Effect Of The Xingnaojing Injection On Traumatic Brain Injury And Its Mechanism

Part I Effect of zhe xingnaojing injection on oxidative stress in rat model of traumatic brain injuryObjectiveTo evaluate the effects of different concentrations of zhe xingnaojing injection on oxidative stress injury in rats with traumatic brain injury(TBI).MethodsA total of 216 male Wistar rats were randomly divided into control group,sham operation group,TBI model group,Xingnaojing low-dose group,Xingnaojing medium-dose group and Xingnaojing high-dose group,36 in each group.The rat model of traumatic brain injury was made by Feeney s free fall method.The sham operation group only performed the skull retraction,and the blank group did not accept any treatment.The sham operation group,the blank control group and the TBI model group were injected with normal saline injection 5ml/kg·d,the Xingnaojing low dose group,the Xingnaojing middle dose group and the Xingnaojing high dose group were injected with 0.5mg/kg d,1 mg/kg d and 2 mg/kg d of Xingnaojing injection,respectively.Blood sample and brain tissue were collected randomly after 1h,3d and 7d,8 cases at each time.The levels of MDA and SOD in brain tissue,the levels of hs-CRP and TNF-? in blood samples,and the apoptosis index of brain tissue in each group was detected.Results(1)After the TBI model was constructed,MDA in the brain tissue of rats reached the highest level at 3 days after operation,and SOD level decreased to the lowest level 3 days after surgery.At 3d and 7d,the MDA level of TBI in the TBI model group and the Xingnaojing groups decreased with the dose of Xingnaojing injection;the middle and high dose groups were significantly lower than the TBI model group and the low dose group(P<0.05),there was no statistical difference between the dose groups(P>0.05).The levels of SOD in the TBI model group and the Xingnaojing group increased with the dose of Xingnaojing injection,and there was no statistical difference between the middle and high dose groups(P>0.05).(2)Serum hs-CRP and TNF-a significantly increased after model establishment,which was the highest at 3 days after model establishment.hs-CRP and TNF-a in the TBI model group and Xingnaojing treatment group showed a decreasing trend with the increase dose of Xingnaojing injection.There was no significant difference between the middle dose group and the high dose group(P>0.05).(3)The results of apoptosis detection showed that the apoptosis rate of brain cells was the highest at 3 days after model establishment.The apoptosis rate of brain cells at 3d and 7d was the highest in TBI model group and the lowest in blank control group.The apoptotic rate of brain cells decreased with the increase of Xingnaojing injection dose,and the middle dose group and the high dose group were significantly lower than the TBI model group and the low dose group(P<0.05),there was no statistical difference between the middle dose group and the high dose group in apoptosis(P<0.05).Conclusions(1)The xingnaojing injection can effectively reduce oxidative stress injury and inflammatory response after rat model construction,and reduce the level of central neuron apoptosis;(2)The protective effect of Xingnaojing injection on TBI rat model was dose-dependent,and the middle dose group(1mg/kg·d)could achieve a clear protective effect.Part II Clinical study on effect of the xingnaojing injection on oxidative stress in patients with moderate or severe traumatic brain injuryObjectiveTo investigate the clinical effect of Xingnaojing injection on moderate to severe traumatic brain injury.Methods104 patients with moderate to severe TBI were selected and randomly divided into treatment group and control group,with 52 cases in each group.The control group received conventional TBI treatment,and the treatment group was treated with Xingnaojing injection.The GCS and GOS scores of different groups were evaluated.On the day of admission,3d,7d and 14d after treatment,venous blood was collected to detect serum oxidative stress index(MDA,SOD)and inflammatory index(hs-CRP and TNF-a).The interval of memory arousal recovery and memory quotient(MQ)were evaluated before and after treatment.Results(1)94 subjects completed the program of this study,including 48 in the treatment group and 46 in the control group.There were no significant differences in age,gender,baseline GCS score,injury type,therapy and underlying disease between the treatment group and the control group(P>0.05).(2)With the progress of treatment,the GCS scores of the treatment group and the control group showed an upward trend,and the GCS improvement of the treatment group was more significant,which was significantly higher than that of the control group at 7 and 14 days after admission(P<0.05).The GOS scores 1 month after treatment in the treatment group was slightly higher than the control group,but with no statistical difference(P>0.05).The recovery time of conscious arousal in the treatment group and the control group was 7.4±1.4d and 8.2± 1.7,respectively,and the treatment group was significantly lower than the control group(P<0.05).(3)Serum MDA level was the highest at 3 days after admission,and then showed a downward trend;Serum SOD level was the lowest at 3 days after admission,and then showed an upward trend.The serum MDA level of the treatment group was significantly lower than that of the control group at 3d,7d and 14d after admission,and the SOD activity was significantly higher than that of the control group(P<0.05).(4)Serum TNF-a and hs-CRP increased significantly within 3 days after admission,and then decreased,which was significantly lower than admission at 14 days after admission.There were no significant differences in serum TNF-a and hs-CRP between the two groups(P>0.05).The levels of TNF-a and hs-CRP in the treatment group were significantly lower than those in the control group at 3d,7d and 14d after admission(P<0.05).(5)After treatment,the positive rate of MQ in the treatment group and the control group were 58.3%and 69.7%,respectively,but with(?)o statistical difference(P>0.05).Conclusions(1)The xingnaojing injection can reduce oxidative stress and inflammatory injury in patients with moderate to severe TBI,and then reduce secondary injury;(2)The xingnaojing injection can promote neurological recovery in patients,which is of good clinical application value.