| Background:Stroke refers to brain ischemic or hemorrhage based on blood vessel wall lesion or blood flow disorders,which cause temporary or persistent,local or diffused brain damage. It is a kind of disease of high incidence,high morbidity,high mortality,high recurrence rate and low cured rate. China has 1.95 million of new stroke patients each year, and 1.56 million people died of stroke,5-7 million people survive of cerebral apoplexy. To a developing country, it is undoubtedly a heavy burden to the society and patients'family. Therefore the research of stroke prevention and therapy is always a hotspot in the medical field. Cerebrovascular disease and heart disease are ranked in the first three main causes of death, and heart disease is a risk factor for stroke. Cerebrovascular disease and cardiovascular disease have many common in the pathophysiological mechanisms. Exploring their clinical and basic relationship has been the hot topic all the while. TCM is a kind of medicine of curing disease from more capable of targets and aspects. YiNaokang is an experienced formula of Guangdong hospital of TCM's famous professor LiuMaocai for curing stroke,it has a function of supplementing qi and activating blood circulation eliminating phlegm and freeing channel and has been exploited to be the hospital's preparations and been widely used in clinical and clinical curative effect is distinct, consequently it is of great significance to further study its mechanism of curing stroke.Objective:This dissertation is made up of two parts, the first part was clinical research and the second was animal experiment. The clinical research part is based on the Ministry of Science and Technology's 10th five year science research project "Demonstration Research of Acute Ischemic Stroke's Syndrome Differentiation and Therapeutic Effect Evaluation" (NO.2004BA721A02)'s database. Its main purpose is to evaluate the TCM comprehensive plan's therapeutic effect on these acute ischemic stroke patients who once have heart disease through statistic their NIHSS,BI,SS-QOL score and SSTCM related scores and compared them with Western Medicine's foundational scheme. Animal experiments is designed to study how the YiNaokang affect the atherosclerosis SD mices'and AS based acute ischemic stroke SD mices'blood cholesterol,ox-LDL,ICAM-l,VEGF,etc, so as to explain its mechanism.Method:This study's clinical part based on the Ministry of Science and Technology's 10th five year science research project "Demonstration Research of Acute Ischemic Stroke's Syndrome Differentiation and Therapeutic Effect Evaluation" (NO.2004BA721A02)'s database, firstly analysis and describe the patients who has heart disease, then statistic their BI,NIHSS,SS-QOL score and SSTCM related scores to compare the therapeutic effect of TCM comprehensive treatment and western medicine's basic treatment, at the same time, pair the back and forth time of the different kinds of scores of TCM comprehensive treatment group's so as to evaluate the TCM comprehensive treatment's effect on them.Animal experiments part:select male SD rats weighted 180g±20g, using random number way to divide them into A group (normal) 15;B-E group (model) 100, among them group C is atherosclerosis group,D is composite group,B is Yi Naokang foregoing group,E is YiNaokang group,F is lipitor group. At the 8th day the 100 rats of groupB,C,D,E,F would be given intraperitoneal injection of VD3 one-time and then begain to supply with high fat feed to copy AS model, at the 65th day, inject ET-1 near the MCA area except group C to copy AIS model. Observe the general condition of them, at the 74th,10 rats would be picked out randomly to draw blood so as to test (ELISA way) blood lipids and LDL,ox-LDL,ICAM,VEGF concentration, pick out 2 randomly from each group to observe the brain pathological change.Result:Clinical research:①Of all patients,106 patients have heart disease, occupied 19.73%,60 have coronary heart disease or angina or miocardial infarction, occupied 56.60% of all the patients with heart disease,11.55% of all the 537 patients;②NIHSS,BI,SS-QOL,TCM related scores of AIS patients with heart disease between A, B groups have no significant statistical difference (P>0.05);③Treated with TCM comprehensive method, between the AIS patients with and without heart disease, the NIHSS scores have significant statistical difference(P<0.05) at the baseline, have no significant statistical difference on the day 7th,14th,21th; the BI scores have significant statistical difference (P<0.05) on the day 60th,90th, have no significant statistical difference on the 21th day (P>0.05);SS-QOL score have no significant statistical difference on the 14th,21th day (P>0.05), have significant statistical difference(P<0.05) on the day 60th,90th; SSTCM-Severity score have no significant statistical difference on the 0th,7th day (P>0.05), have significant statistical difference(P<0.05) on the day 14th,21th,60th,90th; SSTCM-Influence on day-life have no significant statistical difference on the 0th day (P>0.05), have significant statistical difference on the day7th,14th,21th,60th,90th (P<0.05); SSTCM-Total Score have no significant statistical difference on the 0th,7th day (P>0.05), have significant statistical difference on the day 14th,21th,60th,90th(P<0.05).④The different kinds of scores of AIS patients with heart disease in the TCM comprehensive treatment group compared back and forth time all have significant statistical difference.Experiment research:①The YiNaokang foregoing group's TCHO,TG,LDL,HDL,ApoA are significant statistically different compared with AS group. The YiNaokang foregoing group's ox-LDL,ICAM,VEGF level are significant statistically different compared with AS group, and in lowering TG,HDL, YiNaokang foregoing group and YiNaokang group are significantly statistically different compared with AS group. Chinese traditional medicine showed numerical advantage over lipitor group in reducing TCHO and TG, LDL-C.②In reducing TCHO,TG,LDL-C and rising ApoA, the YiNaokang foregoing group,YiNaokang group and lipitor group have significant statistical difference compared with AS and AIS group. YiNaokang foregoing group,YiNaokang group showed numerical advantage over lipitor group in reducing TCHO,TG and LDL-C. YiNaokang foregoing group,YiNaokang group and lipitor group have statistical significant difference compared with AS group and AIS group in lowering ox-LDL. YiNaokang foregoing group,YiNaokang group and lipitor group have significant statistical difference compared with AIS group in lowering ICAM. YiNaokang foregoing group,YiNaokang group and lipitor group have significant statistical difference compared with AS group and AIS group in VEGF level.Conclusion:Clinical research:①Stroke patients with higher prevalence of coronary artery disease;②The TCM comprehensive treatment doesn't show significant statistical difference compared with western medicine's basic treatment on patients with and without heart disease;③The symptoms are obviously heavier on the AIS patients with heart disease than those without heart disease in different time; The TCM comprehensive treatment show good effect on AIS patients without heart disease in the first 2 weeks, but show effect on AIS patients with heart disease after the first 2 weeks.④The TCM comprehensive treatment show good effect on the AIS patients with heart disease through comparing the different kinds of scores of AIS patients with heart disease back and forth time.Experiment research:①YiNaokang could prevents atherosclerosis devel-opment through reducing TCHO,LDL,TG,ox-LDL,ICAM,VEGF and rising HDL,ApoA level.②YiNaokang can significantly decrease AIS SD rats's ox-LDL, ICAM and VEGF level, so it is inferred that YiNaokang's treatment effect on ischemic stroke is probably through regulating lipid metabolism and lowering ox-LDL,VEGF,ICAM in the process of atherosclerosis'formation and development. |
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