| BackgroundStroke is known as "the first killer of human health", with high prevalence, high mortality, high morbidity and high recurrence rate. It is a serious public health problem of global issues. Cerebrovascular disease is the second cause of death in China, of which 1/3 of the patients died, the other 1/3 of patients had permanent disabilities, increasing burden considerably to social and family.Studing on stroke disease risk factors for treatment and prevention of stroke is the first question, by controlling these risk factors to prevent stroke. Diabetes is a major risk factor for stroke and one of the independent risk factor for atherosclerotic cerebrovascular disease. So treating cerebral infarction from the risk factors, and exploring its possible mechanism which is an important way to reduce the morbidity and mortality, improve quality of life and to prevent recurrence. Chinese medicine have unique advantages in the treatment of stroke. A comprehensive treatment program can obtain the best results, when we face the storke patients of many critical clinical syndrome. The comprehensive treatment based on traditional Chinese medicine consists of including yinaokao capsule, Huatuozaizao pill and Fleabane injection.PurposeThis study was designed to retrospectiviy analysis of the database by using a variety of statistical methods. Discussing the therapeutic effect of the comprehensive treatment based on traditional Chinese medicine for acute ischemic stroke patients with diabetes mellitus for neurologic impairment, disability, activities of daily living, traditional Chinese Medicine Syndrome and Symptoms. We copy the rat model of acute ischemic stroke based on atherosclerosis through animal experiments, and assess it from the behavioral, biochemical, immunohistochemistry and pathology; Mainly abserving the effect of Yinaokang capsule on blood biochemical parameters about insulin resistance and adiponectin levels, expression of adiponectin in vascular wall and pathological changes in brain tissue. We try to explain the possible action mechanism about Yinaokao capsule treating acute ischemic stroke from the insulin resistance.MethodClinical research:We analyzed retrospectively the database by the statistical analysis software SPSS13.0. Observing the effect of acute ischemic stroke patients with diabetes and without diabetic in the group of treated by the comprehensive treatment based on TCM. The effect consists of the level of neurological impairment, disability level, ADL, BI, their stroke symptom of TCM. Observing the effect of the acute ischemic stroke patients with or without a history of diabetes treated by the compretensive treatment based on TCM or Western medicine treatment. We discuss the effect of the compretensive treatment based on TCM for acute ischemic stroke with diabetes for their stroke symptom of TCM, the level of neurological impairment, disability level, BI, ADL.Animal experiment,115 rats were randomly divided into normalcontrol group, atherosclerotic group, compound model group, the Yinaokang capsule prevention group, Yinaokang capsule treatment group, Atorvastatin Calcium capsule treatment group., We replicate the rat models of atherosclerosis by feeding them high fat diet, then copy the ischemia model based on atherosclerosis rate models. Evaluating the model from the behavioral, biochemical, pathological and other aspects. We give Yinaokang Capsule to the the Yinaokang capsule prevention group in advance, and Yinaokang Capsule, Atorvastatin Calcium capsule to the other groups in normal treatment time. We evaluate the effect of the Yinaokang Capsule treatment from the behavior (Zea Longa neurological evaluation score), biochemical (glucose, insulin, adiponectin, free fatty acids, and calculated insulin resistance index), immunohistochemistry (adiponectin expression level in carotid artery expression), brain pathology, brain water content and so on. We try to explain the possible action mechanism about Yinaokao capsule treating acute ischemic stroke from the insulin resistance.ResultClinical part:For the comprehensive treatment based on TCM group with diabetes and non-diabetic patients of acute ischemic stroke after treatment, Results:There is no significantly difference in neurologic impairment, disability level, activities of daily living, Stroke symptom score of TCM between the two groups patients(P>0.05). After treated by the comprehensive treatment based on TCM or western medicine treatment for the acute ischemic stroke patients with diabetes. We can obtain that there are significant differences in decline, with statistically significant (P<0.05), compared with the baseline NIHSS score in the first 21 days for the degree of neurological impairment scores. There is significant difference between the GOS score (p<0.05) for disability levels between two groups in 21 days; BI index is not significant difference (P>0.05) on the first 21 days, following 60 days and 90 days;Stroke syndrome of TCM about life in 21 days,90 days has the statistically significant difference (P<0.05).It is seen that the comprehensive treatment based on TCM can improve neurologic impairment; to reduce the level of 21-day disability; to reduce the 90-day ADL after treatment;to reduce the 21-day and 90-day SSTCM; to improve the living capacity of patients up to 90 days; There is the trend of improving the quality of life of patients treated by the comprehensive treatment based on TCM. It is worth further research to the comprehensive treatment based on TCM.Experimental part:We feed the rats high fat diet to induce hyperlipidemia-insulin resistant rats, based on which reproducing the acute ischemia-reperfusion rat models in this study, which according to the pathogenesis of human ischemic stroke. Yinaokang capsule can reduces the blood glucose level, insulin level, insulin resistance index of the rat models compared before and after treatment; Atorvastatin Calcium capsule can reduce the insulin levels of the rat model, both medicines have little effect on the level of adiponectin. Atorvastatin Calcium capsule can reduce the level of free fatty acid of the rat model;the Yinaokang capsule prerusing can reduce the level of free fatty acids in rats. Three treatment groups are compared with eath other. The effect of Yinaokang capsule is better than Atorvastatin Calcium capsule for reducing the level of blood glucose. There is no significant difference between the three groups eath other in reducing insulin levels, insulin resistance index, adiponectin. The preusing Yinaokang effect of the reduction of free fatty acids better than the Atorvastatin Calcium capsule. no significant differences.Adiponectin Immunohistochemistry of the rats'carotid artery showes that positive adiponectin expression (2+) in the rats'vascular wall of compound model group weaker than the normal group (3+) before treatment. The positive expression of adiponectin is significantly increased strength than before in all of intervention groups after drug intervention. Expression of adiponectin in strength (4+) of the perusing Yinaokng group more strong than the other groups (3+) among them. We can see that Yinaokang capsule and Atorvastatin Calcium capsule can increase the expression of adiponectin in vascular wall, while improving insulin resistance of the rat model, And the expression of adiponectin of preusing Yinaokang group is enhanced more significantly than the other two groups.Pathological examination of brain tissue showed:the brain tissue of composite model group has serious edema and inflammation after treatment. There are significant cortical neurons repaired, inflammation disappeared, edema alleviated for intervention groups which compared with composite model in the same time. The effect is more better of perusing Yinaokang group than Yinaokang group, which suggests that preventive treatment of acute ischemic stroke effect is remarkable.Brain water content of the three intervention groups is decreased than of composite model group. But there is no statistical significance among the three groups.ConclusionClinical part:The comprehensive treatment of TCM can improve neurologic impairment degree, reduce disability levels, improve life ability, reduce SSTCM of the acute ischemic stroke with diabetic patients; The comprehensive treatment of TCM can improve the quality of life of patients with the trend.Experimental part:Yinaokang capsule can reduce the free fatty acid levels of ischemic stroke rats, and pre-using Yinaokang group'effect more better; Yinaokang capsule can significantly reduce the insulin resistance index, improve the adiponectin expression of the rats'carotid, improve the brain issue edema, repair the damaged cortical neurons of brain, and reduce the perivascular edema. The experiment results show that the treatment effect of Yinaokang by improving insulin resistance state, and prevention of drug better than the short-term medication. |
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