目的 探討通心絡(luò)膠囊聯(lián)合復(fù)方腦肽節(jié)苷脂注射液治療急性腦梗死恢復(fù)期的臨床療效。方法 選取2020年6月—2021年6月在廊坊市中醫(yī)醫(yī)院接受治療的105例急性腦梗死恢復(fù)期患者，根據(jù)用藥差別將所有患者分為對照組52例，治療組53例。對照組患者靜脈滴注復(fù)方腦肽節(jié)苷脂注射液，20 mL同0.9%氯化鈉注射液300 mL配伍，1次/d；治療組在對照組基礎(chǔ)上口服通心絡(luò)膠囊，4粒/次，3次/d。兩組均連續(xù)治療2周。觀察兩組的臨床療效，比較兩組相關(guān)量表評分、細胞因子水平、血栓彈力圖指標和頸動脈超聲指標的變化情況。結(jié)果 治療后，治療組患者總有效率為98.11%，顯著高于對照組的80.77%（P<0.05）。治療后，兩組患者日常生活活動能力量表（ADL）評分、健康促進生活方式量表Ⅱ（HPLPⅡ）評分、肢體運動功能量表（FMA）評分均較治療前顯著升高，而美國國立衛(wèi)生院卒中量表（NIHSS）評分顯著降低（P<0.05）；并以治療組患者改善的更明顯（P<0.05）。治療后，兩組患者血清腦源性神經(jīng)營養(yǎng)因子（BDNF）、轉(zhuǎn)化生長因子-β1（TGF-β1）、基質(zhì)細胞衍生因子-1（SDF-1）均較治療前顯著升高，而氧化應(yīng)激骨橋蛋白（OPN）、高遷移率族蛋白B1（HMGB1）水平均顯著降低（P<0.05）；并以治療組改善的更明顯（P<0.05）。治療后，兩組患者血栓彈力圖反應(yīng)時間（R值）、凝固時間（K值）均較治療前顯著降低，而凝固角（Angle角）、血栓最大幅度（MA值）均顯著增加（P<0.05），并以治療組患者改善更為明顯（P<0.05）。治療后，兩組頸動脈管腔狹窄程度、CCA僵硬指數(shù)均較治療前顯著降低，而擴張指數(shù)、順應(yīng)指數(shù)均顯著升高（P<0.05），并以治療組改善更明顯（P<0.05）。結(jié)論 通心絡(luò)膠囊聯(lián)合復(fù)方腦肽節(jié)苷脂注射液治療急性腦梗死恢復(fù)期具有較好的臨床療效，可有效促進患者神經(jīng)功能恢復(fù)，保護腦神經(jīng)功能，提高患者運動功能，改善機體細胞因子表達，有著良好的臨床應(yīng)用價值。

Objective To explore the clinical efficacy of Tongxinluo Capsules combined with compound porcine cerebroside and ganglioside in treatment of convalescence of acute cerebral infarction. Methods A total of 105 patients with acute cerebral infarction convalescence who received treatment in Langfang Hospital of Traditional Chinese Medicine from June 2020 to June 2021 were selected, and all patients were divided into control group (n=52) and treatment group (n=53) according to medication difference. Patients in the treatment group were iv administered with Compound Porcine Cerebroside and Ganglioside Injection, 20 mL was compatible with 0.9% sodium chloride injection 300 mL, once daily. Patients in the treatment group were po administered with Tongxinluo Capsules on the basis of the control group, 4 tablet/time, three times daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the scores of related scales, cytokine levels, thrombolysis indexes and carotid ultrasound indexes were compared between the two groups. Results After treatment, the total effective rate in the treatment group was 98.11%, significantly higher than that in the control group (80.77%, P < 0.05). After treatment, the scores of activities of Daily Living Scale (ADL), Health Promotion Lifestyle Scale Ⅱ (HPLP Ⅱ) and Limb Movement Function Scale (FMA) in two groups were significantly increased compared with before treatment, while the scores of National Institutes of Health Stroke Scale (NIHSS) were significantly decreased (P < 0.05). The improvement was more obvious in the treatment group (P < 0.05). After treatment, serum levels of brain-derived neurotrophic factor (BDNF), transforming growth factor -β1 (TGF-β1), and stromal cell derived factor-1 (SDF-1) in two groups were significantly increased compared with those before treatment. The levels of oxidative stress osteopontin (OPN), high mobility group protein B1 (HMGB1) were significantly decreased (P < 0.05). The improvement was more obvious in the treatment group (P < 0.05). After treatment, reaction time (R value) and coagulation time (K value) in two groups were significantly decreased compared with before treatment, while coagulation Angle (Angle) and maximum thrombus (MA value) were significantly increased (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). After treatment, the degree of carotid artery stenosis and CCA stiffness index were significantly decreased in both groups, while the dilation index and compliance index were significantly increased (P < 0.05), and the improvement was more obvious in the treatment group (P < 0.05). Conclusion Tongxinluo Capsules combined with compound porcine cerebroside and ganglioside has good clinical effect in treatment of convalescence of acute cerebral infarction, and can effectively promote the recovery of patients' nerve function, protect the brain nerve function, improve patients' motor function and the expression of cytokines, which has a good clinical application value.

R971

廊坊市科技計劃項目（2015013061）