通窍化栓汤对缺血性脑卒中患者生活质量的影响及机制的探析(1)
摘要 目的：观察通窍化栓汤用于提高缺血性脑卒中患者生活质量的临床疗效以及对相关细胞因子的影响。方法：选取2012年3月至2013年7月贵阳中医一附院中医内科收治的缺血性脑卒中患者70例，采用随机数字表法将分为治疗组(通窍化栓汤+现代康复训练)35例及对照组(现代康复训练)35例。治疗结束后比较2组视觉模拟(VAS)疼痛评分、血液流变学、临床总有效率以及Bcl-2、Bax与caspase-3蛋白水平表达的变化。结果：1)2组患者经过4个疗程的治疗2组患者疼痛评分及临床症状评分均有明显下降，与治疗前比较，P<0.05，其中治疗组改善的趋势较对照组明显，差异有统计学意义(P<0.05)；2)比较2组血液流变学指标比较显示：2组治疗后Vs、Vd及Vd均高于治疗前，而治疗组升高较对照组明显(P<0.05)；3)对分子生物学指标进行检测，结果显示通窍化栓汤联合现代康复训练更可上调外周血Bcl-2浓度，下降Bax、caspase-3表达水平，与治疗组比较，P<0.05。结论：通窍化栓汤能够有效提高了生活质量，为临床同类治疗开拓思路。同时通窍化栓汤发挥作用可能参与Bcl-2、Bax与caspase-3细胞因子的调控作用相关。
关键词 缺血性脑卒中；生活质量；细胞因子；通窍化栓汤
Abstract Objective：To observe the Tongqiao Huashuan Decoction′s effect on blood circulation and quality of life related cytokines in patients with ischemic stroke.Methods：A total of 70 patients in Guiyang first affiliated hospital of traditional Chinese medicine from March 2012 to July 2013 with ischemic stroke were divided into two groups by random number table，35 cases in observation group (treated with Tongqiao Huashuan Decoction and modern rehabilitation) and 35 cases in control group (modern rehabilitation).The visual analog (VAS) pain score，rheology，clinical total efficiency and Bcl-2，Bax and caspase-3 protein expression levels were compared between the two groups after treatment.Results：1) After treatment，VAS scores，clinical improvement rates in two groups showed statistically significant differences (P<0.05)，the observation group had significantly better results than the control group；2) After treatment，blood flow velocity (Vs)，mean blood flow velocity (Vd)，diastolic velocity (Vm) increased significantly (P<0.05)，the magnitude of the observation group increased significantly than the control group (P<0.05)； 3) After the plasma treatment，the Bcl-2 expression increased significantly compared with the control group，while the plasma Bax and caspase-3 expression levels decreased，the treatment group had significantly different results compared with the control group (P<0.05).Conclusion：Tongqiao Huashuan Decoction can effectively improve the quality of life，which provides new ideas for the clinical treatment of the disease.Tongqiao Huashuan Decoction′s mechanism may be involved in the regulation of Bcl-2，Bax and caspase-3 cytokines.
Key Words Ischemic stroke； Quality of life； Cytokines； Tongqiao Huashuan Decoction
中圖分类号：R255.2文献标识码：Adoi：10.3969/j.issn.1673-7202.2017.01.021
缺血中风是目前临床常见的疾病，该病并非单一因素作用而成，其发生发展与机体多条生物分子信号通路关系密切，而信号通路目前备受关注，被视为脑血管疾病研究的前沿领域，脑细胞的增殖与凋亡是目前研究较为透彻的内容，而其中Bcl-2、Bax与caspase-3蛋白是热门话题[1]。目前临床认为中医药是治疗脑血管疾病后遗症的有效措施，20世纪初，英国研究人员Jubb RW等进行的一项多中心大样本的临床调查中证实中医药可有效改善关节活动度[2]。同时美国研究人员Suarez-Almazor ME也认为根据脑卒中患者具体功能障碍适当选择不同类别的中医手段可产生理想的疗效。本团队在多年临床中发现通窍化栓汤可有效提高缺血中风患者的日常生活能力，但目前尚未有文献报道其作用机理，我们设想：通窍化栓汤治疗缺血脑卒中是否通过Bcl-2、Bax与caspase-3蛋白进行桥接？我们进行观察分析总结，现将结果报道如下。, 百拇医药(蔡静 朱广旗)
关键词 缺血性脑卒中；生活质量；细胞因子；通窍化栓汤
Abstract Objective：To observe the Tongqiao Huashuan Decoction′s effect on blood circulation and quality of life related cytokines in patients with ischemic stroke.Methods：A total of 70 patients in Guiyang first affiliated hospital of traditional Chinese medicine from March 2012 to July 2013 with ischemic stroke were divided into two groups by random number table，35 cases in observation group (treated with Tongqiao Huashuan Decoction and modern rehabilitation) and 35 cases in control group (modern rehabilitation).The visual analog (VAS) pain score，rheology，clinical total efficiency and Bcl-2，Bax and caspase-3 protein expression levels were compared between the two groups after treatment.Results：1) After treatment，VAS scores，clinical improvement rates in two groups showed statistically significant differences (P<0.05)，the observation group had significantly better results than the control group；2) After treatment，blood flow velocity (Vs)，mean blood flow velocity (Vd)，diastolic velocity (Vm) increased significantly (P<0.05)，the magnitude of the observation group increased significantly than the control group (P<0.05)； 3) After the plasma treatment，the Bcl-2 expression increased significantly compared with the control group，while the plasma Bax and caspase-3 expression levels decreased，the treatment group had significantly different results compared with the control group (P<0.05).Conclusion：Tongqiao Huashuan Decoction can effectively improve the quality of life，which provides new ideas for the clinical treatment of the disease.Tongqiao Huashuan Decoction′s mechanism may be involved in the regulation of Bcl-2，Bax and caspase-3 cytokines.
Key Words Ischemic stroke； Quality of life； Cytokines； Tongqiao Huashuan Decoction
中圖分类号：R255.2文献标识码：Adoi：10.3969/j.issn.1673-7202.2017.01.021
缺血中风是目前临床常见的疾病，该病并非单一因素作用而成，其发生发展与机体多条生物分子信号通路关系密切，而信号通路目前备受关注，被视为脑血管疾病研究的前沿领域，脑细胞的增殖与凋亡是目前研究较为透彻的内容，而其中Bcl-2、Bax与caspase-3蛋白是热门话题[1]。目前临床认为中医药是治疗脑血管疾病后遗症的有效措施，20世纪初，英国研究人员Jubb RW等进行的一项多中心大样本的临床调查中证实中医药可有效改善关节活动度[2]。同时美国研究人员Suarez-Almazor ME也认为根据脑卒中患者具体功能障碍适当选择不同类别的中医手段可产生理想的疗效。本团队在多年临床中发现通窍化栓汤可有效提高缺血中风患者的日常生活能力，但目前尚未有文献报道其作用机理，我们设想：通窍化栓汤治疗缺血脑卒中是否通过Bcl-2、Bax与caspase-3蛋白进行桥接？我们进行观察分析总结，现将结果报道如下。, 百拇医药(蔡静 朱广旗)