Abstract:Aim To investigate the clinical efficacy and preliminary mechanism of Yiqi Huoxue Jiangzhuo decoction combined with butylphthalide in the treatment of transient ischemic attack (TIA). Methods A total of 120 patients with TIA admitted to the First Peoples Hospital of Nanyang from January 2022 to March 2023 were selected as the research subjects and randomly divided into three groups with 40 cases in each group. The control group 1 was given butylphthalide, the control group 2 was given Yiqi Huoxue Jiangzhuo decoction, and the observation group was given Yiqi Huoxue Jiangzhuo decoctionn combined with butylphthalide for 2 months of treatment. After 2 months of treatment, the clinical efficacy and adverse reaction rate were compared among the three groups. The ABCD2 scores, national institute of health stroke scale (NIHSS) scores, and serum biochemical indicators (soluble CD40 ligand (sCD40L), lipoprotein-associated phospholipase A2 (Lp-PLA2), high-sensitive C-reactive protein (hs-CRP), peripheral blood Kelch-like epichlorohydrin-related protein-1 (Keap1)-nuclear factor E2-related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway-related protein levels (Keap1, Nrf2, ARE) , and hemodynamic indicators (mean blood flow velocity (Vm), mean blood flow volume (Qm), cerebral vascular resistance (R) were compared before treatment and at 1 and 2 months after treatment in the three groups. Results The total clinical efficacy rate in observation group was significantly higher than that in control group 1 and control group 2 (P＜0.05), but there was no significant difference between the two control groups (P＞0.05). Compared with before treatment, the ABCD2 scores and NIHSS scores in the three groups showed a significant downward trend after 1 month and 2 months of treatment, and the decrease in observation group was larger than that in control group 1 and control group 2 (P＜0.05), but there was no significant difference between the two control groups (P＞0.05). Compared with before treatment, sCD40L, Lp-PLA2, and hs-CRP in the three groups showed a significant downward trend after 1 month and 2 months of treatment, and the decrease in observation group was larger than that in control group 1 and control group 2 (P＜0.05). Compared with before treatment, Keap1 protein in the three groups showed a significant downward trend after 1 month and 2 months of treatment, and the decrease in observation group was larger than that in control group 1 and control group 2 (P＜0.05), but there was no significant difference between the two control groups (P＞0.05). Compared with before treatment, the Nrf2 protein and ARE protein in the three groups showed a significant increase trend after 1 month and 2 months of treatment, and the increase amplitude in observation group was larger than that in control group 1 and control group 2 (P＜0.05), but there was no significant difference between the two control groups (P＞0.05). Compared with before treatment, Qm, Vm of the three groups increased and R decreased significantly at 1 month and 2 months after treatment, and the Qm, Vm in observation group were significantly higher than that in control group 1 and control group 2, while R was significantly lower than that in control group 1 and control group 2 (P＜0.05). Conclusion Yiqi Huoxue Jiangzhuo decoction combined with butylphthalide is more effective than butylphthalide and Yiqi Huoxue Jiangzhuo decoction alone in treating TIA, can improve neurological function, cerebral hemodynamics, inhibit inflammatory response, and has a certain degree of safety, and its mechanism of action is related to the regulation of Keap1-Nrf2/ARE signaling pathway.

Abstract:Aim To investigate the effects of butylphthalide combined with edaravone on carotid intima-media thickness (IMT) and neurological function in elderly patients with acute cerebral infarction. Methods From January 2014 to March 6,2 elderly patients with acute cerebral infarction in the Department of Neurology in our hospital were randomly divided into edaravone treatment group and butylphthalide combined edaravone treatment group (combined treatment group), 46 cases in each group. Edaravone treatment group was treated with edaravone, and combined treatment group was treated with edaravone and butylphthalide for 90 days. The therapeutic effects of the two groups were observed, carotid IMT and plaque area were evaluated, and neurological function was evaluated by NIHSS score, modified Rankin scale (mRS) score and Barthel index. At the same time, the occurrence of adverse reactions in the two groups was observed. Results The total effective rate of combined treatment group was significantly higher than that of edaravone treatment group (P＜0.05). After treatment, carotid IMT and plaque area in the two groups were significantly lower than those before treatment (P＜0.05), and significantly lower in the combined treatment group than those in the edaravone treatment group (P＜0.05), the NIHSS score and mRS score in the combined treatment group were lower than those in the edaravone treatment group (P＜0.05), and the Barthel index was significantly higher than that in the edaravone treatment group (P＜0.05), there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05). Conclusion Butylphthalide combined with edaravone can significantly reduce carotid IMT in elderly patients with acute cerebral infarction and improve their nerve function, the clinical effect is remarkable and the safety is high.

Abstract:Aim To observe the effect of butylphthalide (NBP) injection on the expression of the neuronal apoptosis, SIRT1 and PGC-1α in hippocampus CA1 of rats with focal cerebral ischemia-reperfusion, then explore the mechanisms of neuroprotection from NBP. Methods 160 male SD rats were randomly divided into sham group, middle cerebral artery occlusion group (MCAO group), high dose NBP post-treatment group (high dose group), middle dose NBP post-treatment group (middle dose group) and low dose NBP post-treatment group (low dose group). Focal cerebral ischemia reperfusion model was established with the improved Zea Longa method. The later four groups were further divided into 6 h, 12 h, 24 h, 48 h and 72 h point after model. TUNEL staining was used to observe the expression of neuronal apoptosis. Immunohistochemistry and quantitative real-time PCR were used to observe the expression of SIRT1 and PGC-1α. Results Compared with MCAO group, the number of apoptotic cells were significantly decreased and the number of SIRT1 and PGC-1α positive cells were significantly increased in NBP post-treatment group at each time point (P＜0.05).Compared with low dose and middle dose group, the number of apoptotic cells were significantly decreased and the number of SIRT1 and PGC-1α positive cells were significantly increased in high dose group (P＜0.05). Compared with low dose group, the number of SIRT1 positive cells were significantly increased except for 6 h and the number of PGC-1α positive cells were significantly increased except for 6 h and 72 h in middle dose group at related point (P＜0.05). Compared with MCAO group, the expression of SIRT1 and PGC-1α mRNA were significantly increased in high dose group at each time point (P＜0.05). Conclusion The findings demonstrate that NBP can inhibit cell apoptosis and relieve the brain damage of focal cerebral ischemia reperfusion in rats, which may significantly associate with the up-regulating of SIRT1 and PGC-1α.

Abstract:Aim To study the protective effect of Dl-n-butylphthalide on neurovascular unit in rats following chronic cerebral hypoperfusion. Methods Forty-eight Wistar rats were randomly divided into sham group,hypoperfusion model group and butylphthalide group.In the rats assigned to the ischemic model group and butylphthalide group,the bilateral common carotid arteries were ligated.The ultrastructure change on neurovascular unit was evaluated by electron microscopy. Results Compared with hypoperfusion model group,butylphthalide has a protective role of neurovascular unit in decreasing endothelial cells edema,reducing neuronal mitochondrial crista fragmentation.Butylphthalide can reduce the neurovascular unit micro environment disturbance. Conclusion Treatment with butyphthalide improved the neurovascular unit of hypoperfused rats.