“毒损脑络”临床特征治疗前后对比及相关研究

【作者】 郭志英；

【导师】 邹忆怀；

【作者基本信息】 北京中医药大学 ， 中医内科， 2008， 硕士

【摘要】 目的:以现代临床脑缺血损害发病和发展过程为研究范例,观察缺血性中风急性期可能与毒有关的临床特征(5个非特异性症状:情绪不稳、表情呆滞或反应迟钝、神疲乏力或少气懒言、嗜睡、头昏沉)治疗前后的变化情况,并寻找非特异性症状与高敏C反应蛋白之间的联系。同时观察苦碟子组和血塞通组治疗前后非特异性症状的变化情况,探讨清热解毒活血法在中风急性期治疗中的作用,从而反推中风病急性期“毒损脑络”的病机。方法:收集缺血性中风发病72小时以内的患者,随机分为苦碟子治疗组和血塞通对照组进行干预治疗,分别于发病72小时内和发病第14天采集相关信息,主要包括非特异性症状、高敏C反应蛋白和NIHSS量表,并对采集数据进行统计学分析,研究治疗前后以及治疗组和对照组之间是否存在差异,并进行非特异性症状与高敏C反应蛋白之间的相关性分析。结果:在中风病急性期,非特异性症状出现的比例为83.3%,其中头昏沉、神疲乏力或少气懒言出现的次数最多。治疗后非特异性症状在数量和程度上均有不同程度的减轻。对于治疗后组间的比较,通过好转和无效来判断,结果神疲乏力或少气懒言、头昏沉两个症状在治疗后存在显著差异,P值分别0.036、0.033(P<0.05),而其他三个症状治疗后两组之间不存在显著差异。发病72小时内,出现非特异性症状和未出现非特异性症状的患者进行高敏C反应蛋白的比较,P=0.017(P<0.05),差异显著,而在发病第14天二者比较P=0.763(P>0.05),无显著差异。非特异性症状与Hs-CRP的相关性分析表明,非特异性症状数量与Hs-CRP的数值之间在发病72小时内存在正相关,P=0.0359(P<0.05),而在第14天时二者无相关性,P=0.2657(P>0.05);五个非特异性症状分开研究,只有神疲乏力或少气懒言与Hs-CRP之间在72小时内存在正相关,P=0.0428(P<0.05)。关于NIHSS分值的比较,苦碟子和血塞通均能降低急性期NIHSS分值,P值分别为0.003、0.009(P<0.05),差异显著,但治疗后两组之间无显著差异。结论:通过研究发现,可能与毒相关的非特异性症状伴随中风病的发生出现或加重,随着治疗后病情的好转而减轻,非特异性症状的出现伴有Hs-CRP的升高,非特异性症状的减轻伴有有Hs-CRP的下降。进行相关性分析发现,中风病72小时内,Hs-CRP值越高出现非特异性症状的数值越多,且Hs-CRP越高,出现神疲乏力或少气懒言的可能性较其他四个非特异性症状大。同时通过对照观察,发现清热解毒活血较单纯活血化瘀能更好的改善头昏沉、神疲乏力或少气懒言症状,另外三个非特异性症状两组间未发现显著差异,从清热解毒活血法改善非特异性症状的疗效反证其契合的病机可能为热毒。更多还原

【Abstract】 Objective: Studying the onset and evolution of the cerebral ischemia, to observe the before and after change of clinical feature related to toxin possibly(5 nonspecific symptoms:emotionally instability,dull expression,lack of energy,hypersomnia,heavy head) at the acute stage of cerebral ischemia,and simultaneity in search of the relationship between nonspecific symptoms and High-Seneitivity C-reactive protein.Meanwhile, observing the before and after change of the nonspecific symptoms in the group of kudiezi and xuesaitong, probe into the effect of heat-clearing, detoxicating and promoting blood circulation methods in treating stroke in acute stage. Then inversely get the pathogenesis of“toxin damage brain collaterals”in acute stage of stoke.Methods: Patients who got stroke within 72 hours are randomly disparted into groups of kudiezi and xuesaitong,and related information within 72 hours and the 14th day after the onset of stroke is collected,including nonspecific symptoms,Hs-CRP and NIHSS scale. Then statistical analysis is used to view if there is difference between the two groups,and the relationship between nonspecific symptoms and High-Seneitivity C-reactive protein.Results: In the acute stage of stroke, the occurring proportion of nonspecific symptoms is 83.3%, heavy head and lack of energy are more than the rest three symptoms. All the nonspecific symptoms alleviated after treatment in some way. For the five nonspecific symptoms, only the symptoms of lack of energy and heavy head have significant deviation after treatment between the two groups,and P-value is 0.036,0.033(P<0.05), the rest three nonspecific symptoms have no significant deviation after treatment.Within 72 hours after the onset of stroke,the difference of the Hs-CRP between the patients with and without nonspecific symptoms is significant,P=0.017(P<0.05),but in the 14th day there is no significant deviation, P=0.763(P>0.05).Studying the relationship between nonspecific symptoms and Hs-CRP,there is a positive correlation between the number of nonspecific symptoms and the value of Hs-CRP within 72 hours after the onset of stoke,P=0.0359(P<0.05);but there is no positive correlation in the 14th day, P=0.2657(P>0.05).And in the five nonspecific symptoms,only for lake of energy,there is a positive correlation with Hs-CRP,P=0.0428 (P<0.05). About NIHSS,the two groups can both make the score of NIHSS decline in the acute stage of stroke after treatment,and P-value is0.003、0.009(P<0.05),there is significant deviation ,but there is no significant deviation between two groups.Conclusion: From the study,we can see that nonspecific symptoms about toxin in some way occurred or deteriorated by the happening of stroke,and lightened by the ameliorating of stroke.And nonspecific symptoms about toxin occurred with the the High-Seneitivity C-reactive rising up, nonspecific symptoms about toxin ameliorated with High-Seneitivity C-reactive going down. Within 72 hours of the onset of stroke, there are both positive correlations between the number of nonspecific symptoms and the value of Hs-CRP, between the occurance of lack of anergy and the value of Hs-CRP.By observing the two different groups, we concludede that the methods of heat-clearing, detoxicating and activating collaterals is better than that of simple promoting blood circulation and activating collaterals in improving heavy head and lack of energy,but there is no significant deviation about the rest three nonspecific symptoms, then the discussion comes out that there is toxin in pathopoiesis in the acute stage of stroke according to the curative effect of heat-clearing, detoxicating and activating collaterals methods.更多还原