背景:脑梗死有多种发病机制,自由基及其脂质过氧化作用参与了动脉粥样硬化和脑缺血后神经细胞的损害过程.复方丹参是一种临床上常用的治疗脑梗死和冠心病的活血化瘀中药,其作用机制还有许多不明之处.目的:观察复方丹参对脑梗死患者神经功能缺损程度及自由基的影响,并探讨其可能作用机制.设计:随机对照研究.单位:一所大学医院的神经内科.对象:2002-02/12锦州医学院附属第一医院神经内科住院患者538例,其诊断符合第四届全国脑血管病学术会议通过的"各类脑血管疾病诊断要点",均经脑CT扫描确诊,均为发病在72 h以内的首次发病的动脉粥样硬化性脑梗死患者.排除伴有心肌梗死、心力衰竭、心房颤动,肝肾功能不全,消化道出血,血管性痴呆和延髓麻痹以及中途不合作者.符合上述标准的患者为68例,其中男38例,女30例;年龄52～78岁,平均(64.62±5.80)岁.入选病例按先后顺序和对照组自愿原则采用抽签法随机分成研究组和对照组.方法:两组基础治疗相同,研究组在此基础上加用复方丹参注射液,加入生理盐水250mL中静脉注射,1次/d,连用14 d为1个疗程;对照组应用血栓通注射液15 mL,加入生理盐水250 mL中静脉注射,1次/d,连用14 d为1个疗程.主要观察指标:①临床神经功能缺损程度评分.②临床疗效评定.③血清脂质过氧化物(lipoperoxide,LPO)水平和超氧化物歧化酶(superoxide dismutase,SOD)活性的测定.结果:两组治疗后神经功能缺损程度评分的减少经自身对照均具有统计学差异(研究组:28.62±6.76比13.84±8.16和对照组:28.58±7.05比21.52±8.24,t=8.134和t=3.796,P＜0.001),而研究组评分的减少更明显,与对照组治疗后比较差异有非常显著性意义(t=3.861,P＜0.001);复方丹参治疗脑梗死的有效率为88.24%,显著优于对照组(67.65%)(x2=4.19,P＜0.05);复方丹参能使患者血清的LPO水平[(8.69±1.28)nmol/L比(5.86±1.42)nmol/L,t=8.628,P＜0.001]明显降低,与对照组治疗后相比亦具有统计学差异[(5.86±1.42)nmol/L比(8.56±0.95)nmol/L,t=9.125,P＜0.001];同时显著升高血清的SOD活性[(26.25±4.64)mkat/g比(30.01±3.87)mkat/g,t=3.629,P＜0.001],与对照组治疗后相比亦具有统计学差异[(30.01±3.87)mkat/g比(26.33±4.14)mkat/g,t=3.778,P＜0.001 ].结论:复方丹参能显著改善脑梗死患者的神经功能缺损程度,治疗脑梗死疗效确切;能降低脑梗死患者血清LPO含量,升高血清SOD活性.推测清除自由基和抗脂质过氧化损伤可能是其重要的机制之一,为其在临床上治疗脑梗死提供了进一步的理论依据.
揹景:腦梗死有多種髮病機製,自由基及其脂質過氧化作用參與瞭動脈粥樣硬化和腦缺血後神經細胞的損害過程.複方丹參是一種臨床上常用的治療腦梗死和冠心病的活血化瘀中藥,其作用機製還有許多不明之處.目的:觀察複方丹參對腦梗死患者神經功能缺損程度及自由基的影響,併探討其可能作用機製.設計:隨機對照研究.單位:一所大學醫院的神經內科.對象:2002-02/12錦州醫學院附屬第一醫院神經內科住院患者538例,其診斷符閤第四屆全國腦血管病學術會議通過的"各類腦血管疾病診斷要點",均經腦CT掃描確診,均為髮病在72 h以內的首次髮病的動脈粥樣硬化性腦梗死患者.排除伴有心肌梗死、心力衰竭、心房顫動,肝腎功能不全,消化道齣血,血管性癡呆和延髓痳痺以及中途不閤作者.符閤上述標準的患者為68例,其中男38例,女30例;年齡52～78歲,平均(64.62±5.80)歲.入選病例按先後順序和對照組自願原則採用抽籤法隨機分成研究組和對照組.方法:兩組基礎治療相同,研究組在此基礎上加用複方丹參註射液,加入生理鹽水250mL中靜脈註射,1次/d,連用14 d為1箇療程;對照組應用血栓通註射液15 mL,加入生理鹽水250 mL中靜脈註射,1次/d,連用14 d為1箇療程.主要觀察指標:①臨床神經功能缺損程度評分.②臨床療效評定.③血清脂質過氧化物(lipoperoxide,LPO)水平和超氧化物歧化酶(superoxide dismutase,SOD)活性的測定.結果:兩組治療後神經功能缺損程度評分的減少經自身對照均具有統計學差異(研究組:28.62±6.76比13.84±8.16和對照組:28.58±7.05比21.52±8.24,t=8.134和t=3.796,P＜0.001),而研究組評分的減少更明顯,與對照組治療後比較差異有非常顯著性意義(t=3.861,P＜0.001);複方丹參治療腦梗死的有效率為88.24%,顯著優于對照組(67.65%)(x2=4.19,P＜0.05);複方丹參能使患者血清的LPO水平[(8.69±1.28)nmol/L比(5.86±1.42)nmol/L,t=8.628,P＜0.001]明顯降低,與對照組治療後相比亦具有統計學差異[(5.86±1.42)nmol/L比(8.56±0.95)nmol/L,t=9.125,P＜0.001];同時顯著升高血清的SOD活性[(26.25±4.64)mkat/g比(30.01±3.87)mkat/g,t=3.629,P＜0.001],與對照組治療後相比亦具有統計學差異[(30.01±3.87)mkat/g比(26.33±4.14)mkat/g,t=3.778,P＜0.001 ].結論:複方丹參能顯著改善腦梗死患者的神經功能缺損程度,治療腦梗死療效確切;能降低腦梗死患者血清LPO含量,升高血清SOD活性.推測清除自由基和抗脂質過氧化損傷可能是其重要的機製之一,為其在臨床上治療腦梗死提供瞭進一步的理論依據.
배경:뇌경사유다충발병궤제,자유기급기지질과양화작용삼여료동맥죽양경화화뇌결혈후신경세포적손해과정.복방단삼시일충림상상상용적치료뇌경사화관심병적활혈화어중약,기작용궤제환유허다불명지처.목적:관찰복방단삼대뇌경사환자신경공능결손정도급자유기적영향,병탐토기가능작용궤제.설계:수궤대조연구.단위:일소대학의원적신경내과.대상:2002-02/12금주의학원부속제일의원신경내과주원환자538례,기진단부합제사계전국뇌혈관병학술회의통과적"각류뇌혈관질병진단요점",균경뇌CT소묘학진,균위발병재72 h이내적수차발병적동맥죽양경화성뇌경사환자.배제반유심기경사、심력쇠갈、심방전동,간신공능불전,소화도출혈,혈관성치태화연수마비이급중도불합작자.부합상술표준적환자위68례,기중남38례,녀30례;년령52～78세,평균(64.62±5.80)세.입선병례안선후순서화대조조자원원칙채용추첨법수궤분성연구조화대조조.방법:량조기출치료상동,연구조재차기출상가용복방단삼주사액,가입생리염수250mL중정맥주사,1차/d,련용14 d위1개료정;대조조응용혈전통주사액15 mL,가입생리염수250 mL중정맥주사,1차/d,련용14 d위1개료정.주요관찰지표:①림상신경공능결손정도평분.②림상료효평정.③혈청지질과양화물(lipoperoxide,LPO)수평화초양화물기화매(superoxide dismutase,SOD)활성적측정.결과:량조치료후신경공능결손정도평분적감소경자신대조균구유통계학차이(연구조:28.62±6.76비13.84±8.16화대조조:28.58±7.05비21.52±8.24,t=8.134화t=3.796,P＜0.001),이연구조평분적감소경명현,여대조조치료후비교차이유비상현저성의의(t=3.861,P＜0.001);복방단삼치료뇌경사적유효솔위88.24%,현저우우대조조(67.65%)(x2=4.19,P＜0.05);복방단삼능사환자혈청적LPO수평[(8.69±1.28)nmol/L비(5.86±1.42)nmol/L,t=8.628,P＜0.001]명현강저,여대조조치료후상비역구유통계학차이[(5.86±1.42)nmol/L비(8.56±0.95)nmol/L,t=9.125,P＜0.001];동시현저승고혈청적SOD활성[(26.25±4.64)mkat/g비(30.01±3.87)mkat/g,t=3.629,P＜0.001],여대조조치료후상비역구유통계학차이[(30.01±3.87)mkat/g비(26.33±4.14)mkat/g,t=3.778,P＜0.001 ].결론:복방단삼능현저개선뇌경사환자적신경공능결손정도,치료뇌경사료효학절;능강저뇌경사환자혈청LPO함량,승고혈청SOD활성.추측청제자유기화항지질과양화손상가능시기중요적궤제지일,위기재림상상치료뇌경사제공료진일보적이론의거.
BACKGROUND: Various etiological mechanisms are involved in cerebral infarction. Both free radicals and lipid peroxidation participate in the atherosclerosis and damage of neural cells after cerebral ischemia. Compound danshen(Radix Salviae Miltiorrhizae) is a common prescribed Chinese herb, acting on activating blood circulation and removing stasis for cerebral infarction and coronary heart disease, but its mechanism has been unknown in many aspects.OBJECTIVE: To observe the effect of compound danshen on neural function defect and free radicals in patients with cerebral infarction so as to probe into its possible mechanisms.DESIGN: A randomized controlled trial.SETTING: Neurological Internal Department of a hospital affiliated to one university.PARTICIPANTS: Totally 538 inpatients were collected in Neurological Internal Department of First Hospital affiliated to Jinzhou Medical College from February to December 2002, their diagnosis compiled with "Diagnostic Keys on Every Type Cerebral Vascular Disorders" adopted on the 4th National Acadenic Meeting on Cerebral Vascular Disorders, and determined by cerebral CT scan. All of those were the first attack of atherosclerosis cerebral infarction in 72 hours. The patients with cardiac infarction, heart failure, auricular fibrillation, insufficiency of liver and kidney function,hemorrhage of digestive tract, vascular dementia and bulbar paralysis and the patients who could not be well cooperated were not included. A total of 68 patients compiled with the standards, of which, 38 patients were male and 30 patients female, aged varied from 52 to 78 years, at the average of (64. 62 ±5.80) years. The patients selected were randomized into study group and the control by lot-drawing nethod according to the hospitalized sequence and volunteer principle of the control.METHODS: The basic treatment was same in two groups. In study group,compound danshen injection was added together with physiological saline 250 mL for intra-venous drip, once daily, continuous 14 days made one course. In the control, thrombosis removing injection 15 mL was added together with physiological saline 250 mL for intra-venous drip, once daily,continuous 14 days made one course.Level of serum lipoperoxide(LPO) and activity of superoxide dismutase (SOD).RESULTS: Statistical differences presented in declined scores of severity of neural function defect after treatment in two groups compared with their own controls(in study group: 28.62 ±6.76 vs 13.84 ± 8.16; in the control:28.58±7.05 vs 21.52±8.24, t=8.134, t=3.796 respectively, P＜ 0. 001 ). The score in study group was declined more obviously compared with the control after treatment, indicating very significant difference ( t = 3. 861, P ＜ 0. 001 ). The effective rate of compound danshen injection was 88.24% in treatment of cerebral infarction, which significantly superior to that in the control(67.65% ) (x2 =4.19, P ＜ 0.05). Compound danshen remarkably reduced serum LPO level[ (8.69 ± 1.28) nmol/L vs (5.86 ± 1.42) nmol/L, t =8. 628, P ＜ 0. 001 ] and statistical differences presented compared with the result in the control after treatment[(5.86±1.42) nmol/L vs(8.56±0.95) nmol/L, t=9.125, P ＜0.001] . Simultaneously, SOD activity in serum was significantly increased, [ (26. 25±4. 64) mkat/g vs(30. 01 ± 3.87) mkat/g, t = 3. 629, P ＜ 0. 001] indicating statistical differences compared with the result in the control after treatment[ (30. 01 ±3.87) mkat/g vs(26.33 ±4. 14) mkat/g, t =3. 778,P ＜ 0.001].CONCLUSION: Compound danshen improves significantly neural function defect in patients with cerebral infarction, with definite therapeutic effects on the treatment. It can reduce serum LPO content and increase serum SOD activity in patients with cerebral infarction. It is predicted that removing free radicals and anti-lipid peroxidation damage is probably one of the important mechanisms of it, which provides a further theoretic evidence for the treatment of cerebral infarction clinically.
