补阳还五汤合四妙散治疗急性左下肢周围型下肢深静脉血栓的效果及对D-二聚体和超敏C-反应蛋白的影响
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摘要
目的观察补阳还五汤合四妙散配合尿激酶对急性左下肢周围型下肢深静脉血栓形成(DVT)患者D-二聚体(D-D)及超敏C-反应蛋白(hs-CRP)的变化。方法选取确诊为急性左下肢周围型DVT并属湿热下注型患者60例,并将其随机分为研究组(n=30)和对照组(n=30)。研究组给予中药方剂(补阳还五汤合四妙散)和西药治疗(口服利伐沙班14 d+静脉滴注尿激酶7 d),对照组给予西药治疗(口服利伐沙班14 d+静脉滴注尿激酶7 d)。两组患者均在治疗前、治疗后第1、4、7、11、14天抽血测定D-D及hs-CRP水平。观察两组患者治疗前后左下肢肿胀、疼痛、色泽、周径及舌脉等情况。结果研究组中医证候疗效显著优于对照组,差异有统计学意义(P <0.05)。研究组治疗后第4、7、11、14天D-D水平低于对照组同期,差异有高度统计学意义(P <0.01)。研究组治疗后第1、4、7、11、14天hs-CRP水平均低于对照组同期,差异有高度统计学意义(P <0.01)。结论补阳还五汤合四妙散配合尿激酶治疗急性左下肢周围型DVT的临床效果优于单纯西药治疗,其机制可能与促进纤溶系统及保护血管内皮细胞两方面有关。
Objective To observe the changes of Buyang Huanwu Decoction and Simiaosan combined with urokinase on D-dimer(DD) and hypersensitive C-reactive protein(hs-CRP) in patients with acute peripheral deep venous thrombosis(DVT) of left lower extremity. Methods Sixty patients with acute left lower extremity DVT were enrolled in the study. They were randomly divided into study group(n = 30) and control group(n = 30). The study group was treated with traditional Chinese medicine(Buyang Huanwu Decoction combined with Simiaosan) and Western medicine(oral Rivaroxaban 14 days + intravenous urokinase 7 days), while the control group was treated with Western medicine(oral Rivaroxaban 14 days + intravenous urokinase 7 days). The levels of D-D and hs-CRP were measured before treatment and on the 1 st, 4 th, 7 th, 11 th and 14 th days after treatment in both groups. The swelling, pain, color, circumference and tongue vein of the left lower limb before and after treatment were observed. Results The efficacy of TCM syndromes in the study group was significantly better than that in the control group, and the difference was statistically significant(P < 0.05). The D-D levels on the 4 th, 7 th, 11 th and 14 th day after treatment in the study group were lower than those in the control group, and the differences were highly statistically significant(P < 0.01). The hs-CRP levels in the study group were lower than those in the control group on the 1 st, 4 th, 7 th, 11 th and 14 th day after treatment,and the differences were highly statistically significant(P < 0.01). Conclusion The clinical efficacy of Buyang Huanwu Decoction combined with Simiaosan combined with urokinase in the treatment of acute peripheral DVT of left lower extremity is better than that of Western medicine alone. Its mechanism may be related to the promotion of fibrinolysis system and the protection of vascular endothelial cells.
Objective To observe the changes of Buyang Huanwu Decoction and Simiaosan combined with urokinase on D-dimer(DD) and hypersensitive C-reactive protein(hs-CRP) in patients with acute peripheral deep venous thrombosis(DVT) of left lower extremity. Methods Sixty patients with acute left lower extremity DVT were enrolled in the study. They were randomly divided into study group(n = 30) and control group(n = 30). The study group was treated with traditional Chinese medicine(Buyang Huanwu Decoction combined with Simiaosan) and Western medicine(oral Rivaroxaban 14 days + intravenous urokinase 7 days), while the control group was treated with Western medicine(oral Rivaroxaban 14 days + intravenous urokinase 7 days). The levels of D-D and hs-CRP were measured before treatment and on the 1 st, 4 th, 7 th, 11 th and 14 th days after treatment in both groups. The swelling, pain, color, circumference and tongue vein of the left lower limb before and after treatment were observed. Results The efficacy of TCM syndromes in the study group was significantly better than that in the control group, and the difference was statistically significant(P < 0.05). The D-D levels on the 4 th, 7 th, 11 th and 14 th day after treatment in the study group were lower than those in the control group, and the differences were highly statistically significant(P < 0.01). The hs-CRP levels in the study group were lower than those in the control group on the 1 st, 4 th, 7 th, 11 th and 14 th day after treatment,and the differences were highly statistically significant(P < 0.01). Conclusion The clinical efficacy of Buyang Huanwu Decoction combined with Simiaosan combined with urokinase in the treatment of acute peripheral DVT of left lower extremity is better than that of Western medicine alone. Its mechanism may be related to the promotion of fibrinolysis system and the protection of vascular endothelial cells.
引文
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[12]欧永强.D-二聚体、同型半胱氨酸、超敏C反应蛋白对深静脉血栓性疾病早期诊断及预后的价值[J].中国老年学杂志,2012,32(11):2290-2291.
[13]宋鑫亮.下肢深静脉血栓形成与超敏C-反应蛋白、D-二聚体、同型半胱氨酸的关系[D].宁夏:宁夏医科大学,2011:1-5.
[14] Cheng X,Zhang L,Xie NC,et al. High Plasma Levels of D-Dimer Are Independently Associated with a Heightened Risk of Deep Vein Thrombosis in Patients with Intracerebral Hemorrhage[J]. Mol Neurobiol,2016,53(8):5671-5678.
[15] Kim SD,Baker P,DeLay J,et al. Thrombomodulin Expression in Tissues From Dogs With Systemic Inflammatory Disease[J]. Vet Pathol,2016,53(4):797-802.
[16] Levy MM,Fink MP,Marshall JC,et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J]. Crit Care Med,2003,31(3):1250-1256.
[17]杨正贵.分析D-二聚体和同型半胱氨酸及超敏C反应蛋白在深静脉血栓性疾病中的应用[J].世界最新医学信息文摘,2018,18(3):11-12.
[2]侯玉芬,刘政.下肢深静脉血栓形成诊断及疗效标准(2015年修订稿)[J].中国中西医结合外科杂志,2016,22(5):520-521.
[3]杜全宇,杨昆,王飞.补阳还五汤的临床研究进展[J].中国当代医药,2015,22(29):16-19.
[4]付振,张念平,时晓东,等.补阳还五汤的药理研究[J].中国医学创新,2010,7(6):178-179.
[5]周玮.补阳还五汤治疗骨科术后深静脉血栓63例[J].西部中医药,2014,27(8):77-78.
[6]霍景山,韩新峰,吴日钊,等.补阳还五汤加减方联合尿激酶治疗急性下肢DVT的临床疗效观察[J].临床医学工程,2015,22(9):1144-1146.
[7]何龙,陈秀明,王在斌,等.补阳还五汤预防高龄人工髋关节置换术后下肢深静脉血栓形成32例[J].中国中医药现代远程教育,2013,11(24):49-50.
[8]唐映红,梁燕,张淑萍,等.补阳还五汤及其有效组分生物碱和苷对动脉血栓形成大鼠抗凝系统活性的影响[J].中国实验方剂学杂志,2007,13(6):39-42.
[9]张伟,贺冰,李亮,等.补阳还五汤促进内皮祖细胞修复损伤血管内皮[J].中国病理生理杂志,2017,33(11):1969-1974.
[10]曹雯,孙洪平,曹琳,等.四妙散的临床运用及作用机制[J].吉林中医药,2017,37(10):976-978.
[11]曾伟,蔡安烈,刘荆陵,等.D-二聚体监测预防急性深静脉血栓的意义[J].中国现代医学杂志,2017,27(14):58-62.
[12]欧永强.D-二聚体、同型半胱氨酸、超敏C反应蛋白对深静脉血栓性疾病早期诊断及预后的价值[J].中国老年学杂志,2012,32(11):2290-2291.
[13]宋鑫亮.下肢深静脉血栓形成与超敏C-反应蛋白、D-二聚体、同型半胱氨酸的关系[D].宁夏:宁夏医科大学,2011:1-5.
[14] Cheng X,Zhang L,Xie NC,et al. High Plasma Levels of D-Dimer Are Independently Associated with a Heightened Risk of Deep Vein Thrombosis in Patients with Intracerebral Hemorrhage[J]. Mol Neurobiol,2016,53(8):5671-5678.
[15] Kim SD,Baker P,DeLay J,et al. Thrombomodulin Expression in Tissues From Dogs With Systemic Inflammatory Disease[J]. Vet Pathol,2016,53(4):797-802.
[16] Levy MM,Fink MP,Marshall JC,et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J]. Crit Care Med,2003,31(3):1250-1256.
[17]杨正贵.分析D-二聚体和同型半胱氨酸及超敏C反应蛋白在深静脉血栓性疾病中的应用[J].世界最新医学信息文摘,2018,18(3):11-12.