| Cerebral apoplexy is a common disease of human,with high morbidity,high mortality,high rate of disability and high recurrence rate of four high characteristics,which greatly endangers the health of the middle-aged and the elderly.Ischemic stroke,also known as stroke,accounts for first of the incidence of stroke,and it is also the first cause of stroke death.The recovery period of cerebral infarction is the best time for patients to recover and improve the symptoms of nerve function defect.The study of the pathogenesis of recovery period can provide the basis for clinical treatment,which has important clinical significance.Qi deficiency and blood stasis syndrome is an important syndrome in the recovery stage of cerebral infarction,and BuYang HuanWu decoction(BYHWT)is the main prescription for treating qi deficiency and blood stasis syndrome in the recovery stage of cerebral infarction.By observing the effect of BuYang HuanWu Decoction and its dismantling prescription on Qi deficiency and blood stasis syndrome in the recovery period of cerebral infarction,the mechanism of improving Qi deficiency and blood stasis syndrome is further explored,and the experimental basis for the in-depth study of the correlation of Qi and Blood is provided.ObjectiveTo study the mechanism of YiQi HuoXue Fang and its decomposed prescriptions in treating qi deficiency and blood stasis syndrome during cerebral infarction.MethodClinical studyA multi center,random,double blind,placebo-controlled trial was used to collect 80 cases of cerebral infarction in the outpatient and ward of three different hospitals,and the patients were randomly divided into four groups:Yiqi group,HuoXue group,YiQi HuoXue group and placebo group to treat for 12 weeks with different oral medicine.The TCM syndrome factor scale(Qi deficiency score,blood stasis score),the neurological deficit score,the Barthel index,the modified Rankin scale and so on were observed before and after the treatment,and the enzyme linked immunization was used.Methods serum SOD,MDA,NO,GLUT4,MMP-9,ET-1 and inflammatory factors were detected.Experimental studyA rat model of blood stasis syndrome of cerebral infarction was established by the method of exhausted swimming under starvation and compound thread suppository.After the model was successful,the model was randomly divided into sham operation group,model group,Yiqi group,blood activating group,Yiqi HuoXue group(BuYang HuanWu Decoction)and 3 weeks of gavage with its gastric drugs,BuYang HuanWu Decoction,supplementing qi and activating blood drugs and activating blood drugs..To calculate the body weight change and death rate of rats before and after administration,evaluate the symptoms of Qi deficiency,Blood stasis and nerve function,observe the morphological changes of the nerve cells in the infarct area and infarct area in rats by HE staining,observe the ultrastructure of the frontal parietal and hippocampal neurons in the rat brain under the electron microscope,and observe the rat serum by enzyme immunoassay.Changes of SOD and MDA index;Western Blot and PCR method were used to measure the protein expression and gene expression of Sirt-1-PGC1-alpha signaling pathway in rat cerebral cortex.ResultClinical research1.After treatment,the Qi deficiency score of each group decreased,and the decrease of YiQi group and YiQi HuoXue group was more obvious(P<0.01).The group of YiQi HuoXue group was significant compared with the placebo group;the blood stasis score decreased,and the blood circulation group and the YiQi HuoXue group decreased obviously(P<0.01).2.After treatment,the NIHSS scores were significantly reduced,the mRs score was reduced,and the Barthel index score increased,but there was no significant difference between the treatment group and the placebo group.3.After treatment,the serum levels of MDA and GLUT-4 were reduced.Compared with the placebo group,the content of MDA and GLUT-4 in the serum of YiQi HuoXue group was significantly lower than that of the placebo group(P<0.05 or P<0.01).4.The amount of serum SOD protein in all groups increased after treatment.Compared with the placebo group after treatment,the content of serum SOD in each treatment group increased,and the increase of the supplementing qi and activating blood group was more obvious.5.After treatment,the content of serum NO in the group of Yiqi and YiQi HuoXue group was lower than that of the placebo group after treatment,and the difference was significant in the treatment group,and the difference was more significant(P<0.05).6.After treatment,the content of IL-1 beta,ET-1 and MMP-9 in each group decreased,and the reduction of the YiQi HuoXue group was more obvious,the difference was significant(P<0.05).There was no statistical difference between the groups after treatment(P>0.05).Experimental Study1.Compared with the sham operation group,the serum Qi deficiency/blood stasis score of the model group was higher,the difference was statistically significant(P<0.01).Compared with the model group,the Qi deficiency and blood stasis score of the YiQi HuoXue Recipe and the dismantling group were significantly lower than those in the model group(P<0.01).2.The mortality rate of the model group is the highest,up to 38%,and the mortality of the YiQi group and HuoXue group is 23%.The lowest mortality rate of the YiQi HuoXue group is 15%.3.The body weight of the rats in the exhausted swimming rats was significantly reduced(P<0.01),and the weight of the model group decreased significantly at the 3 week after the operation(P<0.01),and the weight of the rats in the YiQi HuoXue Recipe and the dismantling group increased significantly(P<0.05).4.At 3 weeks after operation,the score of nerve function of model group was lower than that of 24h after operation.Compared with the model group,the score of nerve function of the YiQi HuoXue Recipe and the dismantling group decreased(P<0.01).5.HE staining showed that the large nerve cells in the middle cerebral artery necrosis area of the rat model group were seriously damaged,and the area of middle cerebral artery necrosis in the YiQi HuoXue Recipe and the dismantling group became smaller and the nerve cell injury was reduced.6.Under electron microscope,the structure of cortical and hippocampal neurons in the model group was destroyed and mitochondria were swollen and denatured,and the damage of neurons and mitochondria could be alleviated by the YiQi HuoXue Recipe and the dismantling group.7.YiQi group,HuoXue group and YiQi HuoXue group can improve serum MDA activity and reduce SOD activity.8.YiQi group,HuoXue group and YiQi HuoXue group can improve the expression of Sirt-1,PGC1-alpha,FOXO-3 protein and gene in the cerebral cortex of rats,and reduce the expression of ROS,GLUT-4,NADPH protein and gene.Conclusion1.The treatment of qi deficiency and blood stasis in the recovery period of cerebral infarction has a certain effect on the treatment of qi deficiency and blood stasis syndrome in the recovery period of cerebral infarction.It shows that the Qi supplementing method is also the key link in the treatment of cerebral infarction.Large dose of Astragalus is the key to the prescription of the prescription.2.Supplementing qi and activating blood can increase the content of serum SOD in patients with Qi deficiency and blood stasis in the recovery period of cerebral infarction,and reduce the content of NADPH,MDA,NO,ET-1,MMP9 and IL-1 beta.Among them,the method of Supplementing Qi is superior to the activating blood group in reducing NADPH,MDA,NO,ET-1,MMP9,and the content of beta.3.Supplementing qi and activating blood to treat the syndrome of deficiency of cerebral infarction and blood stasis of cerebral infarction.In regulating the SIRT1/FOXO3-PGC-1 alpha signaling pathway,Yiqi group is superior to the Huoxue group,which provides the experimental basis for the correlation theory of Qi and blood. |
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