目的 探讨龙生蛭胶囊联合阿加曲班治疗急性脑梗死的临床疗效。方法 选取2019年1月-2020年4月天津市中医药大学附属南开中医院收治的急性脑梗死患者146例，随机分为对照组和治疗组，每组各73例。对照组静脉滴注阿加曲班注射液，60 mg加入生理盐水500 mL，持续24 h，3~7 d后调整为20 mg加入生理盐水100 mL，持续2~3 h，2次/d。治疗组患者在对照组的基础上，口服龙生蛭胶囊治疗，5粒/次，疗程为2周。观察两组患者临床疗效，比较治疗前后两组患者生活质量、神经功能缺损评分（NIHSS）、Barthel指数（BI）评分、劲动脉斑块，及钙调素（CAM）、肿瘤坏死因子-α（TNF-α）、正五聚体蛋白-3（PTX-3）、生长分化因子-15（GDF-15）和白细胞介素-6（1L-6）水平。结果 治疗后，治疗组的总有效率为93.15%，明显高于对照组的79.45%（P<0.05）。治疗后，两组生理功能、情感功能和社会功能评分较治疗前的明显升高（P<0.05），治疗组升高更明显（P<0.05）。两组患者在治疗的第7天、第14天，NIHSS评分与BI评分较治疗前明显改善（P<0.05），治疗组在治疗的第14天，NIHSS评分与BI评分明显好于对照组（P<0.05）；与对照组相比，治疗组IMT厚度和斑块面积降低更为显著（P<0.05）。治疗后，两组CAM、TNF-α、PTX-3、GDF-15和1L-6水平较治疗前显著降低（P<0.05），而且与对照组相比，治疗组下降更为明显（P<0.05）。结论 龙生蛭胶囊联合阿加曲班治疗急性脑梗死效果显著，能够有效的提高患者的生活质量，降低神经功能缺损的严重程度和斑块面积，有效的改善临床指标。

Objective To investigate the curative effect of Longshengzhi Capsules combined with argatroban in treatment of ischemic stroke. Methods Patients (146) with ischemic stroke in Nankai Hospital of Traditional Chinese Medicine Affiliated to Tianjin University of Traditional Chinese Medicine from January 2019 to April 2020 were randomly divided into control and treatment groups, and each group had 73 cases. Patients in the control group were iv administered with Argatroban Injection, 60 mg added into normal saline 500 mL for 24 h, then adjusted the dose to 20 mg added into normal saline 100 mL for 2-3 h after 3-7 d, twice daily. Patients in the treatment group were po administered with Longshengzhi Capsules on the basis of the control group, 5 grains/time, the course of treatment was 2 weeks. After treatment, the clinical efficacy was evaluated, and the quality of life, NIHSS score, BI score, carotid plaque, and the levels of CAM, TNF-α, PTX-3, GDF-15, and IL-6 in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 93.15%, which was significantly higher than that of the control group (79.45%) (P<0.05). After treatment, the scores of physiological function, emotional function and social function in the two groups were significantly higher than those before treatment (P<0.05), especially in the treatment group (P<0.05). The NIHSS score and BI score in the two groups were significantly improved on the 7th and 14th day after treatment (P<0.05). On the 14th day of treatment, the NIHSS score and BI score of the treatment group were significantly better than those of the control group (P<0.05). Compared with the control group, the IMT thickness and plaque area in the treatment group decreased more significantly (P<0.05). After treatment, the levels of CAM, TNF-α, PTX-3, GDF-15, and IL-6 in the two groups were significantly lower than those before treatment (P<0.05), and the levels in the treatment group were more significantly lower than those in the control group (P<0.05). Conclusion The effect of Longshengzhi Capsules combined with argatroban in treatment of ischemic stroke is significant, can effectively improve the quality of life, reduce the severity of neurological impairment and plaque area, effectively improve clinical indicators.

R971

天津市医药卫生科技发展计划基金资助项目（20162011）