基于TLR4/NLRP3信号通路探讨通腑泻热活血汤辅助西医治疗瘀热腑实证脑出血后脑水肿的临床效果OA
Clinical effect of Tongfu Xiere Huoxue decoction as an adjunct to Western medicine in the treatment of cerebral edema after intracerebral hemorrhage with stasis-heat and fu-organ excess syndrome based on TLR4/NLRP3 signaling pathway
目的 基于Toll样受体4(TLR4)/核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)信号通路探究通腑泻热活血汤辅助西医治疗瘀热腑实证脑出血后脑水肿的临床效果.方法 选取2024年1月—2025年1月常州市中医医院收治的118例瘀热腑实证脑出血后脑水肿患者,随机数字表法分为对照组(59例,常规西医治疗)、观察组(59例,通腑泻热活血汤辅助西医治疗),均连续治疗2周.比较两组治疗效果、美国国立卫生研究院卒中量表(NIHSS)评分、脑水肿体积、颅内压、外周血炎症和氧化应激指标[C反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)、丙二醛(MDA)、超氧化物歧化酶(SOD)]及血清TLR4、NLRP3 mRNA表达水平,并比较不良反应及预后情况.结果 观察组总有效率为98.31%(58/59)高于对照组的84.75%(50/59,P<0.05).治疗1、2周后,观察组NIHSS评分、脑水肿体积、颅内压、血清TLR4和NLRP3 mRNA表达以及外周血CRP、NLR、MDA水平均低于对照组,SOD水平高于对照组(P<0.05).两组不良反应总发生率差异无统计学意义(P>0.05);治疗后3个月,观察组改良Rankin量表评分等级优于对照组(P<0.05).结论 通腑泻热活血汤辅助西医治疗可有效改善瘀热腑实证脑出血后脑水肿患者的神经功能,减轻脑水肿,降低颅内压,且安全性良好.其作用可能与减轻炎症及氧化应激反应有关,TLR4/NLRP3信号通路可能参与其中.
Objective To investigate the clinical effect of Tongfu Xiere Huoxue decoction as an adjunct to Western medicine for intracerebral hemorrhage(ICH)with stasis-heat and fu-organ excess pattern based on the Toll-like receptor 4(TLR4)/NOD-like receptor protein 3(NLRP3)signaling pathway.Methods A total of 118 ICH patients with stasis-heat and fu-organ excess pattern who were admitted to Changzhou Hospital of Traditional Chinese Medicine from January 2024 to January 2025 were selected.They were divided into the control group(n=59,treated with conventional Western medicine)and the observation group(n=59,treated with Tongfu Xiere Huoxue decoction as an adjunct to Western medicine).Both groups received treatment for 2 consecutive weeks.The two groups were compared in terms of the therapeutic effects,the National Institutes of Health Stroke Scale(NIHSS)scores,the volume of cerebral edema,intracranial pressure,peripheral blood inflammatory and oxidative stress markers[C-reactive protein(CRP),neutrophil/lymphocyte ratio(NLR),malondialdehyde(MDA),superoxide dismutase(SOD)],and the expression levels of serum TLR4 and NLRP3 mRNA,as well as adverse reactions and prognosis.Results The total effective rate of the observation group was 98.31％(58/59),which was higher than that of the control group(84.75％,50/59,P<0.05).At 1 and 2 weeks after treatment,the NIHSS score,volume of cerebral edema,intracranial pressure,mRNA expression of serum TLR4 and NLRP3,and levels of CRP,NLR,and MDA in peripheral blood of the observation group were all lower than those of the control group,while the SOD level was higher than that of the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05),and at 3 months after treatment,the modified Rankin scale score of the observation group was higher than that of the control group(P<0.05).Conclusion Tongfu Xiere Huoxue decoction,as an adjunct to Western medicine,can effectively improve the neurological function of patients with intracerebral hemorrhage-induced cerebral edema with stasis-heat and fu-organ excess pattern.It can also reduce cerebral edema,lower intracranial pressure,and has good safety.Its effects may be related to the alleviation of inflammation and oxidative stress responses,and the TLR4/NLRP3 signaling pathway may be involved.
孔炎铖;阮永兰;黄智;王迪
常州市中医医院创伤急救中心,江苏 常州 213003常州市中医医院脑病科,江苏 常州 213003常州市中医医院创伤急救中心,江苏 常州 213003常州市中医医院创伤急救中心,江苏 常州 213003
脑出血脑水肿通腑泻热活血汤TLR4/NLRP3信号通路炎症反应氧化应激
intracerebral hemorrhagecerebral edemaTongfu Xiere Huoxue decoctionTLR4/NLRP3 signaling pathwayinflammatory responseoxidative stress
《临床误诊误治》 2026 (13)
93-99,7
国家自然科学基金资助项目(82405288)
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