Based On Metabonomics Study The Mechanism Of Buyang Huanwu Decoction In The Treatment Of Patients With Cerebral Infarction In The Recovery Period

PurPose:1.To observe the clinical efficacy of Buyang Huanwu decoction in treating patients with qi and blood stasis syndrome in convalescent stage of cerebral infarction.2.Based on metabonomics,the serum metabolites of convalescent patients with cerebral infarction were compared with those of healthy controls,and the specific serum metabolites of convalescent patients with cerebral infarction were screened and analyzed,to explore the possible pathological role of these metabolites in the convalescent stage of cerebral infarction.3.Compare the blood metabolism spectrum before and after Buyang Huanwu decoction in the treatment of patients with qi deficiency and blood stasis syndrome of cerebral infarction,and analyze these metabolites to explore the mechanism of Buyang Huanwu decoction in the treatment of cerebral infarction in convalescent stage.Method:Randomized controlled clinical trial,32 patients with qi deficiency and blood stasis syndrome in convalescent stage of cerebral infarction were included,they were randomly divided into treatment group(16 cases)and control group(16 cases).On the basis of conventional western medicine in the treatment of cerebral infarction,the treatment group was treated with Buyang Huanwu decoction formula granule and the control group was treated with Placebo formula granule for 12 weeks.The observation Points of curative effect were selected on the day of entering the group and 12 weeks of treatment,observing the changes of(NIHSS)score of National Institutes of Health Stroke scale and TCM Syndrome Factor scale.At the same time,fasting venous blood samples were taken from patients before and after treatment,and then freezing the centrifuged serum in a refrigerator at-80 degrees Celsius.Based on the metabonomics technology of LC/MS,the multidimen-sional statistical method was used to analyze the serum metabolite spectrum of the patients with cerebral infarction in the treatment group and the control group before and after treatment and the healthy control group,to explore the changes and significance of metabolites in patients with cerebral infarction before and after treatment,and to explore the effect mechanism of Buyang Huanwu decoction in treating convalescent patients with cerebral infarction.Result:After 12 weeks of treatment,the degree of neurological impairment was significantly improved in both groups,according to the clinical evaluation of western medicine,the effective rate of the two groups is more than 85%;NIHSS score and TCM syndrome score were improved as compared with those before treatment(P<0.01).After 12 weeks of treatment,the score of TCM qi deficiency syndrome in the treatment group was significantly lower than that in the placebo group,but there was no significant difference in NIHSS score and blood stasis score between the two groups.Compared with healthy subjects,the increased levels of serum substances in convalescent patients with cerebral infarction were Oleic acid?L-valine?PC(18:0/20:4(8Z,11Z,14Z,17Z))?PC(20:3(5Z,8Z,11Z)/20:3(5Z,8Z,11Z))?PC(14:0/22:5(4Z,7Z,10Z,13Z,16Z))?PC(16:1(9Z)/22:2(13Z,16Z))?L-acetylcarnitine and LysoPC(20:4(8Z,11Z,14Z,17Z)),the declined substances are DHEA.Compared with before treatment,in the treatment group,the substances that rose after treatment in the convalescent patients with cerebral infarction were PC(18glaze),PC(18Z),PC(18:1(9Z)/20:4(5Z),11Z(11Z)14Z),PC(PC),linoleic acid(linoleic acid),arachidonic acid(arachidonic acid),SM(d18chrol)and SM(d18pur0),while palmitic acid decreased.Compared with before treatment,the substances that increased in the placebo group after treatment were PC(O-16:0/18:2(9Z,12Z))and L-acetylcarnitine,while those decreased were oleic acid,linoleic acid,arachidonic acid,total lysine,3-hydroxy-3-methyl-2-oxobutyric acid,and PC(16:1(9Z)/22:2(13Z,16Z))in the placebo group.Conclusion:1.Buyang Huanwu decoction combined with western medicine is superior to western medicine in improving the symptoms of qi deficiency in convalescent patients with cerebral infarction,but there is no significant difference between Buyang Huanwu decoction and western medicine in improving the degree of neurological deficit and blood stasis symptoms.2.L-acetylcarnitine,L-valine and dehydroepiandrosterone(DHEA)may be used as marker metabolites in the convalescent stage of cerebral infarction.3.Buyang Huanwu decoction can regulate the metabolic level of patients with qi deficiency and blood stasis syndrome in the recovery stage of cerebral infarction to a certain extent,and can increase the contents of some unsaturated fatty acids(linoleic acid,arachidonic acid),phosphatidyl choline(PC(o-16:1)?PC(o-18:1)?PC(18:0/20:4(8Z,11Z,14Z,17Z))),sphingomyelin(SM(d18:1)and SM(d18:0))in serum,while decrease the contents of palmitic acid.It can decrease the level of palmitic acid in serum,regulate energy metabolism,improve the degree of atherosclerosis,protect nerve cells damaged after ischemia and improve nerve function.However,this conclusion needs to be further explored and verified.The results of this study only preliminarily reveal the effect of Buyang Huanwu decoction on the metabolic level and the trend of metabolic changes in convalescent patients with cerebral infarction,and its reliability remains to be further verified.