通脑饮基于CYP2C19基因慢代谢人群急性脑梗死痰瘀滞络证的临床疗效观察

发布时间：2018-05-24 22:00

本文选题：通脑饮 + 急性缺血性脑梗死　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：探讨中药方剂通脑饮对于氯吡格雷慢代谢基因型的急性缺血性脑卒中患者在促进神经功能恢复和改善血管狭窄等方面的临床疗效。方法：基于氯吡格雷CYP2C19的基因类型,可以将人群分为快代谢(EM)、中代谢(IM)、慢代谢(PM)三类,本次研究对象主要为慢代谢型及快代谢型,各选入40例患者。其中,慢代谢(PM组)为治疗组,快代谢(EM组)为对照组。快代谢组以氯吡格雷75mg qd单抗治疗为主,慢代谢组以阿司匹林100mg qd加用通脑饮250ml bid为主,余治疗均给以同样的西医基础药物,口服药物疗程均为3个月,分别于首诊日,治疗第7日、14日及90日观察中医症状、神经功能缺损评分、生活能力状态、中风复发率状况,研究其对中慢代谢患者神经功能恢复的临床疗效；观察首诊日及治疗第90天大脑中动脉流速变化。结果：治疗后,两组大脑中动脉流速较前均有下降(P0.05),神经功能缺损评分和改良Rankin评分较治疗前均有显著下降(P0.05),同时改良Barthel指数较前均显著升高(P0.05)；通脑饮组神经功能缺损评分、改良Rankin评分等较氯吡格雷单抗对照组组差异具有统计学意义(均P0.05),并且在改善大脑中动脉狭窄方面的疗效不亚于氯吡格雷组。结论：通脑饮可以明显改善氯吡格雷慢代谢基因型急性缺血性脑梗死患者神经功能缺损症状、提高患者生活质量、改善颅内动脉狭窄,与阿司匹林单抗联用疗效显著。
[Abstract]:Objective: to investigate the clinical efficacy of Tongnao decoction (TNY) in promoting the recovery of nerve function and improving vascular stenosis in patients with acute ischemic stroke with clopidogrel slow metabolic genotype. Methods: based on the gene types of clopidogrel CYP2C19, the population could be divided into three groups: fast metabolic CYP2C19, middle metabolic CYP2C19 and slow metabolic CYP2C19. The subjects of this study were mainly slow metabolic type and fast metabolic type, each of which was selected from 40 patients. The slow metabolism group (PM group) and the fast metabolism group (EM group) were used as the control group. The fast metabolism group was treated with clopidogrel 75mg QD monoclonal antibody, the slow metabolism group was treated with aspirin 100mg QD plus Tongnaoyin 250ml bid, and the rest of the treatment was given the same western medicine. The course of oral treatment was 3 months, respectively, on the first day of diagnosis. On the 7th, 14th and 90th day of treatment, the symptoms of traditional Chinese medicine (TCM), the score of neurological deficit, the state of living ability and the recurrence rate of apoplexy were observed, and the clinical curative effect on the recovery of nerve function in patients with moderate and slow metabolism was studied. The velocity of middle cerebral artery (MCA) was observed on the first day of diagnosis and 90 days after treatment. Results: after treatment, the flow velocity of the middle cerebral artery in both groups was lower than that before treatment (P 0.05), the neurological deficit score and the modified Rankin score were significantly lower than those before treatment, and the modified Barthel index was significantly higher than that before treatment, and the nerve function defect score of Tongnaoyin group was significantly higher than that of the control group. The modified Rankin score was significantly higher than that of clopidogrel monoclonal antibody control group (all P 0.05), and the effect on improving middle cerebral artery stenosis was no less effective than that in clopidogrel group. Conclusion: Tongnaoyin can obviously improve the symptoms of neurological deficit, improve the quality of life and improve the stenosis of intracranial artery in patients with clopidogrel slow metabolic genotype acute ischemic cerebral infarction.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

【参考文献】