目的：探讨醒脑静注射液对急性脑梗死（ACI）血瘀证患者细胞因子和临床疗效的影响。方法采用前瞻性随机对照研究方法，选择湖北省荆门市第一人民医院神经内科的70例ACI住院患者，按随机数字表法分为对照组和中西医结合治疗组，每组35例。对照组采用西医常规治疗；中西医结合治疗组在常规治疗基础上加用醒脑静注射液30 mL静脉滴注，每日1次；两组疗程均为14 d。检测两组治疗前后血清γ-干扰素（IFN-γ）和白细胞介素（IL-2、IL-5、IL-10）水平；观察两组患者治疗前后神经功能缺损程度评分（NFDS）、改良的Rankin量表（MRS）评分和日常生活活动能力（ADL）评分。结果两组治疗后血清细胞因子IFN-γ和IL-2水平均较治疗前明显降低〔IFN-γ（ng/L）：对照组为32.62±5.34比45.89±9.28，中西医结合治疗组为20.45±6.39比46.02±8.15；IL-2（ng/L）：对照组为8.62±1.51比14.23±2.19，中西医结合治疗组为3.47±0.76比13.09±1.32〕，IL-5及IL-10明显升高〔IL-5（ng/L）：对照组为68.39±8.89比36.80±6.32，中西医结合治疗组为89.20±9.17比37.26±6.08；IL-10（ng/L）：对照组为27.66±5.47比15.59±3.27，中西医结合治疗组为38.54±7.66比16.17±4.29〕，且以中西医结合治疗组变化更显著〔IFN-γ（ng/L）：20.45±6.39比32.62±5.34，IL-2（ng/L）：3.47±0.76比8.62±1.51，IL-5（ng/L）：89.20±9.17比68.39±8.89，IL-10（ng/L）：38.54±7.66比27.66±5.47，均P＜0.05〕。两组治疗后NFDS评分、MRS评分均较治疗前明显降低〔NFDS（分）：对照组为12.38±4.26比27.16±6.35，中西医结合治疗组为7.59±2.09比28.53±7.57；MRS（分）：对照组为3.39±1.51比4.58±1.07，中西医结合治疗组为1.39±0.76比4.65±1.12〕，ADL评分则较治疗前明显升高（分：对照组为38.17±2.24比24.25±3.53，中西医结合治疗组为48.43±1.32比23.51±2.17），且以中西医结合治疗组的改善更显著〔NFDS（分）：7.59±2.09比12.38±4.26，MRS（分）：1.39±0.76比3.39±1.51，ADL评分（分）：48.43±1.32比38.17±2.24，均P＜0.05〕。结论醒脑静注射液能明显调控ACI血瘀证患者血清炎性细胞因子IFN-γ、IL-2、IL-5、IL-10水平，对神经功能缺损程度的恢复及ADL具有较好的改善作用。%Objective To observe the effects of Xingnaojing injection on cytokine and clinical efficacy of patients with acute cerebral infarction (ACI) and blood stasis syndrome (BSS).Methods A prospective randomized controlled trial was conducted. Seventy hospitalized patients with ACI in the Neurological Department of the First People's Hospital of Jingmen of Hubei Province were enrolled, and they were randomly divided into a combination of traditional Chinese and western medicine group and a control group, 35 cases in each group. Both groups received conventional treatment. The combination therapy group additionally received Xingnaojing intravenous drip 30 mL, once a day on the basis of the control remedy. The therapeutic course in both groups was 14 days. In the two groups before and after treatment, the serum levels of γ-interferon (IFN-γ) and interleukins (IL-2, IL-5 and IL-10) were detected; the neurological function defect scale (NFDS) score, the modified Rankin scale (MRS) score and the daily living activity (ADL) score were observed.Results Compared with the levels before treatment, serum levels of IFN-γ and IL-2 were significantly decreased after treatment [IFN-γ (ng/L): the control group was 32.62±5.34 vs. 45.89±9.28, combination therapy group was 20.45±6.39 vs. 46.02±8.15; IL-2 (ng/L): the control group was 8.62±1.51 vs. 14.23±2.19, combination therapy group was 3.47±0.76 vs. 13.09±1.32], while the levels of IL-5 and IL-10 were obviously increased [IL-5 (ng/L): the control group was 68.39±8.89 vs. 36.80±6.32, combination therapy group was 89.20±9.17 vs. 37.26±6.08; IL-10 (ng/L): the control group was 27.66±5.47 vs. 15.59±3.27, combination therapy group was 38.54±7.66 vs. 16.17±4.29], and the changes in the combination therapy group were more significant [IFN-γ (ng/L):20.45±6.39 vs. 32.62±5.34, IL-2 (ng/L): 3.47±0.76 vs. 8.62±1.51, IL-5 (ng/L): 89.20±9.17 vs. 68.39±8.89, IL-10 (ng/L): 38.54±7.66 vs. 27.66±5.47, allP < 0.05]. Compared with the scores before treatment, NFDS score and MRS score were significantly decreased after treatment (NFDS score: the control group was 12.38±4.26 vs. 27.16±6.35, the combination therapy group was 7.59±2.09 vs. 28.53±7.57; MRS score: the control group was 3.39±1.51 vs. 4.58±1.07, the combination therapy group was 1.39±0.76 vs. 4.65±1.12), but the ADL score was significantly increased after treatment (the control group was 38.17±2.24 vs. 24.25±3.53, the combination therapy group was 48.43±1.32 vs. 23.51±2.17), and the improvement in the combination therapy group was more significant (NFDS score: 7.59±2.09 vs. 12.38±4.26, MRS score: 1.39±0.76 vs. 3.39±1.51, ADL score: 48.43±1.32 vs. 38.17±2.24, allP < 0.05).Conclusion The Xingnaojing injection can significantly regulate the levels of serum cytokines IFN-γ, IL-2, IL-5, IL-10, and improve the recovery of function of damaged nerve and the ADL in patients with ACI.
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