【目的】探讨通圣方对急性脑梗死介入术后患者氧化三甲胺 （TMAO） 及相关代谢底物的影响与临床疗效评估。 【方法】采 用前瞻性随机对照研究方法，将48例急性大血管闭塞性脑梗死 （AIS-LVO） 并行血管内治疗 （EVT） 的患者分为观察组25例和 对照组23例。经急诊EVT术后，对照组给予西医常规治疗，观察组在对照组的基础上给予鼻饲或口服通圣方治疗，疗程为 7 d并随访3个月。观察2组患者术前、术后7 d和90 d的美国国立卫生研究院卒中量表 （NIHSS） 评分的变化情况，比较2组患 者基于改良Rankin量表 （MRS） 评分的功能结局预后评估情况，并探讨通圣方对血清TMAO及相关代谢物胆碱、甜菜碱、左 旋肉碱的影响。 【结果】（1） 术后7 d和90 d，2组患者的NIHSS评分均较术前下降 （P＜0.01） ，且观察组在术后7 d和90 d 对 NIHSS评分的下降幅度均明显优于对照组，差异均有统计学意义 （P＜0.01） 。 （2） 术后90 d，观察组的良好功能结局率为 96.00% （24/25） ，明显高于对照组的69.57% （16/23） ，差异有统计学意义 （P＜0.05） 。 （3） 术后7 d和90 d，观察组的TMAO及左 旋肉碱、甜菜碱水平均较术前有较明显的下降趋势，但差异无统计学意义 （P＞0.05） ，而对照组的TMAO、左旋肉碱及甜菜 碱水平均较术前明显升高 （P＜0.01） ；组间比较，观察组术后7 d的TMAO、左旋肉碱及甜菜碱水平均较对照组明显下降，差 异均有统计学意义 （P＜0.05） 。 （4） Spearman相关性分析结果显示TMAO与NIHSS评分、左旋肉碱、胆碱存在显著正相关 （P＜ 0.05或P＜0.01） 。 【结论】通圣方对EVT术后7 d的AIS-LVO患者有显著疗效，有助于导向良好的功能结局，其机制可能是通 过左旋肉碱、甜菜碱通路以降低TMAO水平，从而改善卒中患者的神经功能缺损症状。

Objective To investigate the effect of Tongsheng Prescription on trimethylamine N-oxide （TMAO） and related metabolites substrate in patients with acute cerebral infarction after intervention and to evaluate its clinical efficacy. Methods A prospective randomized controlled study was conducted in 48 patients with acute ischemic stroke with large vessel occlusion （AIS-LVO） who had received endovascular treatment （EVT） . The patients were divided into an observation group （25 cases） and a control group （23 cases） . After emergency EVT，the control group was treated with routine western medicine，and the observation group was treated with nasogastric feeding or oral use of Tongsheng Prescription on the basis of treatment for the control group. The course of treatment lasted for seven days，and then the patients were followed up for three months. Before operation，7 days and 90 days after operation， National Institutes of Health Stroke Scale （NIHSS） scores in the two groups were observed. The functional prognosis evaluated with Modified Rankin Scale （MRS） scores was compared between the two groups， and the effects of Tongsheng Prescription on serum TMAO and related metabolites choline，betaine and L-carnitine were investigated. Results （1） On the postoperative day 7 and 90，the NIHSS scores of the two groups were decreased compared with those before operation （P＜0.01） ，and the decrease of NIHSS scores on the postoperative day 7 and 90 in the observation group was significantly superior to that in the control group （P＜0.01） . （2） On the postoperative day 90，the rate of good functional outcome in the observation group was 96.00%（24/25），which was significantly higher than 69.57% （16/23） in the control group，and the difference was statistically significant （P＜0.05） . （3） On the postoperative day 7 and 90，the levels of TMAO，L-carnitine and betaine in the observation group tended to decrease compared with those before operation，but the difference was not statistically significant （P＞0.05） . However， the levels of TMAO， L-carnitine and betaine in the control group were significantly increased compared with those before operation （P＜0.01） . On the postoperative day 7，the levels of TMAO， L-carnitine and betaine in the observation group were significantly lower than those in the control group，and the differences were statistically significant （P＜0.05） . （4） Spearman correlation analysis showed that TMAO was positively correlated with NIHSS score，L-carnitine and choline （P＜0.05 or P＜0.01） . Conclusion Tongsheng Prescription has a significant effect on AIS-LVO patients seven days after EVT. The Prescription is beneficial to obtain a good functional outcome，and its mechanism may be related to the decrease of TMAO level through L-carnitine and betaine pathways，so as to improve the neurological deficit symptoms of stroke patients.

R277.7

广东省自然科学基金基础与应用基础研究基金项目 （编号：2022A1515011665）；东莞市科学技术局社会发展科技项目 （编号： 20211800905032）；东莞市卫生局“宁为民东莞市名中医传承工作室建设项目” （编号：东卫办[2019]36号）