To Study Of The Clinical Efficacy And Mechanism Of Erigeron Breviscapus On Ischemic Stroke By CT Perfusion Imaging

ObjectivesThe study was aimed to evaluate 1)the establishment of collateral circulation for ischemic stroke patients who were treated with Erigeron Breviscapus injection;2)the effectiveness of Erigeron Breviscapus injection in the rehabilitation function and the disease outcome.The establishment of collateral circulation was evaluated by computed tomography perfusion(CTP).The effectiveness of Erigeron Breviscapus Injection was observed via monitoring the regulating effect of vascular endothelial growth factor(VEGF),hypoxia inducible factor-1(HIF-1a),angiopoietin-1(Angiopoietin,Ang-1),Ang-2,Interleukin-6(IL-6),plasma homocysteine(Hcy)in two areas:1)the mechanism between the therapeutic effect of Erigeron Breviscapus Injection on ischemic stroke and the formation of collateral circulation;2)the effect on the rehabilitation prognosis of patients.MethodTwo steps were taken for the study.Firstly,literature review,secondly clinical research.Through studying literatures from HowNet,VIP and Wanfang database,literature review provided a summary the knowledge of ischemic stroke in modern medicine and Traditional Chinese Medicine(TCM)Literature review also promoted a better understanding in the clinical significance and methods of establishing collateral circulation as well as rehabilitation prognosis for ischemic stroke patients,Thus,sufficient theoretical foundation was laid for clinical research.The second step was to conduct a randomized controlled clinical trial.We recruited 73 ischemic stroke patients.38 patients were in the experimental group and 35 patients were in the control group.Both groups were given symptomatic and supportive treatment as the basic treatment.the experimental group was additionally given Erigeron Breviscapus Injection 30ml each time,diluted with 250 ml 0.9%sodium chloride,once a day for 2 weeks.In the control group,250ml 0.9%sodium chloride injection was given intravenously once a day for 2 weeks.Within 48 hours and 30 days after admission,the formation of collateral circulation of cerebrovascular was assessed by CTP.Blood samples were collected from abdominal veins on the 1st,14th and 30th days after admission,and serum levels of vascular endothelial growth factor,HIF-la,Ang-1,Ang-2,IL-6 and Hey were measured.On the 1st,14th and 30th.day,the patients were scored with National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI),Simple Fugl-Meyer Assessment(FMA)and General ICF to evaluate the degree of neurological impairment,activities of daily living,motor function and comprehensive ability.Results1.Blood test results:On the 14th day of treatment,the expression of VEGF and Ang-2 in the serum of the experimental group was significantly higher compared with pre-treatment,and the expression of HIF-1?,Ang-1,IL-6 and Hey was decreased.The difference between pre-and post-treatment was statistically significant(F<0.05).The expression of VEGF and Ang-2 in the serum of the control group was increased,and the expression of HIF-1?,IL-6,Ang-1 and Hey was decreased,among which Ang-2 and HIF-1,The changes of IL-6,Ang-1 and Hey expression were significantly different compared with pre-treatment(P<0.05),but there was no significant difference between pre-and post-treatment in the control group(P>0.05).On the 30th day of treatment,the serum levels of VEGF and Ang-2 in the experimental group were still significantly higher vs.pre-treatment(P<0.05).HIF-1?,IL-6,Ang-1,Hcy The expression of inflammatory response factors was further reduced;the expression of serum VEGF,Ang-2,IL-6,Ang-1,Hcy and other factors in the control group gradually decreased.The results showed that the serum VEGF,Ang-2 expression and Ang-1 expression decreased significantly between the experimental group and the control group at the 14th and 30th day of treatment(P<0.05);HIF-1? The expressions of IL-6 and Hey decreased,and the decrease of HIF-1? was slower in the control group.The decrease of IL-6 and Hey was faster in the control group.There was significant difference between the two groups on the 14th day of treatment(P<0.05).There was no significant difference on the 30th day of treatment(P>0.05).2.Imaging results:Pre-treatment CTP detection indicates that the CBF and CBV blood volume of the affected area(ROI)is slightly lower on the healthy side,but the TTP and MTT time are significantly prolonged.CBF and CBV in the affected area was increased and improved after 30 days of treatment,while TTP and MTT time was shortened at admission.There was a significant difference between the experimental group and the control group(P<0.05).3.Rehabilitation assessment index results:The scores of NIHSS,BI,FMA and ICF were significantly different between the two groups on the 14th and 30th day of treatment(P<0.05);the scores of NIHSS,BI,FMA and ICF were significantly different between the experimental group and the control group on the 14th and 30th day of treatment(P<0.05)Conclusion1.The results showed that Erigeron breviscapus injection promoted the establishment of collateral circulation in the middle cerebral artery of patients with ischemic stroke by increasing the expression of serum vascular endothelial growth factor and Ang-2 and decreasing the expression of Ang-1,IL-6 and Hey.The content of HIF-1? was increased significantly in the early stage of onset and reached a peak,and gradually decreased over time.However,after the intervention of Erigeron breviscapus,the decrease of HIF-1? in the experimental group was slower in the control group,suggesting that the formation of collateral circulation is closely related to the HIF-1?/VEGF signaling pathway.2.CBF and CBV were increased and improved after 30 days of treatment,while TTP time and MTT time were shortened compared with at admission,the time changes of CBF,CBV,TTP and MTTsuggested that blood flow in ischemic penumbra area was improved after treatment of Erigeron breviscapus injection.It could indicate the establishment of collateral circulation to restore local blood supply when we compared the collateral circulation observed by CTA.The results showed that CTP had a strong sensitivity in the diagnosis of collateral circulation.3.The scores of NIHSS,BI,FMA and ICF rehabilitation scale showed that Erigeron breviscapus injection significantly reduced the scores of NIHSS and ICF in the experimental group of patients with ischemic stroke,alleviated the impairment of nervous function,increased the participation ability of patients,improved the scores of BI and FMA,improved the daily living ability of patients,and improved the recovery of limb function.Its function was related to the effective establishment of collateral circulation and the recovery of cerebral blood flow.If collateral circulation was well established,the recovery of brain function,daily living ability and limb behavior ability would be better.