本文選題：腦血管 + 椎動(dòng)脈�。� 參考：《中國(guó)中醫(yī)科學(xué)院》2017年博士論文

【摘要】：隨著神經(jīng)介入技術(shù)和材料的發(fā)展,缺血性腦血管病的介入治療取得了快速發(fā)展,成為治療缺血性腦血管病的重要手段之一。然而,同冠狀動(dòng)脈一樣,腦動(dòng)脈介入術(shù)后同樣面臨血管再狹窄的難題,其中椎動(dòng)脈起始部支架術(shù)后再狹窄率是所有顱內(nèi)、外血管支架成形術(shù)中最高的。與中藥干預(yù)冠狀動(dòng)脈介入術(shù)后再狹窄研究取得的豐碩成果相比,中藥干預(yù)腦血管支架術(shù)后再狹窄的研究還僅僅處于起步階段,研究報(bào)道少,缺乏高質(zhì)量臨床試驗(yàn),對(duì)現(xiàn)有研究也缺少客觀評(píng)價(jià),因而中藥干預(yù)腦血管支架術(shù)后再狹窄的療效尚缺乏循證醫(yī)學(xué)證據(jù)。本研究通過Meta分析的方法,系統(tǒng)評(píng)價(jià)中藥干預(yù)腦血管支架術(shù)后再狹窄的療效,并對(duì)現(xiàn)有文獻(xiàn)的研究質(zhì)量進(jìn)行科學(xué)評(píng)估;同時(shí)通過隨機(jī)對(duì)照試驗(yàn),觀察益氣活血中藥對(duì)椎動(dòng)脈起始部支架置入術(shù)后再狹窄療效的影響,并觀察血瘀證、氣虛證計(jì)分的變化。本研究分為兩部分:第一部分:中藥干預(yù)腦血管支架術(shù)后再狹窄的系統(tǒng)評(píng)價(jià)目的:評(píng)價(jià)中藥干預(yù)腦血管支架術(shù)后再狹窄的有效性及安全性。方法:檢索Pubmed、Cochrane Library、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBMDisk)、中國(guó)知網(wǎng)(CNKI)、萬方數(shù)據(jù)庫、維普資訊網(wǎng)、中國(guó)臨床試驗(yàn)注冊(cè)中心以及其他相關(guān)文獻(xiàn),按照預(yù)先設(shè)定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)篩選資料,采用Revman5.3軟件進(jìn)行Meta分析,并應(yīng)用風(fēng)險(xiǎn)評(píng)估工具進(jìn)行研究質(zhì)量的評(píng)價(jià),應(yīng)用GRADE評(píng)分進(jìn)行證據(jù)級(jí)別的推薦。結(jié)果:共收集到中藥干預(yù)腦血管支架術(shù)后再狹窄的文獻(xiàn)13篇,符合納入標(biāo)準(zhǔn)并最終進(jìn)入Meta分析的研究共4項(xiàng),納入患者304例。Meta分析結(jié)果顯示在常規(guī)西藥治療基礎(chǔ)上加用中藥治療,有可能減少腦血管支架術(shù)后再狹窄的發(fā)生[OR=0.41,95%CI(0.21,0.79)],且無不良反應(yīng);在預(yù)防腦缺血事件復(fù)發(fā)方面,治療組和對(duì)照組間差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:系統(tǒng)評(píng)價(jià)的結(jié)果顯示出中藥聯(lián)合西醫(yī)常規(guī)治療與單純西藥治療相比,再狹窄發(fā)生可能有所減少,但納入的研究都存在明顯的方法學(xué)漏洞,結(jié)果的準(zhǔn)確性和可靠性不高,需要更多高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)。第二部分:益氣活血中藥干預(yù)椎動(dòng)脈起始部支架置入術(shù)后再狹窄的隨機(jī)、雙盲、安慰劑對(duì)照研究目的:觀察益氣活血中藥干預(yù)椎動(dòng)脈起始部支架置入術(shù)后再狹窄的有效性和安全性。方法:采用隨機(jī)、雙盲、安慰劑對(duì)照研究方法,將椎動(dòng)脈起始部支架治療成功后、并符合氣虛證和血瘀證的96例患者隨機(jī)分為兩組,兩組均在常規(guī)西藥治療的基礎(chǔ)性上,試驗(yàn)干預(yù)組同時(shí)給予益氣活血中藥治療,對(duì)照組則同時(shí)給予安慰劑口服,觀察兩組患者服藥6個(gè)月后再狹窄發(fā)生情況及腦缺血事件復(fù)發(fā)情況,以及血瘀證、氣虛證計(jì)分的變化。結(jié)果:隨訪6個(gè)月,有3例退出試驗(yàn),試驗(yàn)干預(yù)組再狹窄發(fā)生率19.1%(9/47),對(duì)照組再狹窄發(fā)生率28.3%(13/46),試驗(yàn)干預(yù)組再狹窄發(fā)生少,但兩組相比無統(tǒng)計(jì)學(xué)差異(P0.05);隨訪期間試驗(yàn)干預(yù)組的腦缺血復(fù)發(fā)事件較對(duì)照組少,6.4%(3/47)vs13%(6/46),但兩組相比無統(tǒng)計(jì)學(xué)差異(P0.05)。試驗(yàn)干預(yù)組的血瘀證計(jì)分和氣虛證計(jì)分均明顯下降,與對(duì)照組相比,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。相關(guān)性分析顯示再狹窄的發(fā)生與支架類型和術(shù)后6個(gè)月氣虛證、血瘀證計(jì)分有關(guān),差異有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:再狹窄可能與血瘀證、氣虛證有關(guān),益氣活血中藥可以降低患者氣虛證、血瘀證計(jì)分,改善患者氣虛、血瘀的狀態(tài),在常規(guī)西藥基礎(chǔ)上加用益氣活血中藥有減少椎動(dòng)脈起始部支架置入術(shù)后6個(gè)月時(shí)再狹窄發(fā)生的趨勢(shì),氣虛證和血瘀證可能是椎動(dòng)脈起始部支架置入術(shù)后再狹窄的影響因素之一,但仍需后期進(jìn)行大樣本試驗(yàn)驗(yàn)證。
[Abstract]:With the development of neural interventional techniques and materials, the interventional therapy of ischemic cerebrovascular disease has developed rapidly and has become one of the most important means for the treatment of ischemic cerebrovascular disease. However, the same as the coronary artery, cerebral artery intervention is also faced with the difficult problem of vascular restenosis after the operation of the vertebral artery stenting. Compared with the fruitful results of the intervention of the coronary artery restenosis after the intervention of the coronary artery, the study on the restenosis after the intervention of the cerebral vascular stent is only in the initial stage. The research reports are few, the high quality clinical trials are lacking, and the existing research is lack of objective evaluation. The effect of drug intervention on restenosis after cerebrovascular stenting is still lack of evidence-based medical evidence. The effect of traditional Chinese medicine on restenosis after cerebral vascular stenting was evaluated by Meta analysis, and the quality of the existing literature was evaluated scientifically. At the same time, the Chinese medicine of Yiqi Huoxue Chinese medicine was observed on the vertebral artery. The effect of the curative effect of restenosis after the initial stent implantation and the changes of blood stasis syndrome and Qi deficiency syndrome were observed. The study was divided into two parts: the first part: the objective of systematic evaluation of Chinese traditional medicine intervention after cerebral vascular stent restenosis: To evaluate the effectiveness and safety of traditional Chinese medicine to intervene restenosis after cerebral vascular stenting. Methods: retrieving Pubmed, Cochrane Li Brary, China biomedical literature database (CBMDisk), Chinese knowledge network (CNKI), Wanfang database, VP information network, Chinese clinical trial registry and other related literature, use Revman5.3 software for Meta analysis according to pre set inclusion criteria and exclusion criteria, and use risk assessment tools for research quality. Results: the GRADE score was used to recommend the level of evidence. Results: a total of 13 literature on restenosis after the intervention of cerebrovascular stenting was collected. 4 studies were conformed to the inclusion criteria and finally entered the Meta analysis. The results of 304 cases of.Meta analysis in the patients showed that the use of traditional Chinese medicine on the basis of conventional western medicine treatment could reduce the brain. The recurrence of restenosis after stent was [OR=0.41,95%CI (0.21,0.79)], and no adverse reaction was found. There was no significant difference between the treatment group and the control group in preventing the recurrence of cerebral ischemia. Conclusion: the results of the systematic evaluation showed that the restenosis may be reduced compared with the traditional Chinese medicine combined with the western medicine. However, there are obvious methodological loopholes in the study, the accuracy and reliability of the results are not high, and more high quality randomized controlled trials are needed. The second part: the intervention of Yiqi Huoxue traditional Chinese medicine to intervene the restenosis after the stenting of the vertebral artery stenting, double blind, placebo pairs of research purposes: To observe the intervention of qi invigorating and activating blood Chinese medicine to intervene the vertebral artery Methods: a randomized, double blind, placebo-controlled study was conducted with a randomized, double-blind, placebo controlled study. 96 patients with Qi deficiency syndrome and blood stasis syndrome were randomly divided into two groups. The two groups were all on the basis of conventional western medicine. The control group was treated with traditional Chinese medicine, and the control group was given the placebo oral administration at the same time. The occurrence of restenosis and the recurrence of cerebral ischemic events in the two groups after 6 months of taking medicine, and the changes of the blood stasis syndrome and Qi deficiency syndrome were observed. The results were followed up for 6 months, 3 cases were withdrawn, the incidence of restenosis was 19.1% (9/47), and the restenosis occurred in the control group. Rate 28.3% (13/46), the experimental intervention group had less restenosis, but there was no statistical difference between the two groups (P0.05). The cerebral ischemia recurrence events in the experimental intervention group were less than the control group, 6.4% (3/47) vs13% (6/46), but there was no statistical difference (P0.05). The scores of blood stasis syndrome and Qi deficiency syndrome in the intervention group were significantly lower than those in the control group, and the control group were significantly lower than those in the control group. The difference was statistically significant (P0.01). The correlation analysis showed that the occurrence of restenosis was related to the type of stent and the 6 months of qi deficiency syndrome and blood stasis syndrome, and the difference was statistically significant (P0.01). Conclusion: restenosis may be related to blood stasis syndrome and Qi deficiency syndrome, and the TCM can reduce Qi deficiency syndrome, blood stasis syndrome, and improve the patient's suffering. The state of qi deficiency and blood stasis, supplementing qi and activating blood with traditional Chinese medicine on the basis of conventional western medicine can reduce the tendency of restenosis at 6 months after the stenting of the vertebral artery. Qi deficiency syndrome and blood stasis syndrome may be one of the factors affecting the restenosis after the stenting of the vertebral artery, but a large sample test still needs to be carried out later.
【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 米玉霞;張廣玉;王艷玲;蘇海濤;丁健;吳婧;;血管內(nèi)治療聯(lián)合藥物治療與單純藥物治療重度椎動(dòng)脈起始段狹窄患者的卒中復(fù)發(fā)率的比較研究[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2017年02期

2 鄭德泉;韓玉惠;鐘耀藝;洪春永;董閩田;盧武生;吳錚;柳景華;;血管腔內(nèi)支架成形術(shù)治療椎動(dòng)脈狹窄[J];血栓與止血學(xué);2016年06期

3 張睿;陳燦中;王燦明;;Apollo支架治療椎動(dòng)脈狹窄的療效觀察[J];臨床合理用藥雜志;2016年34期

4 張廣玉;;椎動(dòng)脈起始部粥樣硬化性狹窄患者血管內(nèi)支架置入術(shù)后再狹窄的危險(xiǎn)因素研究[J];實(shí)用心腦肺血管病雜志;2016年09期

5 童晨光;祁江峽;張曉暉;朱鳳水;;中藥干預(yù)椎動(dòng)脈起始段支架置入術(shù)后再狹窄的回顧性對(duì)照研究[J];中西醫(yī)結(jié)合心腦血管病雜志;2016年10期

6 劉學(xué)春;龔自力;汪青松;黃海濱;管葉明;徐芳;劉紅娟;黃海麗;;支架置入與單純藥物治療孤立性眩暈合并椎動(dòng)脈起始部狹窄患者的近期療效觀察[J];實(shí)用醫(yī)學(xué)影像雜志;2016年02期

7 倪貴華;趙衛(wèi)東;田向陽;倪小宇;孫波;陳林芳;;癥狀性椎動(dòng)脈開口處狹窄支架成形術(shù)后再狹窄的影響因素分析[J];臨床神經(jīng)病學(xué)雜志;2016年02期

8 袁波;劉運(yùn)海;譚莉;劉秋庭;;腦動(dòng)脈狹窄的CTA、DSA對(duì)比研究臨床意義[J];腦與神經(jīng)疾病雜志;2016年04期

9 譚俊杰;;椎動(dòng)脈起始部狹窄患者支架置入與單純藥物治療的療效比較[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2016年05期

10 繆偉;胡春平;黃遲;趙楊;;支架成形術(shù)治療癥狀性椎動(dòng)脈狹窄23例臨床觀察[J];醫(yī)學(xué)影像學(xué)雜志;2016年02期

相關(guān)博士學(xué)位論文 前2條

1 陳博;軟堅(jiān)散結(jié)配方對(duì)頸動(dòng)脈粥樣硬化斑塊干預(yù)作用機(jī)制的研究[D];湖北中醫(yī)藥大學(xué);2014年

2 張若楠;通心絡(luò)抑制血管內(nèi)膜增生的作用和機(jī)制研究[D];河北醫(yī)科大學(xué);2014年

相關(guān)碩士學(xué)位論文 前2條

1 吳梅英;腦心通膠囊聯(lián)合雙聯(lián)抗血小板治療對(duì)攜帶CYP2C19功能缺失基因變異者PCI術(shù)后的影響和成本效果分析[D];福建醫(yī)科大學(xué);2015年

2 和志剛;丹參酮對(duì)頸內(nèi)動(dòng)脈支架成形術(shù)患者圍手術(shù)期高敏C反應(yīng)蛋白及血瘀證積分的影響[D];福建中醫(yī)藥大學(xué);2012年

，

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