益气活血汤对脑分水岭梗死急性期多时点NIHSS,中医证候,HSP-70的影响

目的:探讨益气活血汤对脑分水岭梗死急性期患者多时点美国国立卫生研究院卒中量表(NIHSS)、中医证候、热休克蛋白-70(HSP-70)的影响,及HSP-70的动态变化与疾病发展和中医证候演变的相关性。方法:脑分水岭梗死发病72 h以内的137例患者随机分为治疗组69例,对照组68例。治疗组在对照组治疗的基础上,口服中药益气活血汤。发病3 d内、第7,14天记录NIHSS评分,进行中医证候评价。采集HSP-70,进行比较及相关性分析。结果:治疗后治疗组NIHSS差值高于对照组(P0.05),治疗组气虚和血瘀的改善显著优于对照组(P0.01)。两组发病3~7 d,治疗组HSP-70升高幅度高于对照组(P0.05)。两组发病7~14 d,治疗组HSP-70下降幅度高于对照组(P0.05)。3个时点HSP-70与NIHSS,气虚,血瘀均成负相关(P0.05)。发病3 d内、第7天NIHSS与气虚、血瘀均成显著正相关(P0.01)。发病第14天NIHSS与气虚成正相关(P0.05),与血瘀成显著正相关(P0.01)。结论:益气活血汤有助于改善脑分水岭梗死急性期患者的神经功能缺损情况,对气虚血瘀的中医证候有显著改善作用。益气活血汤可能有利于HSP-70发挥细胞保护功能。因其高度相关性,发病后HSP-70的表达水平在不同时间点的差异与关联能够从微观角度反映脑分水岭梗死急性期患者的神经功能缺损的变化规律及中医证候的演变趋势。

Effects of Yiqi Huoxue Decoction on NIHSS, TCM Syndromes and HSP-70 of Acute Cerebral Watershed Infarction Patients at Several Time Points

Objective: To investigate the effects of Yiqi Huoxue decoction on National Institute of Health stroke scale (NIHSS), traditional Chinese medicine (TCM) syndromes and heat shock protein-70 (HSP-70) scores of acute cerebral watershed infarction patients at several time points, and explore the correlation between dynamic changes of HSP-70 and disease development as well as evolution of TCM syndromes. Method: The 137 patients within 72 h of cerebral watershed infarction were randomly divided into treatment group (69 cases) and control group (68 cases). Patients in treatment group orally took Yiqi Huoxue decoction on the basis of treatment in control group. NIHSS and TCM Syndrome scores were recorded while HSP-70 data were collected within 3 days and on day 7, day 14 after disease onset. Means were compared and correlation analysis was done. Result: The differential value of NIHSS scores before and after treatment in treatment group was higher than that in control group (P < 0.05). The differential values of Qi deficiency score and blood stasis score before and after treatment in the treatment group were significantly higher than those in control group (P < 0.01). Within 3 days to the day 7 after disease onset, the increased degree of HSP-70 in treatment group was higher than that in control group (P < 0.05). From day 7 to day 14 after onset, the decreased degree of HSP-70 in treatment group was higher than that in control group (P < 0.05). HSP-70 was negatively correlated with NIHSS score, Qi deficiency score and blood stasis score at 3 time points (P < 0.05). NIHSS score was significantly positively correlated with Qi deficiency score and blood stasis score within 3 days and on day 7 after onset (P < 0.01). NIHSS score was positively correlated with Qi deficiency score (P < 0.05) and significantly positively correlated with blood stasis (P < 0.01) on day 14 after onset. Conclusion: Yiqi Huoxue decoction can help to improve the neurologic deficits, and significantly improve Qi deficiency and blood stasis of the patients with acute cerebral watershed infarction. Yiqi Huoxue decoction possibly beneficial to the cells protection effect of HSP-70. Because of the high correlation, the difference and relevance of HSP-70 expression level at different time points after onset can reflect the change rule of neurologic deficits and the evolution trend of TCM syndromes in patients with acute cerebral watershed infarction from micro perspective.