Clinical Observation On Efficacy Of Tongnao Decoction In Treating Acute Cerebral Infarction With Intracranial Artery Stenosis And Genotype Mutation Of CYP2C19

Objective Exploring the new treatment of acute cerebral infarction with intracranial artery stenosis and poor metabolizer genotype of CYP2C19,observing the efficacyOf Tongnao decoction in treating acute cerebral infarction with symptom of phlegm and blood stasis,hoping to confirmed that this disease clinical efficacy can be improved and the recurrence rate can be reduced by Chiese medicine combined with western medicine,and provided clinical basis for the efficacy of Chiese medicine treatment.Methods 40 patients which match study standards of medium metabolizer genotype of CYP2C19 are divided randomly into clopidogrel group(short for group 1)20 cases and Tongnao decoction group(short for group 2)20 cases.40 patients which match study standards of poor metabolizer genotype of CYP2C19 are divided randomly into clopidogrel group(short for group 3)20 cases and Tongnao decoction group(short for group 4)20 cases.Each group give basic treatment,clopidogrel group is treated with clopidogrel seventy five milligram everyday,Tongnao decoction group is treated with clopidogrel seventy five milligram everyday and Tongnao decoction twice daily,the course of treatment is ninety days.According to the results to fill in the scale of NIHSS,mRS,Chinese symptom and examination table at 0d,14d,30d,and 90d.Analyzing by SPSS software to compare the clinical efficacy of four groups,and observing the recurrence after 90d of treatment,evaluating the clinical efficacy of Chiese medicine combined with western medicine.Results1.The score comparison aspect:(1)NIHSS score:compare within groups,the scales of group 1 and 3 are not significantly reduced until 90d of treatment(P>0.05);the scales of group 2 significantly reduce when 30d of treatment(P<0.05),the improvement of score is better with the extension of treatment time;the scales of group 4 significantly reduce when 14d of treatment(P<0.05);but the improvement of score is not better with the extension of treatment time.compare between groups,each group has no significant difference at 14 and 30d(P>0.05),when 90d of treatment,the scales of group 2 and 4 reduce significantly(P<0.05).(2)mRS score:compare within groups,the scales of group 1 and 3 are not significantly reduced until 90d of treatment(P>0.05);the scales of group 2 significantly reduce when 30d of treatment(P<0,05),the improvement of score is better until 90d;the scales of group 4 significantly reduce when 14d of treatment(P<0.05),but the improvement of score is not better with the extension of treatment time.compare between groups,each group has no significant difference at 14 and 30d(P>0.05),when 90d of treatment,the scales of group 2 and 4 reduce significantly(P<0.05).(3)Chinese symptom score:compare within groups,the scales of each group significantly reduce when 14d of treatment(P<0.05),the improvement of group 2 and group 4 score is better with the extension of treatment time.compare between groups,each group has no significant difference at 14 and 30d(P>0.05),when 90d of treatment,the scales of group 2 and 4 reduce significantly(P<0.05).2.The examination table comparison aspect:compare within groups,the CysC,TG and HDL with each group which are compared with before and after have no significant(P>0.05);the counts of PLT with group 2 improve significantly after treatment(P<0.05),and the Hcy,TC and LDL reduce significantly(P<0.05);the counts of PLT with group 4 improve significantly after treatment(P<0.05),and Hcy reduce significantly(P<0.05).compare between groups,each group has no significant difference with CysC,Hcy,TC,TG,HDL and LDL(P>0.05),when 90d of treatment,the PLT of group 2 and 4 improve significantly(P<0.05).3.The clinical efficacy comparison aspect:(1)The comprehensive curative effect:each group has no significant difference at 14 and 30d(P>0.05),when 90d of treatment,the comprehensive curative effect of group 2 and 4 is better then others significantly(P<0.05).(2)The long-term efficacy comparison aspect:the number of acute cerebral infarction recurrence cases of group 2 and 4 is less than group 1 and 3(P<0.05),and the number of group 2 is also less than group 4;the outcome of each group after treatment has no significant difference(P>0.05).Conclusion The clinical efficacy of this disease treated with Chiese medicine combined with western medicine is significant,especially for the patients with medium metabolizer genotype of CYP2C19,and the clinical efficacy is better with the extension of treatment time.