Clinical Study Of Tongnao Decoction In The Treatment Of Acute Cerebral Infarction And Intracranial Arteriosclerosis With CYP2C19 Gene Mutation

Purpose:Through the observation of the clinical treatment of acute cerebral infarction patients with intracranial and extracranial arteriosclerosis,and based on the results of CYP2C19 gene detection,the clinical efficacy of Tongnao Decoction combined with conventional western medicine in treating patients with different CYP2C19 gene types of acute cerebral infarction and the improvement effect on intracranial atherosclerosis were discussed,so as to provide the clinical basis for the application of Tongnao Decoction in the treatment of this disease.Method:80 patients with acute cerebral infarction who met the inclusion criteria were selected.According to the CYP2C19 gene test results of patients,patients were randomly assigned to the middle metabolic group and the slow metabolic group,and then the two groups were randomly divided into the control group and the observation group according to the different treatment regimens.Group 1 was metabolized in the CYP2C19 gene and was treated with the control group;Group 2 was metabolized in the CYP2C19 gene and was treated in the observation group;Group 3:CYP2C19 gene slow metabolism,treated with control group;Group 4:CYP2C19 gene slow metabolism,treated with observation group.The number of cases in each group was 20.The patients were followed up.Before treatment,10 days after treatment and 90 days after treatment,the NIHSS score,mRS score and TCM symptom score were filled in,and the blood lipid index was rechecked;TCD and carotid ultrasound were reexamined before and 90 days after treatment.SPSS was used to analyze and compare the curative effect and related examination indexes of the four groups.After 90 days of treatment,the adverse reactions,TIA,cerebral infarction recurrence and death were observed in each group,To evaluate the effect of Chinese and Western medicine in the treatment of acute cerebral infarction and the improvement of intracranial and extracranial arteriosclerosis.Result:1.TCD related indicators(1)MCA:After 90 days of treatment,the VM of group 2 and group 4 was significantly higher than that before treatment(P<0.05),RI and PI values decreased significantly(P<0.05)o There was no significant difference of VM,RI and PI in each group after 90 days of treatment(P>0.05)?(2)BA:Compared with before treatment,VMS in each group were significantly increased after 90 days of treatment(P<0.05),The RI and Pi of group 2 and group 4 decreased significantly(P<0.05),There was no significant difference in RI and PI between group 1 and group 3(P>0.05)?After 90 days of treatment,there was no significant difference in VM,RI and PI among the groups(P>0.05)?2.Related indexes of carotid ultrasound(1)TPA:After 90 days of treatment,TPA decreased significantly in each group compared with that before treatment(P<0.05)?There was no significant difference of TPA in each group after 90 days of treatment(P>0.05)(2)Crouse Score:Compared with before treatment,crouse score of each group decreased significantly after 90 days of treatment(P<0.05)?After 90 days of treatment,crouse score of slow metabolism group(Group 3,group 4)was significantly higher than that of medium metabolism group(group 1,group 2)(P<0.05),There was no significant difference among the other groups(P>0.05)?(3)Vulnerable plaque:The proportion of mixed echo was the highest in each group,After 90 days of treatment,there was no significant change in the nature of plaques in each group compared with before treatment(P>0.05)?3.Blood lipid indexTC and LDL-c in each group decreased significantly with the prolonging of treatment time(P<0.05);TG did not decrease significantly after 90 days treatment(P>0.05);HDL-c levels in group 2 and group 4 were significantly higher on the 90d than before treatment,and the difference was statistically significant(P<0.05),There was no significant difference in HDL-C between group 1 and group 3 after 90 days of treatment and before treatment(P>0.05)?There was no significant difference between the groups after 10 days and 90 days(P>0.05).4.NIHSS score,mRS scale scoreNIHSS score and mRS scale score in each group showed a significant decrease with the extension of treatment time(P<0.05).However,there was no significant difference between 90d and 10d(P>0.05)?There was no significant difference in NIHSS scores and mRS scores between the groups at the 10th and 90th day of treatment(P>0.05)?5.TCM syndrome scoreWith the prolongation of treatment time,the scores of TCM syndromes in each group showed a significant downward trend(P<0.05)?90 days after treatment,the TCM syndrome score of group 4 was significantly lower than that of group 3(P<0.05)?Conclusion:The combined treatment of Tongnao Decoction and conventional western medicine has certain advantages in improving TCD related indexes of patients;The combined treatment of Tongnao Decoction and conventional western medicine can improve the blood lipid index of patients,and the level of HDL-C can be significantly increased when compared with western medicine alone;TPA and Crouse scores could be improved in each group,but the nature of plaques could not be improved.Treatment in each group can improve the relevant efficacy indicators.When CYP2C19 gene is slowly metabolism,the TCM syndrome score can be significantly improved by combining Tongnao Decoction with conventional western medicine compared with conventional western medicine alone;Except for the Crouse scores,the difference of slow metabolism in CYP2C19 gene had no significant effect on each group.