醒脑静对中风后认知功能障碍的疗效及机制

目的:观察醒脑静治疗中风后老年患者认知障碍的疗效,并探讨其基于脑脊液中PI3K/AKT信号通路的作用机制。方法:选取2016年1月至2016年6月收住我科的诊断为"中风"的老年患者90例,随机分成对照组和治疗组,各45例。2组均使用常规治疗,治疗组注射醒脑静注射液20 m L,对照组注射等量生理盐水。在治疗后1 d及治疗后3、7 d使用恢复质量评估(Physician Quality Reporting System,PQRS)量表新认知评价体系评估患者的认知功能水平。利用蛋白免疫印迹法(Western blotting)检测治疗前(T0)、治疗后1个月(T1)、2个月(T2)、3个月(T3)和4个月(T4)不同时间点脑脊液中PI3K、AKT、p AKT、Bcl、Bax的浓度。结果:1)治疗后2组患者认知功能均出现降低,对照组变化较治疗组明显,2组患者治疗后7 d的MMSE评分恢复正常,而PQRS评分则显示患者仍存在认知功能缺损。2)PQRS评分显示,对照组治疗后发生OCD15例(33.3%),治疗组治疗发生OCD 9例(20%);MMSE评分显示,对照组治疗后发生OCD 15例(33.3%),治疗组治疗后发生OCD 9例(20%)。PQRS评分显示OCD发生率明显高于MMSE评分(P0.05)。3)Western blotting结果显示:与T0相比,2组T1、T2、T3及T4时间点PI3K、p AKT、bcl水平明显降低,而bax水平明显升高,其中各时间点对照组各标志性蛋白水平变化的趋势较治疗组明显(P0.05)。结论:醒脑静对老年中风患者中风后认知功能的恢复作用显著,此机制可能与介导PI3K/AKT信号通路的标志性蛋白表达水平有关。

Clinical Efficacy and Mechanism of Xingnaojing on Cognitive Function on Elderly Patients after Stroke

To observe Xingnaojing on cognitive function in elderly patients after stroke, and to discuss the effect on PI3K/AKT signal pathway in the cerebrospinal fluid. Methods:A total of 90 cases of elderly patients after stroke in our hospital during January 2016-June 2016 were included into the study. According to the random principle, they were divided to observation group and the control group. On 1 d before, 3 d and 7 d after treatment, through recovery Physician Quality Reporting System (PQRS) the new cognitive evaluation system, cognitive function levels of the patients were accessed. The PI3K, AKT, pAKT, Bcl, and Bax concentration changes were detected by Western blotting before treatment (T0),after treatment 1 mouth(T1), 2 mouth(T2), 3 mouth(T3), 4 mouth(T4), in the different time points in cerebrospinal fluid. Results:1) cognitive function the two groups both reduced, the changes of control group were more obviously than the observation group, MMSE scores went back to normal in both of the two groups 7 d after treatment, while the PQRS scores showed that the patients still had cognitive function defects. 2)PQRS scores showed that the incidence of postoperative OCD was 15 cases(33.3%) in control group and 9 cases(20%)in observation group; MMSE scores showed that the incidence of postoperative OCD was 15 cases(33.3%) in control group and 9 cases(20%)in observation group; PQRS score showed the OCD incidence was significantly higher than MMSE scores.3) Western blotting results showed that the concentration of PI3K, pAKT, Bcl decreased in the two groups of T1, T2, T3, and T4 compared with the T0, while the Bax levels rose. The iconic protein concentration change trend of every time point of the control group was more obviously than the observation group, the differences were statistically significant (P<0.05). Conclusion:The effect of Xingnaojing on cognitive function in elderly patients before or after Stroke is clear, the impact mechanism may be related to the mediation on iconic protein expression levels of PI3K/AKT signal pathway.