| Backgrand Cerebral infarction, also known as cerebral ischemic stroke, are corresponding neurological deficits due to cerebral artery blood flow interruption, regional cerebral hypoxic-ischemic tissue necrosis by variety reasons.if we can recover the oxygen and blood supply in the irrigator time after cerebral ischemia,it can provide nutrients for nerve and synapse regeneration, improve nerve function in patients. However, with the recovery of the ischemic area blood supply, may also lead to further tissue damage and dysfunction, namely is Ischemic reperfusion, I / R.Recent studies show that after cerebral ischemia-reperfusion injury, it can start their own angiogenic mechanism, establish collateral circulation, adapt or against hypoxic-ischemic brain injury, and promote the recovery of the physiological function of neurons. Therefore, appropriate regulation within endogenous angiogenesis and vascular network reconstruction effectively improve blood supply to the brain is essential for the recovery of neurological function after ischemia.Angiogenesis refers to the newborn and then plastic capillary sprouting from pre-existing collateral vessels, this is a complex physiological and pathological processes, including three consecutive link [1]:(1)growth factor receptors on endothelial cells are activated, increased permeability activation of vascular endothelial cells, basement membrane is dissolved;(2)endothelial cell proliferation, migration and proliferation bud;(3) bureaucratic remodeling, vascular smooth muscle cells, astrocytes cells proliferation and differentiate into mature blood vessel lumen.Endothelial progenitor cells can be directly differentiate into progenitor cells of endothelial cell, the number and function of endothelial progenitor cells as reflect endothelial cell markers [2]This article gives analysis in two ways, through animal experiments and clinical observations. First one is the basis of preliminary studies, the establishment of cerebral ischemia and reperfusion model in medicine Naomaitong interventions were used α-smooth muscle action(α-SMA) and CD133 as vascular smooth muscle cells(VSMC) and vascular endothelial progenitor cells(EPS) markers to reflectangiogenesis after focal cerebral ischemia in the infarct zone.While the clinical efficacy Naomaitong treatment of elderly patients with cerebral infarction were evaluated to detect expression of CD133 in patients with cerebral infarction in elderly explore mechanisms Naomaitong cerebral ischemic injury and the likely impact on.The subject focus on the ischemic stroke pathophysiological characteristics of elderly patients, and also explore the role of Chinese medicine treatment for ischemic stroke and its influence on angiogenesis.Is shows great social significance and scientific value.Objectives: 1. Using an animal model(SD rats) of ischemic focal intraluminal middle cerebral artery,observed the rats after I / R injury in young and aged rats with cerebral ischemia(I) 3h reperfusion(I / R) 24 h, 3d, 6d, 12 d cerebrovascular ultrastructural changes; and study reperfusion of Naomaitong to the aged rats with cerebral ischemia injury; 2. By exploring young model group, aging model group, nimodipine group, rats I3 h Naomaitong group, I / R24 h, I / R 3d, I / R 6d, I / R 12 d cerebral cortex penumbra microvascular α- SMA expression, revealing the aged rats I / R brain angiogenesis characteristics and Naomaitong to its impact. 3. By studying young model group, aging model group, nimodipine group, rats I3 h Naomaitong group, I / R24 h, I / R 3d, I / R 6d, I / R 12 d cerebral cortex penumbra CD133 expression changes in aged rats revealed I / R angiogenesis characteristics and Naomaitong to its impact. 4. By observing elderly patients with cerebral infarction the first day of admission, the 14 th day of treatment, the 28 th day of treatment and clinical symptoms NHISS scale score score quantization table, explore what affects Naomaitong bring elder cerebral ischemis patients to their nerve function. 5. The 28 days CD133 protein expression in peripheral blood; expolring elder cerebral infarction patients’ peripheral blood CD133 expression changes and Naomaitong to their impacts.Methods 1. Using MCA suture focal cerebral ischemia(I) 3h reperfusion(I / R) 24 h, 3d,6d, 12 d animal models.Observing at different time points ultrastructural changes inbrain tissue after cerebral I / R by electron microscopy, explore Naomaitong affected to the aged rats with cerebral ischemia reperfusion injury pathological changes in brain tissue. 2. Using MCA occlusion in rats focal cerebral ischemia(I) 3h reperfusion(I / R) 24 h, 3d, 6d, 12 d animal model, using immunohistochemistry compare the rats in each group I 3h, I / R1 d, I / R3 d, I / R6 d, after I / R12 d cerebral cortex penumbra microvascular changes in α-SMA expression, exploring what impacts Naomaitong bring to the aged rats after ischemia-reperfusion microvascular changes in the expression of α-SMA impact. 3. Using MCA occlusion in rats focal cerebral ischemial(I) 3h reperfusion(I / R) 24 h, 3d, 6d, 12 d animal model, using immunohistochemistry compare cerebral ischemia 3h and then each group perfusion 1d, 3d, 6d, 12 d after cerebral cortex penumbra CD133 expression changes, exploring what impacts Naomaitong bring to ischemia reperfusion CD133 expression in brain tissue; 4. Observing the selected 72 cases of patients with ischemic stroke on clinic.On the basis of conventional therapy, named them as Naomaitong-using group and the control group, measured in each group of patients admitted to hospital the first day, the 14 day of, the 28 day of treatment and clinical symptoms NHISS Scale score score quantization table, exploring what affects Naomaitong in elderly patients with cerebral ischemia to their nerve function. 5. By flow cytometry selected patients admitted to hospital the first day, the 14 day of treatment, CD133-positive peripheral blood marks the 28 day of treatment, exploring the impacts that Naomaitong give to the elder peripheral blood CD133 patients with cerebral infarction expression of changes.Result 1. The brain tissue ultrastructural changes on the aged rats with cerebral ischemia reperfusion and Naomaitong to their impact. Young sham-operated rats group showed continuous and complete vascular basement membrane, normal endothelial cells’ structure, clear mitochondrial structure, seen endocytic vesicles in the cytoplasm; young model group showed the basement membrane, mitochondria and perivascular edema in varying degrees, in I / R1 d, I / R3 d most severe, I / R6 d, I / R12 d gradually reduced; microvessels around elder shamgroup was not edema, endothelial cells and mitochondrial structure is basically complete, swallowing vesicles reduced; for the aging model group, perivascular,cytoplasmic and mitochondrial became edema, particularly in I / R 3d heaviest; nimodipine group rats’ endothelial cell mitochondria were edema, particularly I / R12 d heaviest; Naomaitong group showed mild perivascular edema, endothelial cell mitochondria swelling in I / R12 d significantly reduced. 2.The impact of aging brain when I R α-SMA protein expression changes and drive its expression Naomaitong The experimental results showed that: a small amount of expression of α-SMA-positive youth sham group and the sham group of aging are visible; the positive expression group of young model I / R 1d rise at the beginning, I / R6 d, I / R 12 d at a higher level; compared with the model group, youth, aging model group I 3h, I / R1 d, I / R3 d, I / R12 d expression group were lower than those of young model(P <0.05, P <0.01); compared with the same time the aging model group, Naomaitong group and α-SMA expression nimodipine group were higher than the aging model group(P <0.05). 3.The proteim expression time changes of aging rats’ brain I / R CD133 and Naomaitong its expression The experimental results showed that: the young and the aged sham group sham group were seen few positive CD133 expression, expression began to rise at the I / R 1d, I / R6 d highest, I / R 12 d began to decline; the same time with the young model group CD133 expression in aging model group points relatively low, at I / R3 d, with statistical significance(P <0.05, P <0.01) when the I / R6d; aging model group compared with the same point in time, nimodipine and brain brain tissue Naomaitong group CD133 expression levels were increased(P <0.05, P <0.01); compared with the nimodipine group at the same time point, Naomaitong group I 3h, I / R1 d, I / R3 d, I / R6 d, I / R12 d CD133 expression in rat brain tissue levels increased, but not statistically significant. 4.Naomaitong on NHISS scale score and TCM symptom rating scale changes in patients with cerebral infarction The clinical observation that: compared with the control group at the same time, the 14 day of treatment, the treatment group the 28 day Naomaitong NHISS scale scores than the control group; compared with the control group of the same time, the 14 day of treatment(P <0.05.) treatment of 28 days clinical symptoms of cerebral veins through group grading scale scores than the control group(P <0.05.) 5. Naomaitong’s influence on the expression time changes of peripheral bloodCD133 of elder patients with cerebral infarction. After the loss of cell cytometry discovery: the elderly CD133 expression in peripheral blood of patients with cerebral infarction up to 14 d and Naomaitong group was higher(P <0.01), 28 d CD133 expression lower than the 14 days(P <0.01), still higher than the day of admission(P <0.01).Conclusion 1. Under the same condition I / R injury, compared with the model group at the same time,the young, the aged rat model group appeared earlier injury, damage heavy, slow recovery; aging model group compared with the same point in time, Naomai through group pathological tissue injury and nimodipine group lesser extent especially in rat brain tissue damage Naomaitong group lightest, fastest repair, suggesting Naomaitong can significantly improve the aging brain I / R after the organization injury; 2. After the aging brain I / R injury, visible expression of angiogenesis within the brain tissue protein marker α-SMA, and with the extension of the brain I / R time, the expression gradually increased; aging model group compared with the same point in time, The expression levels of Naomaitong group and nimodipine group increased α-SMA protein, especially Naomaitong group significantly, suggesting Naomaitong promote angiogenesis aged rats after cerebral I / R; 3. After the aging brain I / R injury, angiogenesis within the brain tissue visible markers CD133 protein expression, and with the extension of the brain I / R time, the expression gradually increased; compared with the same time the aging model group, cerebral veins The expression level through group and nimodipine group α-SMA protein increased, especially Naomaitong group significantly, suggesting Naomaitong promote angiogenesis aged rats after cerebral I / R; 4. Elder patients with cerebral ischemia in the pathogenesis of acute clinical symptoms NHISS grading scale score and the highest score quantization table, with the extension of cerebral ischemia time, the score decreased, Naomaitong group significantly, suggesting Naomaitong can improve elder patients with cerebral ischemic neurological function; 5. Elder patients with cerebral ischemia in the pathogenesis of acute peripheral blood CD133 expression seen in the treatment of 14 days maximum positive expression, the treatment 28 days has declined significantly Naomaitong group, suggestingNaomaitong can promote cerebral ischemia in elder patients after angiogenesis. |
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