Objective To analyze the mechanism of Xueshuantong injection combined with intravenous thrombolysis with alteplase in the treatment of patients with acute cerebral infarction (ACI) based on the high mobility group protein B1 (HMGB1)/Toll-like receptor 4 (TLR4) signaling pathway.

Methods A total of 106 ACI patients were randomly divided into control group (n=53) and study group (n=53). The control group received intravenous thrombolysis with alteplase, while the study group received Xueshuantong injection treatment on the basis of the control group. Clinical efficacy and adverse reactions, the National Institutes of Health Stroke Scale (NIHSS) scores before treatment and on the 7th and 14th day after treatment, the expression levels of HMGB1 mRNA and TLR4 mRNA in mononuclear cells of peripheral blood before and after treatment as well as the protein contents of HMGB1 and TLR4 in serum, and the levels of inflammatory factors interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) before and after treatment were compared between two groups. Pearson test and Spearman test were used to analyze the correlations of the expression levels of HMGB1 mRNA and TLR4 mRNA in mononuclear cells of peripheral blood and the protein contents of HMGB1 and TLR4 in serum with the NIHSS score and the total effective rate in patients with ACI.

Results The NIHSS score of the study group was significantly lower than that of the control group at 7 and 14 days after treatment (P < 0.05); after treatment, the expression levels of HMGB1 mRNA and TLR4 mRNA in both groups decreased significantly when compared to those before treatment, and the expression levels of HMGB1 mRNA and TLR4 mRNA in the study group were significantly lower than those in the control group (P < 0.05); after treatment, the serum protein contents of HMGB1 and TLR4 in both groups decreased significantly when compared to those before treatment, and the serum protein contents of HMGB1 and TLR4 in the study group were significantly lower than those in thecontrol group (P < 0.05); after treatment, the levels of serum TNF-α and IL-6 in both groups decreased significantly when compared to those before treatment, and serum TNF-α and IL-6 levels in the study group were significantly lower than those in the control group (P < 0.05). The total effective rate was 75.47% in the control group and 94.34% in the study group, and there was a significant difference between two groups (P < 0.05); the total incidence of adverse reactions was 9.43% in the control group and 15.09%in the study group, and there was no significant difference between two groups (P>0.05). Pearson test showed that the expression levels of HMGB1 mRNAand TLR4 mRNA in mononuclear cells of peripheral blood and the serum protein contents of HMGB1 and TLR4 in ACI patients were positively correlated with NIHSS score (r=0.431, 0.443, 0.396, 0.375, P < 0.001); Spearman test showed that the expression levels of HMGB1 mRNA and TLR4 mRNA in mononuclear cells of peripheral blood and the serum protein contents of HMGB1 and TLR4 in ACI patients were negatively correlated with the total effective rate of treatment (r=-0.536, -0.481, -0.475, -0.506, P < 0.001).

Conclusion Combination of Xueshuantong injection and intravenous thrombolysis with alteplase can effectively improve the neurological function of patients with ACI and reduce the level of inflammation in the body, and the therapeutic mechanism may be related to downregulation of the HMGB1/TLR4 signaling pathway.