摘要
目的:研究益气活血中药人参果和三七的提取物的去瘀生新作用与诱生血管生成、改善血液灌注是否具有内在的联系。
方法:细胞实验,以体外培养的人脐静脉内皮细胞(HUVEC)为靶细胞,用细胞免疫化学法、流式细胞术、酶联免疫吸附试验(ELISA)、反转录PCR(RT-PER)等方法观察三七和人参果提取物对HUVEC细胞增殖、表达和分泌VEGF等的影响。动物实验,采用大鼠急性心梗模型,采用免疫组化法和ELISA等方法检测大鼠缺血心肌中基质金属蛋白酶(MMPs)、组织型基质金属蛋白酶抑制剂(TIMPs)、血管内皮细胞生长因子(VEGF)和血清中VEGF的表达量等。临床研究,采用回顾性研究收集了128例急性心肌梗死(AMI)病例,观察分析了AMI患者的主要临床分型和中药治疗情况。
结果:细胞实验,结果表明三七和人参果提取物能显著促进HUVEC增殖、分泌和表达VEGF等。动物实验,结果表明三七和人参果提取物能显著促进心梗2周后的大鼠的缺血区心肌VEGF、MMP的表达,并提高VEGF在血清中的浓度。临床回顾性研究,结果表明AMI患者临床分型主要包括了气虚、阴虚、阳虚、血瘀、气滞、痰阻、寒凝等证。其中本虚证中气虚型占全部病例的39.1%,气阴两虚型占30.5%,标实证中血瘀型占全部病例的28.9%,痰瘀互阻占56.3%,气滞血瘀占5.5%。临床治疗中,78.1%的患者同时使用了静脉的益气药和活血药,9.4%的患者应用了静脉的益气药,5.5%的患者应用了静脉的活血药。口服煎剂方药中使用频率高的中药主要也以益气活血中药为主。
结论:气虚血瘀是急性心梗的主要临床证型,临床上中药治疗也以应用益气活血中药为主。中药人参果和三七能够改善心梗后症状,其机制可能是通过促进内皮细胞增殖、迁移、分泌和表达VEGF,提高血清中VEGF的浓度,并促进MMP等的表达等作用,进而促进缺血区心肌的侧支血管形成而达到的,为临床治疗提供了实验依据。
Objective: Study the affections on internal associations of removing blood stasis and promoting tissue regeneration and inducing generating collateral branch blood vessels , improving blood perfusion and diminishing area of ischemia of ginseng and notoginseng, which are Chinese traditional medicines of supplementing qi and activating blood circulating. Reveal the scientific meanings and processing mechanisms of Chinese traditional medicines of supplementing qi and activating blood circulating on removing blood stasis and promoting tissue regeneration.Method: In cellular experiment, the HUVEC were selected to be the models and were observed their proliferation , secreting VEGF , VEGF mRNA expression. In animal experiment, rat AMI models were established and were killed after 2 weeks.The expressions of MMP, TIMP, VEGF in ischemia myocardium and expression of VEGF in serum were observed through the ways of immunohistochemistry and ELISA. In clinical study, 128 cases of AMI have been collected through reviewing analysis and observed the major clinical typing and treating conditions of Chinese drugs.Results: In cellular experiment, Ginseng and notoginseng can promoting the HUVECs to proliferates secrete and express VEGF markedly. In animal experiment, Ginseng and notoginseng can promoting the expressions of VEGF and MMP in ischemia myocardium. In the same time, Chinese traditional medicines of supplementing qi and activating blood circulating can inhance the concentration of VEGF in serum.. In clinical study, qi deficiency syndrome accounts for 39.1 % of deficiency syndrome in origin, syndrome of deficiency of both qi and yin accounts for 30.5%. Blood stasis type accounts for 28.9% of superficiality excess syndrome, bloodysputum and blood stasis obstruction type accounts for 56. 3 % , stagnancy of qi and blood stasis accounts for 5. 5 % . In clinical treatment, 78.1 % of patients were treated with both qi-reinforcing drugs and blood-activating drugs through vein, 9.4% of patients were treated with qi-reinforcing drugs and 5.5% of patients were treated with blood-activating drugs. In oral decoction treatment, the frequency of using Chinese drugs of supplementing qi and activating blood circulation is the highest.Conclusion: Deficiency of qi and blood stasis is the major clinical typing and
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