目的 探讨补阳还五汤对缺血性脑卒中气虚血瘀证模型大鼠肠道菌群及其相关血浆代谢产物的影响。方法 采用中医证型与大脑中动脉闭塞（middle cerebral arteryocclusion，MCAO）联合造模的方法，建立缺血性脑卒中气虚血瘀证大鼠模型，随机分为对照组、补阳还五汤（24 g/kg）组、双歧杆菌（0.81 g/kg）组。除对照组大鼠ig生理盐水外，其余各组大鼠ig相应药物，72 h后处死大鼠，取全脑采用TTC染色检测脑梗死体积，取盲肠内容物采用16S rRNA基因测序检测肠道菌群，分离血浆用代谢组学法检测血浆代谢产物，并建模分析肠道菌群与代谢产物之间的联系。结果 与对照组比较，补阳还五汤显著改善缺血性脑卒中气虚血瘀证大鼠神经行为学评分（P<0.05），减小脑梗死体积（P<0.001），调节肠道菌群（P<0.01），影响缺血性脑卒中气虚血瘀证大鼠血浆代谢轮廓；双歧杆菌四联活菌片对缺血性脑卒中气虚血瘀证大鼠肠道菌群及代谢产物影响较小，对大鼠神经行为学评分、脑梗死体积无显著影响。结论 补阳还五汤可能通过调节缺血性脑卒中气虚血瘀证大鼠的肠道菌群，继而影响其血浆代谢轮廓，从而发挥治疗缺血性脑卒中血瘀证的作用。

Objective To study the effect of Buyang Huanwu Decoction (补阳还五汤) on gut microbiota and plasma metabolites in ischemic stroke rats with qi deficiency and blood stasis syndrome. Methods Rat models with qi deficiency and blood stasis of ischemic stroke were established by combing TCM syndrome and middle cerebral arteryocclusion (MCAO) modeling methods. Rats were divided into control group, Buyang Huanwu Decoction (24 g/kg) group and bifidobacterium (0.81 g/kg) group. Except rats in control group were ig normal saline, rats in the other groups were ig corresponding drugs. After 72 h, whole brain of rats were collected and TTC staining were performed to detect the volume of cerebral infarction; Contents of cecum were collected to detect the intestinal flora by 16S rRNA gene sequencing; Plasma were separated to detect the plasma metabolites by metabolomics, the relationship between intestinal flora and metabolite were analyzed by establishing model. Results Compared with control group, Buyang Huanwu Decoction improved neurological deficit score (P<0.05), reduced the infarct volume (P<0.001), and regulated the gut microbiota significantly (P<0.01). Therefore, it affected the plasma metabolites profile of ischemic stroke in rats model. Conversely, bifidobacterium quadruple viable tablets displayed little effect on gut microbiota and plasma metabolites, which had no effect on neurological deficit score and infarction volume. Conclusion Buyang Huanwu Decoction has a therapeutic effect on qi deficiency and blood stasis syndrome by regulating rats gut microbiota of ischemic stroke and influencing the plasma metabolism profile.

R285.5

国家自然科学基金资助项目（81774174）；湖南中医药大学研究生科研创新项目（2018CX01）