| Purpose:1.To observe the clinical effect of different traditional Chinese medicine injections for promoting blood circulation and removing blood stasis in the treatment of ischemic stroke by network meta-analysis.2.To observe the clinical efficacy of salvianolic acid for injection in the treatment of ischemic stroke in convalescence,and to observe its mechanism of promoting blood circulation and removing blood stasis by metabonomics.Methods:In Study one,we searched Chinese and English databases to obtain the literatures on the treatment of ischemic stroke with traditional Chinese medicine injections of promoting blood circulation and removing blood stasis.After layer by layer to screening,a total of 25 literatures were included,and R software was uesd for data processing and analysis.In Study two,39 convalescent patients with ischemic stroke who met the inclusion criteria were included.The patients were from Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine and Beichen District Hospital.of Tianjin.The course of treatment was 14 days.The NIHSS score and Barthel index before and after treatment were compared to observe the clinical efficacy of drugs.Principal component analysis and orthogonal partial least square method were used to analyze the different metabolites and metabolic pathways.Results:In Study one,traditional Chinese medicine injections for promoting blood circulation and removing blood stasis in the treatment of ischemic stroke by network meta-analysis.1.The results showed that 6 kinds of traditional Chinese medicine injections combined with conventional western medicine were better than conventional western medicine in improving the effective rate,NIHSS score and plasma viscosity.2.Breviscapine injection may be the best drugs in improving clinical efficiency,Xueshuantong injection may be the best drugs in improving NIHSS,and salvianolic acid for injection may be the best drugs in reducing plasma viscosity.In Study two,Therapeutic effect and metabolomics Study of salvianolic acid for injection in the treatment of convalescent ischemic stroke.1.The NIHSS scores of patients before and after drug treatment were 7.95 ± 3.15 and5.21 ± 2.86 respectively,and the Barthel Index scores of patients before and after drug treatment were 75.13 ± 12.06 and 90.26 ± 9.93 respectively;the NIHSS scores and Barthel index of patients after treatment with salvianolic acid injection for 14 days were significantly improved,the difference was statistically significant(P < 0.05).The results showed that salvianolic acid for injection can improve the clinical symptoms of patients with ischemic stroke in recovery period to a certain extent,and has certain clinical application value.2.The results of multivariate statistical analysis based on metabonomics technology showed that there were 30 different metabolites before and after salvianolic acid treat ment in patients with ischemic stroke at recovery stage.21 different metabolites were detected in metabolomics,among which L-valine,bilirubin,palmitoylsphingomyelin,ara chidonic acid and L-glutamic acid decreased after administration;hexadecamide,betain e,3-indoxylsuphate,Acetyl-L-carnitine,glycodeoxycholic acid,deoxycholic acid,Dodec yl sulfate,choline,citric acid,hippuric acid,3-hydroxybenzaldehyde,eicosapentaenoic a cid,oleic acid alkyne,imidazoleacetic increased after administration;Two different com pounds,N-acetyl-glycoproteins and D-3-hydroxybutyric were detected in NMR group,the contents of them were less before administration and increased significantly after adm inistration.Nine kinds of compounds were detected in lipid group,among which free f atty acid and phosphatidylglycerol decreased after administration;triglyceride,lysophosph atidylethanolamine,phosphatidylethanolamine,lysophosphatidylinositol,phosphatidylinosit ol,phosphatidylcholine and phosphatidylcholine increased after administration.3.A total of 22 metabolic pathways were detected in this study,among the main7 metabolic pathways were d-glutamine and d-glutamate metabolism;alanine,aspartate a nd glutamate metabolism;glycerophospholipid metabolism;porphyrin and chlorophyll met abolism;glycine,serine and threonine;glyoxylate and dicarboxylate metabolism;histidine metabolism.The major metabolic pathways are involved in the amino acid metabolism,lipid metabolism,energy metabolism and tricarboxylic acid cycle.Conclusion:1.Traditional Chinese medicine injections for promoting blood circulation and rem oving blood stasis can effectively treat ischemic stroke,which shows that2.Salvianolic acid for injection can effectively improve the clinical symptoms of p atients with ischemic stroke in convalescence;it can improve cerebral ischemia sympto ms by regulating amino acid metabolism,lipid metabolism and energy metabolism.Plas ma metabonomics suggests that amino acid metabolism and lipid metabolism may be r elated to the mechanism of salvianolic acid for injection. |
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