作者：宋雪云，王少伟，吴胜峰，彭亮，李曼

单位：

073000河北省定州市，河北省第七人民医院神经内二科 通信作者：宋雪云，E-mail：doctorhx2021@163.com

Units：

Neurology Department, Hebei Seventh People's Hospital, Dingzhou 073000, China Corresponding author: SONG Xueyun, E-mail: doctorhx2021@163.com

关键词：

缺血性脑卒中; 动脉粥样硬化; 风痰阻络证; 癫狂梦醒汤; 辛伐他汀; 神经功能;

Keywords：

Ischemic stroke; Atherosclerosis; Wind-phlegm blocking collaterals; Diankuang Mengxing decoction;Simvastatin; Neurological function

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.064

Funds：

河北省中医药管理局中医药类科研计划项目（2021210）

摘要：

背景缺血性脑卒中(IS)是我国常见的卒中类型,发病率、致残率、死亡率及复发率均较高。超过80%的IS是由动脉粥样硬化导致动脉狭窄或闭塞所致,即大动脉粥样硬化型缺血性脑卒中(LAA-IS),该类患者病情较严重,预后较差。中医药治疗脑卒中由来已久,目前关于癫狂梦醒汤联合辛伐他汀治疗LAA-IS恢复期的效果罕有报道。目的 探讨癫狂梦醒汤联合辛伐他汀治疗LAA-IS恢复期(风痰阻络证)的临床疗效及其对患者神经功能的影响。方法 选取河北省第七人民医院2020年3月至2021年2月收治的LAA-IS恢复期(风痰阻络证)患者100例,采用随机数字表法分为对照组(n=50)和观察组(n=50)。在常规治疗基础上,对照组患者采用辛伐他汀片口服治疗,观察组患者在对照组基础上联合癫狂梦醒汤内服治疗,两组患者均持续治疗4周。比较两组患者的临床疗效及治疗前后颈动脉内中膜厚度(CIMT)、美国国立卫生研究院卒中量表(NIHSS)评分、中医证候积分、血脂指标〔低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、载脂蛋白B(ApoB)及总胆固醇(TC)〕、血管炎症因子〔中性粒细胞与淋巴细胞比值(NLR)、基质金属蛋白酶9(MMP-9)、脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏C反应蛋白(hs-CRP)〕,并记录患者治疗期间不良反应发生情况。结果 观察组患者临床疗效优于对照组(P<0.05)。治疗后,两组患者CIMT分别小于本组治疗前,NIHSS评分、中医证候积分分别低于本组治疗前,且观察组患者CIMT小于对照组,NIHSS评分、中医证候积分低于对照组(P<0.05)。治疗后,两组患者血清LDL-C、TG、ApoB及TC水平分别低于本组治疗前,且观察组患者低于对照组(P<0.05)。治疗后,两组患者NLR及血清MMP-9、Lp-PLA2、hs-CRP水平分别低于本组治疗前,且观察组患者低于对照组(P<0.05)。两组患者治疗期间均未出现明显不良反应。结论 癫狂梦醒汤联合辛伐他汀治疗LAA-IS恢复期(风痰阻络证)的临床疗效确切,可有效改善患者的中医证候及血脂指标,减轻机体炎症反应,促进神经功能恢复,延缓病情进展,且安全性较高。

Abstract：

【Abstract】　Background Ischemic stroke (IS) is a common type of stroke in China, with a high incidence, disabilityrate, mortality and recurrence rate. More than 80% of IS is caused by arterial stenosis or occlusion caused by arteriosclerosis,as large-artery atherosclerosis type of ischemic stroke (LAA-IS) in recovery stage, the patients have serious illness and poorprognosis. Traditional Chinese medicine (TCM) has been used to treat stroke for a long time. At present, there are few reports aboutthe effect of Diankuang Mengxing decoction combined with simvastatin in the treatment of the recovery stage of LAA-IS. ObjectiveTo discuss the clinical effect of Diankuang Mengxing decoction combined with simvastatin in the treatment of the recovery stageof LAA-IS (wind-phlegm blocking collaterals syndrome) and its impact on neurological function of patients. Methods A totalof 100 patients at the recovery stage of LAA-IS (wind-phlegm obstructing collaterals syndrome) admitted to the Hebei SeventhPeople's Hospital from March 2020 to February 2021 were selected, and they were divided into the control group (n=50) and theobservation group (n=50) by random number table method. On the basis of routine treatment, patients in the control group weretreated with simvastatin tablets orally, and patients in the observation group were treated with Diankuang Mengxing decoctionbased on control group, both groups were continuously treated for 4 weeks. Clinical effect and carotid intima-media thickness(CIMT) , National Institutes of Health Stroke Scale (NIHSS) score, TCM syndrome score, blood lipid indexes [low density lipoproteincholesterol (LDL-C) , triglyceride (TG) , apolipoprotein B (ApoB) , total cholesterol (TC) ] , vascular inflammatory factors [neutrophilto lymphocyte ratio (NLR) , matrix metalloproteinase 9 (MMP-9) , lipoprotein-associated phospholipase A2 (Lp-PLA2) , highsensitivity C reactive protein (hs-CRP) ] were compared between the two groups before and after treatment, and incidence of adversereactions during treatment of the two groups was recorded. Results Clinical effect of the observation group was better than thatof the control group (P < 0.05) . After treatment, CIMT of the two groups was less than that before treatment, NIHSS score, TCMsyndrome score were lower than those before treatment, respectively (P < 0.05) ; and CIMT in the observation group was less thanthat of the control group, NIHSS score, TCM syndrome score were lower than those of the control group (P < 0.05) . After treatment,serum levels of LDL-C, TG, ApoB, TC of the two groups were lower than those before treatment, respectively (P < 0.05) ; and serumlevels of LDL-C, TG, ApoB, TC in the observation group were lower than those of the control group (P < 0.05) . After treatment, NLRand serum levels of MMP-9, Lp-PLA2, hs-CRP of the two groups were lower than those before treatment, respectively (P < 0.05) ;and NLR and serum levels of MMP-9, Lp-PLA2, hs-CRP in the observation group were lower than those of the control group (P< 0.05) . There was no serious adverse reactions during treatment of the two groups.Conclusion Diankuang Mengxing decoctioncombined with simvastatin have an exact clinical effect on the recovery stage of LAA-IS (wind-phlegm blocking collateralssyndrome) , and can improve TCM syndrome and blood lipid indexes, reduce the inflammatory reaction of the body, promote therecovery of neurological function, delay the progress of the disease, and with high safety.

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