疗ACI的作用机制,探索脑梗死急性期有效的中医药治疗,为临床治疗提供理论的依据。方法:将符合选择标准的60例ACI患者随机分为治疗组(A组)和对照组(B组),并设立健康老年人30例为正常对照组(C组),观察病例,分为治疗组(A组)和对照组(B组),各组患者的年龄、性别、既往病史等经统计学处理无显著性差异,具有可比性,A组给予静脉滴注灯盏细辛,B组给予速避凝皮下注射;治疗前后分别检测VEGF、sICAM-1,并对患者的血瘀证积分、神经功能缺损积分等分别做出评定。结果:1.两组之间的疗效比较,治疗组明显优于对照组(P＜0.05=;2.治疗后两组ACI患者血清VEGF、sICAM-1的含量较治疗前均有显著性改善P＜0.01,但治疗组在治疗后VEGF增高较对照组更为明显P＜0.01;治疗组在治疗后sICAM-1的含量与对照组比较P＞0.05;3.血瘀证积分均较治疗前有显著性改善P＜0.01,但治疗组较对照组改善明显P＜0.05;4.ACI患者血瘀证病情的轻重与sICAM-1含量存在显著正相关r=0.901,P＜0.01;与VEGF呈显著负相关r=-0.788,P＜0.01。结论:血清VEGF、sICAM-1与ACI血瘀证密切相关;灯盏细辛能改善ACI患者的脑血液循环,减轻脑组织缺血性损伤,是脑梗死急性期安全有效的药物。更多还原

【Abstract】 Acute cerebral infarction, which is abbreviating ACI, is one of the severe cases in internal medicine. The major pathological basis of ACI is atherosclerosis, which take 80 percents. The angiemphraxis caused ischemic and anoxemia in the corresponding blood supply brain tissue. This formed centre zone of necrosis and ischemia semidarkness lane. Thus to improve the blood supply in the ischemia semidarkness lane is the key point in decreasing the infarct size. At the same time, how to lighten the inflammatory reaction is already one of the important steps in clinical treatment on ischemic cerebrovascular disease. ACI belongs to the stroke in traditional Chinese medicine. ACI is similar to acute cerebrovascular disease in modern medicine. From the endo-meridians on, a large quantity of physicians emphasize the important position of stagnant blood in the pathogenesis of stroke.This article takes it for granted that the core pathogenesis of the stroke is disharmonizing Qi and blood. The key point of the pathological changes is blood stasis. Thus the treatment method of activating blood circulation to dissipate blood stasis is the basic ones in treating the stroke. This study is based on the former investigation results and to move forward a single step for the variation rule of vascular endothelial growth factor (VEGF) and soluble intercellular adhesion molecule-1 (sICAM-1), in the patients of ACI with the syndrome of blood stasis. Then we observed the affection on VEGF and sICAM-1 in patients of ACI with the syndrome of blood stasis. All the results could provide guideline for clinical treatment on patients with ACI.Objective: To investigate the changes of Vascular Endothelial Growth Factor (VEGF), Soluble Intercellular Adhesion Molecule-1 (sICAM-1), symptom of neurologic impairment in patients with Acute Cerebral Infarction (ACI) of TCM syndrome of blood stasis with erigeron injection. To analyze the mechanism of erigeron injection on ACI, which provides the indexes for clinical treatment of ACI.Methods : According to the diagnosis standards and Chinese symptom standards, 60 patients with ACI were randomly divided into treated group (A group) and control group (B group), 30 cases of healthy elders were taken as normal control group (C group).The age, gender and integral of past diseases of all groups had no significant difference by statistic treatment. Patients of A group were treated with erigeron injection through intravenous drip, and the patients in B group used Fraxiparine by subcutaneous injection. The levels of blood serum VEGF, sICAM-1 were respectively measured before and after 14 days’ treatment by enzyme- linked immunospecific assay and integral of syndrome of blood stasis and neurologic impairment were measured simultaneously.Results: 1. Compared the two groups’ curative effect, the treatment group obviously surpassed control group (P<0. 05 = . 2. After treatment, the level of blood serums of VEGF, sICAM-1 changed significantly (P<0.01 = , but in the treated group, the VEGF increasing surpassed the control group (P<0. 01 = . Post-treatment there was no difference of the level of blood serums sICAM-1 between A group and B group. 3. The syndrome of blood stasis had improved (P<0.01 = , but the treated group got better (P<0.05 = . 4. There was significant positive correlation between the syndrome of blood stasis and sICAM-1 (r = 0.901, P<0.01 =, but the negative correlation with VEGF (r = -0.788, P <0.01).Conclusion: The levels of VEGF, sICAM-1 had close correlation with the syndrome of blood stasis. Erigeron injection can effectively reduce cerebral ischemic lesions, improve the cerebral blood circulation. It is effective and safe medicine for the acute stage of Cerebral Infarction.更多还原