【作者】 林培贤；

【导师】 雷惠新；

【作者基本信息】 福建中医学院 ， 中西医结合临床， 2009， 硕士

【摘要】 目的:观察健康人与血瘀证型(BS)脑梗死(CI)患者急性期溶血磷脂酸(LPA)、血小板α颗粒膜蛋白(CD62p)的表达水平,观察不同面积、不同血瘀证积分、不同脑功能受损情况下LPA、CD62p表达水平的差别;观察常规治疗组及丹参川芎嗪注射液治疗组治疗后脑功能评分、血瘀证积分及LPA、CD62p的差别,探讨丹参川芎嗪注射液作为血瘀证型脑梗死患者急性期用药的机理。方法:收集健康人30例,血瘀证型脑梗死患者60例,并将脑梗死病例随机分入常规组及治疗组。常规组酌情给予脱水降颅压、营养神经及拜阿司匹林等常规治疗,治疗组在常规治疗基础上加用丹参川芎嗪注射液10ml/次,1次/天,静滴14天。所有脑梗死病例于入院后第二天及治疗第14天清晨抽取空腹静脉血5ml,半小时内用高速离心机(4000转/分)离心10分钟,使血液分为血清和血浆两部分,分别置于-50℃冰箱保存,采用双抗体夹心酶联免疫吸附法(ELISA法)测定其血浆LPA、CD62p水平。结合患者脑神经功能缺损、血瘀证积分以及脑梗面积大小情况,分析血浆LPA、CD62p水平与神经功能缺损评分、血瘀证积分、脑梗面积大小的关系,并分析丹参川芎嗪注射液对血浆LPA、CD62p水平的影响。结果:1.入院时不同组别血浆LPA、CD62p水平:脑梗死患者血浆LPA(umol/L)、CD62p(%)表达水平分别为4.68±0.93、13.56±5.39,显著高于健康对照组(2.20±0.45,3.61±O.52),差异有统计学意义(P<0.01);常规组血浆LPA(umol/L)、CD62p(%)表达水平分别为4.66±0.98、13.41±5.72与治疗组之间(4.69±0.90、13.71±5.13)无显著差异,差异不具有统计学意义(P>0.05)。2.入院时不同血瘀证积分患者血浆LPA(umol/L)、CD62p(%)水平分别为:轻度血瘀证(4.09±0.49,10.45±3.31),中度血瘀证(5.47±0.45,17.26±2.88),重度血瘀证(6.30±0.20,23.35±2.08),对比可见:轻度血瘀证<中度血瘀证<重度血瘀证,三组之间比较差异均有统计学意义(P<0.01)。3.入院时不同梗死灶面积的LPA(umol/L)、CD62p(%)水平分别为:小面积(3.74±0.28,8.17±2.11),中等面积(4.84±0.67,14.36±3.37),大面积(6.27±0.19,23.39±2.26),对比可见:小面积<中等面积<大面积,三组之间比较差异均有统计学意义(P<0.01)。4.入院时脑梗死患者病情轻重不同,LPA、CD62p水平不同:病人入院后按脑功能缺损评分高低分为轻、中、重3组,其血浆LPA(umol/L)、CD62p(%)水平分别为:病情轻(3.86±0.33,8.86±2.40),病情中度(5.03±0.52,15.40±1.85),病情重(6.21±0.22,22.74±2.41),可以看出LPA、CD62p的表达水平呈:重型>中型>轻型,各组之间差异显著,具有统计学意义(P<0.01)。5.治疗后疗效差异显著:治疗组基本痊愈及显著进步人数分别为10例、14例,明显高于常规组(6例,10例),治疗组显效率及总有效率分别为80.0%、93.3%,均高于常规组的53.3%及73.3%,差异有统计学意义(P<0.05)。6.治疗后血浆LPA、CD62p差异:治疗组治疗后LPA(umol╱L)、CD62p(%)水平分别为:3.01±0.95、4.61±2.64,均低于常规组的3.74±1.48、7.69±6.60,差异有统计学意义(P<0.05)。7.按脑功能恢复情况分为基本痊愈、显著进步、进步、无变化、恶化,其对应LPA下降幅度(%)分别为:47.40±7.82、32.50±9.28、17.26±7.85、12.08±8.39、-7.04±9.37;对应CD62p下降幅度(%)分别为:73.50±7.40、63.80±10.75、56.57±14.78、27.22±16.42、-18.00±20.02,对比可见神经功能缺损恢复程度与LPA、CD62p下降幅度成直线相关(r分别为0.83、0.53,P<0.01)各组间差异具有统计学意义。8.按脑功能恢复情况分为基本痊愈、显著进步、有效、进步、无变化、恶化,其对应血瘀证积分下降幅度分别为:84.81±9.63、68.47±14.35、38.71±13.38、40.02±35.09、-9.22±40.41,分析可见脑神经功能缺损恢复程度与血瘀证积分下降幅度成直线相关(r=0.71,P<0.01)。结论:1.急性脑梗死血浆LPA、CD62p表达水平与脑梗死病情轻重、脑梗死面积呈正相关,同时血浆LPA、CD62p表达水平的下降幅度与脑神经功能缺损的恢复程度相关,可在一定程度上反应脑梗死的发生、发展、转归情况。2.LPA、CD62p水平与中医血瘀证积分呈正相关,可能反映了中医的血瘀程度,治疗后脑功能缺损恢复程度与血瘀证积分下降幅度成正相关,说明中医学的血瘀证理论与现代医学的血栓形成、体循环淤血等血管内血液凝固理论呈一定相关性。3.丹参川芎嗪注射液可以对急性脑梗死患者血浆LPA、CD62p表达及中医血瘀情况进行有效干预,并改善其临床神经功能。更多还原

【Abstract】 Objective:To look into the differentce of blood plasma lysophosphatidic acid(LPA) and P-selection(CD62p) between healthy grown-up and blood stasis ?acute cerebral thrombosis,at the same time,observe the change of blood plasma LPA and CD62p of different acute cerebral thrombosis area、different blood stasis degrees、different Neurological Severity Score(NSS)。To observe the levels of blood plasma LPA、D62p and NSS、blood stasis degree effected by danshen chuanxionqin injection,and further explain the possible mechanism of danshen chuanxionqin injection。Methods:60 patients with blood stasis ´ cerebral thrombosis in hospital no more than 72 hours were randomly divided into group B1(routine treatment group) and group B2(dansh chuanxiongqin injection treatment group).30 cases(male20,female10,mean age 63.87±11.35) were served as B1,30 cases(malel9,female11,mean age 63.43±11.25) were served as B2.30 normal cases(malel8,female12,mean age 64.20±10.47 ) were served as group A(normal contrast group).Routine western medicine(including dehydration and degrading intracranial pressure,controling blood pressure,resisting platelet aggregation and degrading fibrinogen etc.) were given to 30patients of group Bl,and danshen chuanxiongqin injection was given to another 30patients of group B2 in addition.Vein blood samples were collected before breakfast in the second day and the fourteenth day after take into the hospital.Both LPA、CD62p were tested by ELISA.And then analysis the connection between the value of LPA、CD62p and NSS、blood stasis degree,and further explain the influence of danshen chuanxionqin injection to LPA、CD62p。Results:1.The levels of blood plasma LPA、CD62p of group B(the cases with acute cerebral thrombosis) were markedly higher than those in group A(P＜0.01),the difference between group Bl and B2 is insignificant(P＞0.05).2.The higher blood stasis degree,the levels of LPA、CD62p are higher.,the difference among the three groups are significant(P＜0.05).3.The larger area of acute cerebral thrombosis,the levels of LPA、CD62p are higher(P＜0.01),the difference among the three groups are significant(P＜0.05).4.The higher of NSS,the higher of LPA、CD62p(P＜0.05). 5.Group B2 surpasses group B1 obviously in neurologic impairment therapeutic effects(P＜0.05).6.After treatment,the levels of LPA、CD62p of groupB2 are much lower than group B1(P＜0.05).7.After treatment,the descend range of NSS is related to blood plasma LPA、CD62p(r=0.83, 0.53,P＜0.01)8.After treatment,the descend range of NSS is related to blood stasis(r=0.71,P＜0.01)Conclusions:1.The levels of ACTs’ blood plasma LPA、CD62p are obviously higher than healthy grown up,at the same time,the level of LPA、CD62p are correspondence with the area and the disease’ conditions.2.The levels of blood plasma LJA、CD62p are correspondence with the degree of blood stasis,it could illuminated that the LPA、CD62p’ level can reflect the blood plasma’ degree, it could also illuminated that there is some relationship between the blood stasis’ theory and modem gore theory.3.Danshen chuanxionqin injection can effectly affect the prognosis of the patients who suffering blood stasis＆acute cerebral thrombosis,the prognosis is respond to the level of LPA、CD62p,it could be explained that danshen chuanxiongqin injection could restrain blood platelet’s activation,it could restrain blood platelet adhere to injured endothelium,reduce the pathology damage from inflammation after cerebral ischemia,reduce the cerebral edema and improve the blood circulation of partial brain.更多还原