Effects Of Mijian Changpu Prescription On Vascular Cognitive Impairment And Neurotrophic Factors In Patients With Cerebral Infarction Of Intermingled Phlegm And Stasis Type

Objective To observe the effects of Mijian Changpu prescription on vascular cognitive impairment and neurotrophic factors in patients with cerebral infarction of intermingled phlegm and stasis type,exploring the clinical effect and possible mechanism of Mijian Changpu prescription in treatment of vascular impairment in patients with cerebral infarction of intermingled phlegm and stasis type.Methods 138 patients admitted from Hui Nationality Medicine Hospital of Traditional Chinese Medicine Affiliated to Ningxia Medical University from April 2016 to September 2017 were randomly divided into four groups,including Control group,Ginkgo biloba group,Nimodipine group and Mijian Changpu prescription group.34 cases in control group,35 cases in ginkgo biloba group,33 cases in nimodipine group and 36 cases in Mijian Changpu prescription group.Only conventional therapy were given patients in control group.The ginkgo biloba group was given ginkgo biloba extract tablet on basis of routine treatment,two tablets at a time and two times every day.The nimodipine group was given oral nimodipine tablet on basis of routine group,30 mg at a time and three times every day.The Mijian Changpu prescription group was given oral Mijian Changpu prescription decoction at the same time,one dose every day.14 days as a course of treatment,all groups were treated for two consecutive courses.Patients’ scores of the National Institutes of Health Stroke Scale(NIHSS),Mini-mental State Examination(MMSE)and Montreal Congnitive Assessment(MoCA)in all groups were examined before treatment,on the 14 th and 28 th days of treatment,to observe the clinical efficacy.All patients in the enrolled group were taken fasting to collect blood from the elbow vein and then collected the supernatant before treatment and on the 14 th and 28 th days of treatment.The levels of Nerve growth factor(NGF),Glial cell derived neurotrophic factor(GDNF),Brain derived neurotrophic factor(BDNF),Neuron core antigen(NeuN)and Neurone enolase(NSE)were detected,to clarify possible mechanism of Mijian Changpu prescription in treatment of vascular impairment in patients with cerebral infarction.Results1.The gender,age,education level,basic disease,and NIHSS,MMSE and MoCA scores of patients before treatment were not significantly different(P(29)0.05),so the baseline data were comparable.2.After treatment,the total effective rate of the control group was 65.6%,84.8% in the ginkgo biloba group,87.1% in the nimodipine group and 87.5% in the Mijian Changpu prescription group.The total effective rate of the Mijian Changpu prescription group was significantly higher than that of control group,the difference was significant(P(27)0.05).The total effective rate of the Mijian Changpu prescription group was higher than that of ginkgo biloba group and nimodipine group,but there was no statistical difference(P(29)0.05).3.Compared with before treatment,with the extension of treatment time,NIHSS scores were significantly reduced,MMSE and MoCA scores were significantly increased after treated 14 days and 28 days and followed up 3 months,especially patients in Mijian Changpu prescription group treated for 28 days and followed up 3 months improved more significantly(P(27)0.01).Compared with the control group at the same time point,the NIHSS scores of the Ginkgo biloba group,Nimodipine group and Mijian Changpu prescription group were significantly reduced after treatment at each time point(P(27)0.05,P(27)0.01).The scores of MMSE and MoCA increased significantly after treatment in Mijian Changpu prescription group at each time point(P(27)0.05,P(27)0.01).The MMSE and MoCA scores were significantly improved in the ginkgo biloba group and nimodipine group at the 28 th day and followed up 3 months(P(27)0.05,P(27)0.01).Compared with the ginkgo biloba group at the same time,the NIHSS scores of patients treated with nimodipine and Mijian Changpu prescription were significantly reduced at the 28 th day(P(27)0.05,P(27)0.01),and the MMSE scores were significantly improved at each time point after treatment(P(27)0.05,P(27)0.01),MoCA scores was significantly increased at the 28 th day and followed up 3 months(P(27)0.05,P(27)0.01).Compared with the nimodipine group at the same time,although the NIHSS scores of Mijian Changpu prescription group were reduced and the MMSE and MoCA scores were increased,but there was no significant difference between two groups(P(29)0.05).4.The serum levels of NGF,GDNF,BDNF,NeuN and NSE in four groups after treated 14 days and 28 days were better than that before treatment,and the improvement was more significant after treated 28 days than 14 days(P(27)0.05,P(27)0.01),especially the Mijian Changpu prescription groups treated 28 days(P(27)0.01).Compared with the control group at the same time point,the serum levels of NGF,GDNF,BDNF and NeuN of nimodipine group and Mijian Changpu prescription group increased significantly and NSE levels decreased significantly at each time(P(27)0.05,P(27)0.01).Compared with the ginkgo biloba group at the same time point,the serum levels of NGF,GDNF,BDNF and NeuN improved in the nimodipine group and Mijian Changpu prescription group,NSE decreased after treated 28 days in nimodipine group and at each time in Mijian Changpu prescription group(P(27)0.05,P(27)0.01).After treatment,although the serum levels of NGF,GDNF,BDNF,NeuN and NSE better in the Mijian Changpu prescription group than nimodipine group,but there was no significant difference(P(29)0.05).Conclusion1.Mijian Changpu prescription can significantly improve the vascular cognitive impairment in patients with cerebral infarction of intermingled phlegm and stasis type,promote the recovery of neurological function and improve the quality of life.2.Mijian Changpu prescription can improve the cognitive function of patients with cerebral infarction of intermingled phlegm and stasis type,effectively improve the patient’s learning and memory ability,and significantly delay the progression of cognitive impairment.3.Mijian Changpu prescription can significantly improve the vascular cognitive impairment in patients with cerebral infarction of intermingled phlegm and stasis type,which may be related to regulating the level of neurotrophic factor and exerting brain protection.