Clinical Research Of Hua Yu Jie Du Tang On Inflammation After Acute Ischemic Cerebral Vascular Disease

【Objective】Cascade of damage is one of popular theory in the research of ischemic stroke. Its successfully summarized the occurance, development and result of local ischemia on the view of pathophysilogy according to the turn of time. This damage includes 4 processes, they are: excitotoxicity, peri-infarct depolarizations, inflammation and apoptosis. Among them, excitotoxicity and peri-infarct depolarizations take on in the first 24 hours after cerebral ischemia, owing to the shortage of energy supply and the release of K+ and glutanmate.the core of infarction and ischemic penumbra repetitively depolarize, and thus inspire spreading depression from the core to the pneumbra region. Inflammation can be recorded at the first several hours after ischemia, and grow in the following days. The former inflammation lead to toxicity to neurons (including oxygen free radicals and cytotoxic enzyme release,vasomotor reactivity, increased vascular permeability, increased cytokine release, and chemoattractant release) and microvascular occlusion; the latter inflammation is benefit for cleaning and plerosis of lesion. All processes of excitotoxicity, peri-infarct depolarizations, inflammation can aggravate local anoxia and ischemia. It is regarded that mild ischemia will induce apoptosis while severe ischmia induce necrosis. The degree of apoptosis and necrosis could affect the neurological function later, so anti-inflammation is a trend for acute ischmic stroke. Specifically, inflammation followed by ischemic cerebral injury is a dynamic interplay among various cells in the region of the damaged tissue, including neurons, fibroblasts, smooth muscle cells and endothelial cells, ws well as blood components, mainly granulocyte, monocyte, and platelets, which affect the local lesion just as a double edged sword, at first it lead to microvascular occlusion by granulocyte, finally could clean the lesion by monocyte and protect the neuron. So effective control of inflammation could attenuate the damage of ischemic stroke, and get good prognosis.In recent years, the research of traditional chinese medicine (TCM) on stroke develops, one scholar put forward a theory - cerebral collaterals withpoison, which lies to illustrate the path and the result of the poison to brain, spinal cord, and brain vitality caused by the combination of Wind, Phlegm,and Blood Stasis.The bad effect of inflammation of acute ischemic cerebral vascular disease is similar with the effect of Blood stasis and poison in the concept of stroke of TCM, so we design this schedule to observe the effect and mechanism of Hua Yu Jie Du Tang to patients with acute ischemic cerebral vascular disease. 【Method】Design: Prospective, interventional studyPatients and Setting: A total of 51 adults are all from the first and second wards of Neurology department in Xuanwu Hospital from 2002,May to 2002,December.Diagnosis and inclusion criteria: Acute ischemic infarction (onset of syndromes within 72 hours)Measurements: ① General data: gender, age, past history (including hypertension, cholestrol, triglyceride, diabetes mellitus, family history, heart dieases, smoke, high-salt food), complication, examination of TCD (transcranial Doppler) and Extracrainial carotid B ultrosound.② Stroke scale of TCM③ Neurologial deficits evaluation: NIHSS, Modified Scandinavian Scale.④ Parameters: Blood routine (granulocyte, monocyte, platelet, platelet diameter width), TNF-a, IL-1B,MPO(myeloperoxidase), CD62(Platelet activation marker),D-dimer, CRP(C reactive protein), MPA(monocyte-platelet). MPO, CD62 and MPA were measured by flow Cytometry.⑤ Measuring infarct and brain compartment volumes from MRI by hand or software. All results have been standardized.Record and Statistic Method:① At the first day collect and write down the general data of patients after check-in. At the first and 14th day examine blood routine twice. Sampling of CT,MRI, TCD and Extracrainial carotid B ultrosound.② Sampling of TNF-a, IL-1B, MPO, CD62, D-dimer,...