Salvianolate On Acute Large Artery Atherosclerotic Stroke

BackgroundAcute ischemic stroke(AIS)has become a common disease endangering the life of the middle-aged and elderly in China,and large atherosclerotic(LAA)stroke is the most common etiological subtype,which main pathological basis is atherosclerosis.The main guiding ideology of AIS is to restore the blocked blood flow as soon as possible,including drug thrombolysis,intravascular thrombectomy and so on,but it is limited by the treatment time window.For most patients who miss the time window for thrombolysis or thrombectomy,seeking more effective treatment strategies is an important clinical problem to be solved urgently.The efficacy of salvianolate on AIS,which is widely used in the treatment of ischemic cardiomyopathy,has gradually gained attention.However,it is mostly limited to animal experiments and clinical studies with small sample sizes,and the efficacy analysis of LAA stroke subtype is lacking,and the treatment mechanism is still unclear.ObjectiveUsing prospective randomized controlled study to evaluate the clinical efficacy of salvianolate on acute large atherosclerotic(LAA)stroke and explore the effect of salvianolate on the serum intercellular adhesion molecule-1(ICAM-1)in patients with LAA stroke.MethodsFrom November 2018 to November 2019,200 patients with acute LAA stroke from the First Affiliated Hospital of Xinxiang Medical University were randomly divided into control group or intervention group according to a 1:1 ratio using the random number table method.Each group was divided into 3 subgroups of mild,moderate and severe stroke according to the admission NIHSS scores.Both groups of patients were given conventional treatment.The intervention group was given intravenous injection of salvianolate 14 days on the basis of conventional treatment.The control group was given the same amount of normal saline as a placebo.On the day of admission(0d)and 14 days after treatment(14d),the National Institute of Health Stroke Scale(NIHSS)and Modified Barthel Index(MBI)were used to evaluate the neurological impairment and daily living ability of the patients;According to the degree of change of NIHSS score on 0d and 14d,the therapeutic effect and effective rate of patients in the 2 groups and each subgroup were compared;the serum intercellular adhesion molecule-1(ICAM-1)was detected by enzyme-linked immunosorbent assay content;Observe and record the degree of adverse events in two groups of patients.Results(1)There was no significant difference in NIHSS scores between the two groups before treatment(Z=-0.210,P>0.05).After treatment,the NIHSS scores in the intervention group was significantly lower than that in the control group,and the difference was statistically significant(Z=-3.489,P<0.05).The NIHSS scores of the intervention group and the control group were significantly reduced after treatment compared with those before treatment,and the difference was statistically significant(Z=-6.115,-2.568,all P<0.05).(2)There was no significant difference in MBI scores between the two groups before treatment(Z=-1.612,P>0.05).After treatment,the MBI scores in the intervention group was significantly higher than that in the control group,and the difference was statistically significant(Z=-4.133,P<0.05).The MBI scores of the intervention group and the control group were significantly higher after treatment compared with those before treatment,and the difference was statistically significant(Z=-7.148,-2.958,all P<0.05).(3)There was a statistical difference in the overall treatment effect between the two groups of patients(Z=-5.286,P<0.05).In the subgroup analysis,there were significant differences in the overall therapeutic effects between the intervention group and the control group among the three subgroups of mild,moderate and severe stroke(Z=-2.168,-3.770,-3.239,all P<0.05).(4)The total effective rate of the intervention group was higher than that of the control group,the difference was statistically significant(?~2=19.334,P<0.05),and among the three subgroups,in the subgroup of mild stroke,the total effective rate of the intervention group was not statistically significant compared with that of the control group(?~2=0.366,P>0.05),but in the moderate and severe stroke subgroups,the total effective rate significantly increased compared with control group,the difference was statistically significant(?~2=12.752,8.713,all P<0.05).(5)There was no statistically significant difference in serum ICAM-1 levels before treatment between the two groups(Z=-1.213,P>0.05).After treatment,the serum ICAM-1levels in the intervention group was significantly reduced compared with the control group,and the difference was statistically significant(Z=-6.644,P<0.05).The serum level of ICAM-1 in the intervention group and the control group after treatment was significantly lower than that before treatment,and the difference was statistically significant(Z=-7.969,-5.238,all P<0.05).(6)There was no significant difference in the incidence of adverse events between the two groups(P>0.05).ConclusionSalvianolate effectively improve the neurological deficit and the ability of daily living in patients with acute atherosclerotic stroke.The mechanism may be that it can reduce the level of ICAM-1 in serum and block the inflammatory cascade reaction in ischemic brain tissue.