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镇肝熄风汤对急性脑出血阴虚风动证的影响
Effect of Liver-Wind Suppressing Decoction on the Syndr-ome of Stirring of Wind Due to Deficiency of YIN in Acute Cerebral Hemorrhage
【作者】 张希；
【导师】 周德生；
【作者基本信息】 湖南中医药大学 ， 中西医结合临床， 2008， 硕士
【摘要】 目的:本文从理论和临床研究出发探讨了镇肝熄风汤对出血性中风急性期阴虚风动证的临床疗效,并进一步分析了血清基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)在其中的作用,旨在为镇肝熄风汤治疗出血性中风阴虚风动证提供理论依据,为临床决策提供新的思维。方法:选取48例急性基底节脑出血阴虚风动患者随机分为治疗组及对照组。治疗组采用西药常规治疗加口服方药镇肝熄风汤,对照组仅采用西药常规治疗。从中西医两方面比较两组治疗前后神经功能缺损评分及中医症候积分变化并进行疗效评定,比较两组治疗前后的头颅CT血肿体积变化。另选正常健康者12例为正常对照组,将治疗组与对照组于入院时(24小时内)、7天、14天采取空腹静脉血和正常对照组静脉空腹静脉血用ELISA法测定血清MMP-9浓度。理论部分探讨了气化理论,提出气机升降异常,阴阳失衡易发中风,选用滋养肝肾潜阳熄风,沉降浊邪之镇肝熄风汤治疗阴虚风动之急性脑出血以平复气机升降异常调整阴阳失衡。结果:1.治疗后治疗组与对照组组在神经功能缺损评分、中医症候积分、疗效评定及头颅CT测定血肿体积等观察项目均较治疗前均有明显改善(各P值均＜0.05),但治疗组更优于对照组(P＜0.05)。2.治疗组与对照组血浆MMP-9表达在入院时(发病24小时内)均升高,并与血肿周围水肿带体积正相关(r=0.286,P＜0.05),一周后达到高峰,两周后下降。但治疗组在治疗后一周及两周时血浆MMP-9表达均低于对照组(P＜0.05)。结论:镇肝熄风汤对脑出血急性期阴虚风动证有明显疗效,并可通过降低血浆MMP-9的表达以减轻脑水肿与炎症反应从而保护脑细胞。
【Abstract】 Objectives : To observe the therapeutic efficacy of Liver-Wind Suppressing Decoction on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage and further to study the role of matrix metalloproteinase-9 （MMP-9） in the treatment.Methods: In clinical research part, 48 patients of acute cerebral hemorrhage were randomly divided into treatment group and control group. The treatment group took Liver-Wind Suppressing Decoction orally besides receiving conventional therapy, but the control group was only received conventional therapy. Nervous Function Defect Scores, Traditional Chinese Syndrome Medicine Accumulated Points, Clinical Efficiency and head CT were evaluated after treatment comparing to pretherapy. Plasma MMP-9 levels were measured with ELISA in 24 hours, the 7th day and the 14th days after the onste of the disease. In theoretical research part, an overview was done on Chinese medicine treating stroke. Based on gasification theory, a hypothesis was proposed that losing balance between YIN and YANG is the main pathogenesis of stroke, the key treatment of stroke is to balance YIN with YANG Liver-Wind Suppressing Decoction, which represents nourishing liver and kidney, suppressing hyper-YANG to eliminate wind, is applied to treat the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage.Results: 1. Nervous Function Defect Scores and Traditional Chinese Syndrome Medicine Accumulated Points of post-treatment were improved and hematoma volume was reduced comparing to pretreatment （all the P value are lower than 0.05） with more significance in the treatment group than in the control group（P<0.05）.2. In the 2 groups, plasma MMP-9 levels increased after 24h and reached the peak in the 7th day, then decreased after 2 weeks. Plasma MMP-9 levels were positively correlated with brain edema range （r=0.286, P<0.05）. Plasma MMP-9 levels in the treatment group were lower than in the control group （P<0.05 ）.Conclusions: Liver-Wind Suppressing Decoction is effective on the syndrome of stirring of wind due to deficiency of YIN in acute stage of brain hemorrhage, and might protect brain cells by lessening brain edema and inflammation by inhibiting MMP-9 expression.