益气活血通脉汤加味对下肢深静脉血栓后综合征(气虚血瘀证)再通的影响及作用机制
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摘要
目的:观察益气活血通脉汤加味辨证治疗对下肢深静脉血栓后综合征(PTS)(气虚血瘀证)再通的疗效,及对血小板内皮细胞黏附因子-1(PECAM-1),血管细胞黏附分子-1(VCAM-1),基质金属蛋白酶-2(MMP-2),MMP-9和白细胞介素-4(IL-4),IL-6,P-选择素,肿瘤坏死因子-α(TNF-α)的影响。方法:将110例PTS患者,随机按数字表法分为对照组和观察组各55例。均给予肝素抗凝、尿激酶溶栓等保守治疗。对照组口服地奥司明片,0.9 g/次,2次/d。观察组内服益气活血通脉汤加味,1剂/d。两组疗程均连续治疗16周。进行下肢深静脉血栓后综合征的Villalta评分,采用彩色多普勒超声评价治疗后血管再通情况,测量治疗前后下肢周径差,检测治疗前后纤维蛋白原(FIB),D-二聚体(D-D),PECAM-1,VCAM-1,MMP-2,MMP-9,IL-4,IL-6,P-选择素,TNF-α水平。结果:观察组临床疗效有效率为90.91%,好于对照组的76.36%(χ2=4.251,P<0.05);观察组血管再通率为89.1%,好于对照组的69.1%(χ2=6.075,P<0.05);观察组患者在治疗后第12周和第16周Villalta评分均低于对照组(P<0.01);治疗后观察组膝上周径差和膝下周径差均小于对照组(P<0.01);观察组患者血清FIB,D-D和P-选择素水平均低于对照组(P<0.01);观察组血清PECAM-1,VCAM-1,MMP-2,MMP-9水平均低于对照组(P<0.01);观察组血清IL-6和TNF-α水平均低于对照组,IL-4水平高于对照组(P<0.01)。结论:益气活血通脉汤加味辨证治疗PTS,可明显减轻患者的临床症状、体征,提高血管再通率,并能调节炎症因子、血管细胞黏附分子,起到改善血栓的机化和血管再通的作用。
Objective: To discuss the clinical efficacy of dialectical treatment of modified Yiqi Huoxue Tongmai decoction for recanalization post-thrombotic syndrome of lower limbs(PTS) and investigate its effects on levels of Qi deficiency and blood stasis syndrome. And platelet endothelial cell adhesion factor-1(PECAM-1),vascular cell adhesion molecule-1(VCAM-1),matrix metalloproteinase-2(MMP-2),MMP-9,interleukin-4(IL-4),IL-6,P-selectin,and tumor necrosis factor-α(TNF-α). Method: One hundred and ten patients were randomly divided into control group(55 cases) and observation group(55 cases) by random number table. Both groups' patients got heparin for anticoagulation and urokinase for thrombolysis. Patients in contral group additionally got diosmin tablets,0. 9 g/time,2 times/day,while patients in observation group additionally used modified Yiqi Huoxue Tongmai decoction,1 dose/day. The treatment course was 16 weeks in both groups. Score of Villalta was graded,and vascular recanalization was evaluated by color doppler ultrasound. The changes in circumference of lower limb were detected in both groups,and the levels of Fibrinogen(FIB),D-dimer(D-D),PECAM-1,VCAM-1,MMP-2,MMP-9,IL-4,IL-6,P-selectin and TNF-α were detected before and after treatment. Result:The total effective rate was 90. 91% in observation group,higher than 76. 36% in control group(χ2= 4. 251,P <0. 05). Rate of vascular recanalization was 89. 1% in observation group,higher than 69. 1% in control group(χ2= 6. 075,P < 0. 05). At week 12 and week 16 after treatment,scores of Villalta in observation group were lower than those in control group(P < 0. 01),and the changes in top-knee circumference and bottom-knee circumference were all lower than those in control group(P < 0. 01). Levels of FIB,D-D,P-selectin,PECAM-1,VCAM-1,MMP-2,MMP-9,IL-6 and TNF-α in serum of observation group were all lower than those in control group(P < 0. 01),while IL-4 level was higher than that in control group(P < 0. 01). Conclusion: Dialectical treatment of modified Yiqi Huoxue Tongmai decoction in patients with PTS can relieve symptoms and signs of patients,improve rate of vascular recanalization,and regulate inflammatory factors and cell adhesion molecules for ameliorating thrombus.
Objective: To discuss the clinical efficacy of dialectical treatment of modified Yiqi Huoxue Tongmai decoction for recanalization post-thrombotic syndrome of lower limbs(PTS) and investigate its effects on levels of Qi deficiency and blood stasis syndrome. And platelet endothelial cell adhesion factor-1(PECAM-1),vascular cell adhesion molecule-1(VCAM-1),matrix metalloproteinase-2(MMP-2),MMP-9,interleukin-4(IL-4),IL-6,P-selectin,and tumor necrosis factor-α(TNF-α). Method: One hundred and ten patients were randomly divided into control group(55 cases) and observation group(55 cases) by random number table. Both groups' patients got heparin for anticoagulation and urokinase for thrombolysis. Patients in contral group additionally got diosmin tablets,0. 9 g/time,2 times/day,while patients in observation group additionally used modified Yiqi Huoxue Tongmai decoction,1 dose/day. The treatment course was 16 weeks in both groups. Score of Villalta was graded,and vascular recanalization was evaluated by color doppler ultrasound. The changes in circumference of lower limb were detected in both groups,and the levels of Fibrinogen(FIB),D-dimer(D-D),PECAM-1,VCAM-1,MMP-2,MMP-9,IL-4,IL-6,P-selectin and TNF-α were detected before and after treatment. Result:The total effective rate was 90. 91% in observation group,higher than 76. 36% in control group(χ2= 4. 251,P <0. 05). Rate of vascular recanalization was 89. 1% in observation group,higher than 69. 1% in control group(χ2= 6. 075,P < 0. 05). At week 12 and week 16 after treatment,scores of Villalta in observation group were lower than those in control group(P < 0. 01),and the changes in top-knee circumference and bottom-knee circumference were all lower than those in control group(P < 0. 01). Levels of FIB,D-D,P-selectin,PECAM-1,VCAM-1,MMP-2,MMP-9,IL-6 and TNF-α in serum of observation group were all lower than those in control group(P < 0. 01),while IL-4 level was higher than that in control group(P < 0. 01). Conclusion: Dialectical treatment of modified Yiqi Huoxue Tongmai decoction in patients with PTS can relieve symptoms and signs of patients,improve rate of vascular recanalization,and regulate inflammatory factors and cell adhesion molecules for ameliorating thrombus.
引文
[1]陈魁,史吏,高涌.下肢深静脉血栓后综合征的研究及诊疗进展[J].中华全科医学,2012,10(2):284-287.
[2]张皓.下肢深静脉血栓形成后综合征的治疗策略[J].中国血管外科杂志:电子版,2015,7(1):7-8.
[3]焦元勇,章希炜.下肢深静脉血栓形成后综合征外科干预方式与思考[J].中国实用外科杂志,2015,35(12):1291-1294.
[4]吴宇,马勇,鲁俊山.中医药干预骨科术后深静脉血栓形成的研究[J].长春中医药大学学报,2011,27(6):972-974.
[5]徐国华,陈品英,田伟明,等.益气活血通脉汤对骨科大手术后下肢深静脉血栓的防治[J].中国实验方剂学杂志,2014,20(4):188-191.
[6]Evans N S,Ratchford E V.Vascular disease patient information page:the post-thrombotic syndrome[J].Vasc Med,2014,19(4):331-333.
[5]杨光唯,来集富,卢惟钦,等.水蛭素治疗深静脉血栓形成后综合征的临床研究[J].中药材,2016,39(3):663-665.
[6]Vedantham S.Valvular dysfunction and venous obstruction in the post-thrombotic syndrome[J].Thromb Res,2009,123(4):S62-S65.
[7]李晓强,王深明.深静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科杂志,2012,50(7):53-57.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:195.
[9]张玥,于婷婷,刘政,等.深静脉血栓形成中医证型与黏附因子的相关性研究[J].中国中西医结合外科杂志,2015,21(3):215-218.
[10]陶贵录.股肿证型研究进展[J].辽宁中医药大学学报,2014,16(4):225-227.
[11]王涛,杨杰山.中医药预防髋部骨折术后深静脉血栓形成的研究进展[J].四川中医,2010,28(8):38-40.
[12]蒋科卫,温建民,毕春强,等.益气活血中药预防骨科大手术后深静脉血栓的临床观察[J].北京中医药大学学报:中医临床版,2010,17(1):7-10.
[13]田锦林,王伟,李云松,等.下肢深静脉血栓后综合征的Villalta评分及临床应用要点[J].中国普外基础与临床杂志,2015,22(4):486-490.
[14]张利,张永川,赵渝.深静脉血栓形成后综合征研究进展[J].重庆医学,2011,40(11):1123-1125.
[15]刘政,侯玉芬,刘明.P-选择素与下肢深静脉血栓形成的相关性[J].中国中西医结合外科杂志,2010,16(5):537-539.
[16]Hale J S,LI M,Lathia J D.The malignant social network:cell-cell adhesion and communication in cancer stem cells[J].Cell Adh Migr,2012,6(4):346.
[17]Chakraborty S,HU S Y,WU S H,et al.The interaction affinity between vascular cell adhesion molecule-1(VCAM-1)and very late antigen-4(VLA-4)analyzed by quantitative FRET[J].PLo S One,2015,10(3):e0121399.
[18]王涛,赵建华,褚海波,等.浅表血栓性静脉炎管壁MMP-2,MMP-9的表达研究[J].实用医学杂志,2013,29(22):3652-3654.
[19]张泽渊,张自琴.活血化瘀类中药对深静脉血栓形成后综合征相关指标影响的动态观察[J].安徽医药,2017,21(1):119-122.
[2]张皓.下肢深静脉血栓形成后综合征的治疗策略[J].中国血管外科杂志:电子版,2015,7(1):7-8.
[3]焦元勇,章希炜.下肢深静脉血栓形成后综合征外科干预方式与思考[J].中国实用外科杂志,2015,35(12):1291-1294.
[4]吴宇,马勇,鲁俊山.中医药干预骨科术后深静脉血栓形成的研究[J].长春中医药大学学报,2011,27(6):972-974.
[5]徐国华,陈品英,田伟明,等.益气活血通脉汤对骨科大手术后下肢深静脉血栓的防治[J].中国实验方剂学杂志,2014,20(4):188-191.
[6]Evans N S,Ratchford E V.Vascular disease patient information page:the post-thrombotic syndrome[J].Vasc Med,2014,19(4):331-333.
[5]杨光唯,来集富,卢惟钦,等.水蛭素治疗深静脉血栓形成后综合征的临床研究[J].中药材,2016,39(3):663-665.
[6]Vedantham S.Valvular dysfunction and venous obstruction in the post-thrombotic syndrome[J].Thromb Res,2009,123(4):S62-S65.
[7]李晓强,王深明.深静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科杂志,2012,50(7):53-57.
[8]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:195.
[9]张玥,于婷婷,刘政,等.深静脉血栓形成中医证型与黏附因子的相关性研究[J].中国中西医结合外科杂志,2015,21(3):215-218.
[10]陶贵录.股肿证型研究进展[J].辽宁中医药大学学报,2014,16(4):225-227.
[11]王涛,杨杰山.中医药预防髋部骨折术后深静脉血栓形成的研究进展[J].四川中医,2010,28(8):38-40.
[12]蒋科卫,温建民,毕春强,等.益气活血中药预防骨科大手术后深静脉血栓的临床观察[J].北京中医药大学学报:中医临床版,2010,17(1):7-10.
[13]田锦林,王伟,李云松,等.下肢深静脉血栓后综合征的Villalta评分及临床应用要点[J].中国普外基础与临床杂志,2015,22(4):486-490.
[14]张利,张永川,赵渝.深静脉血栓形成后综合征研究进展[J].重庆医学,2011,40(11):1123-1125.
[15]刘政,侯玉芬,刘明.P-选择素与下肢深静脉血栓形成的相关性[J].中国中西医结合外科杂志,2010,16(5):537-539.
[16]Hale J S,LI M,Lathia J D.The malignant social network:cell-cell adhesion and communication in cancer stem cells[J].Cell Adh Migr,2012,6(4):346.
[17]Chakraborty S,HU S Y,WU S H,et al.The interaction affinity between vascular cell adhesion molecule-1(VCAM-1)and very late antigen-4(VLA-4)analyzed by quantitative FRET[J].PLo S One,2015,10(3):e0121399.
[18]王涛,赵建华,褚海波,等.浅表血栓性静脉炎管壁MMP-2,MMP-9的表达研究[J].实用医学杂志,2013,29(22):3652-3654.
[19]张泽渊,张自琴.活血化瘀类中药对深静脉血栓形成后综合征相关指标影响的动态观察[J].安徽医药,2017,21(1):119-122.