| Stroke is the most common neurological diseases may morbidity in the first place, a serious threat to human health and quality of life. Modern medicine ever single therapeutic targets, or neurotrophic-based, or to improve the circulation-based, multi-drug therapy is often combined at the same time, will increase the side effects of the drug. NVU is proposed after the AIS neurons, glia, the overall reaction vessels placed in a micro-units, provides a multi-link, multi-target overall treatment ideas. After many modern medical-. research has yet to find a treatment for AIS has multiple targets, and the efficacy of certain drugs. Chinese medicine has a multi-component multi-target therapeutic advantages. Studies have shown that after Yiqihuoxue with improved clinical symptoms and reduce the inflammatory response AIS to improve the efficacy and mechanism of blood rheology, it has not been the lack-of clinical research on NVU overall protective mechanisms. This paper aims, to analyze from the perspective of bibliometric Chinese medicine treatment of ischemic stroke clinical trials of quantity and content and further observation Yiqihuoxue AIS-NVU treatment efficacy and mechanism of action through clinical studies. A Bibliometric analysisObjective:From the perspective of bibliometric, analyzes clinical trials of traditional Chinese medicine treatment of ischemic stroke, summarizes installment of governance in this area, including syndrome differentiation, treatment, therapies, Chinese medicine and so on. Then provide a reference for future research work.Method: Literature from January1994to2013by the end of December domestic biomedical journals and conferences treatise published in Chinese medicine as interventions in randomized controlled trials, non-randomized control trials. Literature research and content analysis were used. The use of computer databases to retrieve and combine hand searches. Search strategy of " ischemic stroke, cerebral infarction, ischemic cerebrovascular disease, ischemic stroke," and " Chinese medicine, clinical,case control" as key words, be extended retrieval. Using PASW Statistics18.0Statistical Package for the establishment of a database and data analysis.Results:1Terms of the number of documentsInto line with the standard literature1901, which randomized controlled trials787, non-randomized controlled trials1114.20years of clinical trials published in the medical treatment of cerebral infarction and the total number of randomized controlled several literature literature showed increasing trend year by year;non-randomized between1994-2007the number of documents in a growing trend, from2008began to decline. Randomized controlled literature, non-randomized control the number of articles published literature trend by lifting Runs run test, the difference was statistically significant (P<0.05).2Document content2.1staging and interventionIn acute stage, medical treatment up to a maximum AIS clinical trials, there are1611(accounting for84.74%);medicine for the treatment of major interventions AIS, but have focused on staging.①acute phase:Integrative medicine and intervention-based, there are1441(accounting for89.44%,1441/1611);②recovery:In addition to traditional Chinese medicine, acupuncture major proportion, there are51(30.36%,51/168);③sequelae:In addition to traditional Chinese medicine, rehabilitation29(23.77%,29/122) and acupuncture treatment27(22.13%,27/122) accounted for the major proportion.2.2Syndromes of10kinds of syndromeseach of the top three installments frequency has①acute phase:Tanyuzuluo229(representing14.21%), Qixuxueyu212(representing13.16%),wind phlegm Blockage116(7.20%);②recovery:phlegm and blood stasis syndrome29(17.26%), QDBS28(16.67%),hyperactivity syndrome20(11.90%);③sequelae:QDBS58(47.54%), phlegm and blood stasis syndrome29(accounting for23.77%),qi Deficiency17(13.93%).2.3Therapeutic treatment method of11kinds of treatmentTherapies, each installment has a frequency greater than10%of①acute phase:blood circulation act682(46.99%), Yiqihuoxue359(27.31%), sputum stasis Tongzhi Act169(11.73%);②recovery:blood circulation52(30.95%) Yiqihuoxue40(23.81%);③sequelae:Yiqihuoxue41(33.61%), blood circulation23(18.85%).2.4Use of TCMin1901literature, there are1664using traditional Chinese medicine, which has injection therapy962(50.60%), decoction treatment387(20.36%), oral agent therapy291(15.31%); acute phase QDBS application of traditional Chinese medicine injections literature showed that Qi principal of injection, there are19(28.36%,19/67), blood fleabane the most widely used class to have22(32.84%,22/67); decoction treatment, therapies to Yiqihuoxue (including BYHW-D) the highest frequency, there are168(43.41%,168/387), followed by Phlegm Tongzhi1aw, there are75(19.38%,75/387);Therapeutic efficacy of oral agents to Yiqihuoxue highest frequency, there are102(35.05%,102/291), followed by activating blood circulation, there are84(28.87%,84/291).2.5Use of single herbUsing decoction in387treatment literature, involving107kinds of traditional Chinese medicine. Frequency of greater than10%of the medicine are:Chuanxiong346(18.20%), TPG339(17.83%), Shichangpu311(16.36%), peach293(15.41%),safflower287(15.10%), leech254(13.36%), bile Southern Star251(13.20%), Astragalus243(12.78%), Tianma238(12.52%), Tianqi232(12.20%), Angelica225(11.84%), earthworm222(11.68%), Pinellia220(11.57%), Salvia197(10.36%), Citrus191(10.05%).2.6Each case of commonly used Chinese medicine syndromes①QDBS:Astragal us root, red peony, peach kernel, safflower, angelica, earthworm, etc;②wind phlegm closed resistance syndrome:Tianma, French summer, Atractylodes, Citrus, Poria, Chuanxiong, leeches, peach kernel, safflower, etc;③hyperactivity:Gastrodia, Uncaria, Scorpion, abalone, Siegesbeckiae, Achyranthes, Eucommia, mistletoe, antelope horn, chrysanthemum, Tribulusterrestris,Prunella etc;④phlegm Fushi:rhubarb, Glauber’s salt, citrus aurantium, hemp seed, walnuts, Polygonumcuspidatum, GualouKeren;⑤brain water stasis:rhizome,motherwort, Zeeland, Alisma, Passepartout, leech root, pangolin, frankincense, myrrh, etc.;⑥phlegm network card:root,red peony, peach kernel, safflower, Tianqi, leeches, pangolin, Shichangpu, melon, bile Southern Star, Zhuru, Fritillaria and so on.Conclusion:1This document published a few more areas and increasing year by year, the number of randomized controlled clinical trials literature is rising, non-Document number of randomized controlled trials showed a downward trend, clinical research and development of traditional Chinese medicine IS quickly and matures.2Chinese medicine treatment of ischemic stroke in the acute phase of the most studied, and each of TCM drugs and interventions have side Heavy, reflecting the characteristics of traditional Chinese medicine diagnosis and treatment.3. QDBS, phlegm and blood stasis syndrome has always been throughout the course of cerebral infarction, ischemic stroke’s basic pathogenesis, which centered qi, phlegm as the standard4. promoting blood circulation, Yiqihuoxue medicine treatment of ischemic stroke is the most common treatment method.5. Treatment of acute QDBS, Qi Astragalus injection drugs, blood Erigeron Injection drug were used most frequently, the efficacy demonstrated the highest intensity.6. commonly used traditional Chinese medicine normalization of six categories:①blood circulation drugs, such as root, red peony, peach kernel, safflower, pseudo-ginseng, angelica, salvia, hawthorn, Millettla etc.;②Po Yu Ditan drugs, such as ground long, leeches, pangolins;③phlegm drugs, such as French summer, Shichangpu, bile Southern Star, Fritillaria, Zhuru, melon, etc.;④Pingganxifeng drugs, such as Tianma.Scorpion, Uncaria,Stone decided that Siegesbeckiae etc.⑤liver and kidney tonic.nourishing Xifeng drugs, such as peony.turtle shell, Eucommia, Achyranthes, etc.⑥spleen Qi drugs such as Astragalus, Codonopsis, Poria, Atractylodes; clinical according card different type of addition and subtraction. B clinical research componentObjective: 1Observation Yiqihuoxue on AIS QDBS clinical efficacy and safety in patients with NVU protection.2Study early changes of AIS-NVU injury mechanisms in hematological markers, explore Yiqihuoxue treatment AIS-NVU injury mechanism; explore the clinical value of the composite index of Hematology NVU overall evaluation of the. extent of damage.Methods:All cases from Guangdong Provincial Hospital of Neurology inpatient, in strict accordance with the inclusion criteria, exclusion criteria. The main outcome measures relevant literature reference data, sample by sample size of two groups were compared designed formula, were included standard, and completed48cases of hospitalized patients with AIS experimental research for the study were randomly assigned method randomized to the control group and the experimental group, each group of24patients; Both groups were given conventional treatment, the control group with fleabane Injection (huoxuefa), the test group and fleabane+Astragalus injection (Yiqihuoxue) for7days. Observed before and after treatment in patients with the United States National Institutes of Health Stroke Scale (NIHSS score), patients with activities of daily living (ADL) scale (Barthel Index), Chinese stroke patients with neurological deficit score (the study of stroke score), Chinese Qi, stasis syndrome score; blood markers index (S100β protein, FPA, VEGF and MMP-9) were detected by ELISA; laboratory parameters selected platelet aggregation (PAgT) were observed; according to the patient before and after treatment liver and kidney function results, evaluation of Astragalus+fleabane injection combined clinical safetyResults:1. The main outcome measures NIHSS scores before and after treatment in the same group, the difference was statistically significant (P<0.01); After treatment, the difference between before and after treatment, the difference was statistically significant (P<0.01), prompted the two groups of patients are able to reduce the NIHSS improve the neurological deficit, the test group than the control group.2. Secondary outcomes.①ADL Scale (Barthel Index):Compared with the group before and after treatment, the difference was statistically significant (P<0.01); ADL Scale (Barthel Index) comparing the difference between the two groups before treatment and after treatment, the difference was statistically significant (P<0.01); degree of disability level comparison groups after treatment, the difference was statistically significant (P<0.05). Tip two groups can improve ADL scores, improving activities of daily living, reduce the degree of disability Barthel index improved experimental group than the control group.②stroke rating:Compared with the group before and after treatment, the difference was statistically significant (P<0.01), prompted both groups to improve the efficacy of neurological deficit; After treatment, the difference between before and after treatment, the difference was not statistically significant (P>0.05), suggesting that this study is not yet come to trial group improved clinical neurological deficit effective than the control group, considering the inclusion of cases with mild disease mainly before and after the treatment of limb muscle strength and speech points or less relevant.③TCM syndrome score:the same group of qi and blood stasis points after treatment, the difference was statistically significant (P<0.05); After treatment, the difference between before and after treatment, the difference was statistically significant (P<0.01). Tip two interventions can improve the signs and symptoms of blood stasis, higher efficacy of the test group.④efficiency:stroke improvement rate situation:The total effective rate was no difference, but the experimental group markedly effective rate was91.7%in the control group markedly effective rate of50%, suggesting that the experimental group than the control group; qi, blood stasis syndrome Designate improvement rate case:qi improve markedly effective test group was70.8%in the control group and markedly effective rate was25.0%; experimental group stasis improve markedly effective rate was79.2%with the control group, markedly effective rate was41.7%; has prompted experimental group than the control group.3. Serological screening and PAgT S100P protein, FPA, VEGF and MMP-9as NVU injury markers and the same period of observation PAgT, the indicators before and after treatment in the same group, the differences were statistically significant (P<0.05); groups after treatment, the difference between the indexes before and after treatment, the difference was statistically significant (P<0.05); prompt treatment, the method could have an impact on the pathogenesis of early AIS, and by protecting neurons, improve the mechanism of coagulation and fibrinolysis to protect the integrity of the BBB, inhibit platelet aggregation, thrombus dissolution micro role in protecting NVU, NVU test group of multi-target, multi-link protective effect was more significant.C. Experimental group had no adverse reactions during treatment.Conelusion:1. Yiqihuoxue therapy targetd to AIS QDBS, patients can reduce the degree of neurological impairment and disability and improve daily living skills, improve blood stasis syndrome, more effective than simply huoxue Therapy.2. Yiqihuoxue on the AIS-NVU has a protective effect, the combination of blood markers can be screened multi-evaluation mechanism for NVU injury, clinical serology guidance.3Chinese medicine Astragalus+Erigeron Injection clinical applications with high safety, side effects advantage. |
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