补阳还五汤联合西医常规治疗气虚血瘀型急性脑梗死的临床研究

Clinical study of Buyang Huanwu Decoction combined with conventional western medicine in the treatment of acute cerebral infarction of qi deficiency and blood stasis type

关键词:  急性脑梗死  补阳还五汤  美国国立卫生研究院卒中量表  同型半胱氨酸  基质金属蛋白酶-9

Key words:  acute cerebral infarction  Buyang Huanwu Decoction  national institutes of health stroke scale  homocysteine  matrix metalloproteinase-9

摘要:

[目的] 探讨补阳还五汤联合西医常规治疗气虚血瘀型急性脑梗死（ACI）的疗效及对神经功能、同型半胱氨酸（Hcy）和基质金属蛋白酶-9（MMP-9）的影响。[方法] 采用随机对照试验设计，选取2023年10月—2025年8月收治的184例气虚血瘀型ACI患者，使用计算机生成的随机数字序列按照 1∶1的比例分为对照组和观察组，各92例。对照组给予西医常规治疗（控制血压血糖、调脂、抗血小板、改善循环、营养神经等），观察组在对照组治疗基础上加服补阳还五汤，每日1剂，疗程4周。比较两组治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分、中医证候积分、临床疗效，以及血清Hcy、MMP-9、神经元特异性烯醇化酶（NSE）、超氧化物歧化酶（SOD）和丙二醛（MDA）水平。[结果] 治疗后，两组患者的NIHSS评分、中医证候积分及Hcy、MMP-9、NSE、MDA水平均较治疗前显著降低（P<0.05），SOD水平显著升高（P<0.05），且观察组的改善幅度均显著优于对照组（P<0.05）。观察组的临床总有效率为98.91%，显著高于对照组的82.61%（P<0.05）。两组不良反应发生率无显著差异。[结论] 补阳还五汤联合西医常规治疗能显著改善气虚血瘀型ACI患者的神经功能、中医证候及血清学指标，安全性良好，其作用可能是通过多靶点作用干预ACI的多个关键病理环节。

Abstract:

[Objective] To investigate the efficacy of the Buyang Huanwu decoction combined with conventional Western medicine in treating qi deficiency and blood stasis type acute cerebral infarction（ACI），as well as its effects on neurological function，homocysteine（Hcy），and matrix metalloproteinase-9（MMP-9）. [Methods] A randomized controlled trial design was adopted. From October 2023 to August 2025，184 patients with qi deficiency and blood stasis type ACI were selected and randomly divided into the control group and the observation group at a ratio of 1∶1 using a computer-generated random number sequence，with 92 cases in each group. The control group received conventional western medical treatment（controlling blood pressure and blood sugar，lipid regulation，antiplatelet therapy，improving circulation，and nourishing the nervous system，etc.），while the observation group was treated with the Buyang Huanwu decoction in addition to the treatment of the control group，one dose per day，for a course of 4 weeks. The NIHSS scores，TCM syndrome scores，clinical efficacy，and serum levels of Hcy，MMP-9，neuron-specific enolase（NSE），superoxide dismutase（SOD），and malondialdehyde（MDA） before and after treatment were compared between the two groups. [Results] After treatment，the NIHSS scores，TCM syndrome scores，and serum levels of Hcy，MMP-9，NSE，and MDA in both groups were significantly lower than those before treatment（P<0.05），and the SOD level was significantly higher（P<0.05）. The improvement in the observation group was significantly better than that in the control group（P<0.05）. The total clinical effective rate of the observation group was 98.91%，significantly higher than that of the control group（82.61%）（P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups. [Conclusion] The combination of Buyang Huanwu decoction with conventional western medical treatment can significantly improve the neurological function，TCM syndrome，and serum indicators of patients with qi deficiency and blood stasis type ACI. It is safe and its effect may be through multi-target intervention to interfere with multiple key pathological links of ACI.