活血生肌汤内服沐足防治早期糖尿病足气阴两虚脉络闭阻证的作用机制  

Clinical Effect of Oral Huoxue Shengji Decoction and Foot Massage Treatment for Early Diabetic Foot with Qi and Yin Deficiency and Syndrome of Obstruction of Choroid

作　　者：何雄文[1] 王辉[2] 牛美兰[2] 李高申[2] 

机构地区：[1]河南省中医药研究院附属医院,郑州450006 [2]黄河科技学院医学院,郑州450063

出　　处：《中国实验方剂学杂志》2017年第23期182-187,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省科技攻关重点项目(152102310170)

摘　　要：目的:观察活血生肌汤内服和沐足早期糖尿病足(DF)气阴两虚、脉络闭阻证的疗效,并从血管内皮功能、氧化应激和炎症反应方面探讨了其作用机制。方法:将110例DF患者采用住院先后顺序,随机按数字表法分为对照组和观察组各55例。对照组除给予防护措施处,采用甲钴胺注射液,0.5 mg/次,肌内注射,3次/周;和阿司匹林肠溶片,100 mg/次,1次/d。观察组西医处理措施同对照组,并加用活血生肌汤内服和沐足。两组疗程均为12周。检测腓总神经、腓浅神经及胫神经的运动传导速度(MNCV)和感觉传导速度(SNCV);测量治疗前后踝肱指数(ABI);进行治疗前后气阴两虚、脉络闭阻证评分和多伦多临床神经病变评分(TCSS);检测治疗前后一氧化氮(NO),内脂素和血管内皮素-1(ET-1)水平,丙二醛(MDA),超氧化物歧化酶(SOD),细胞间黏附分子-1(ICAM-1),超敏C反应蛋白(CRP)和白细胞介素-6(IL-6)水平。结果:观察组临床总有效率为84%,优于对照组的66.67%(χ2=4.072,P<0.05);观察组腓总神经、腓浅神经及胫神经的MNCV和SNCV均高于对照组(P<0.01);观察组TCSS量表各维度评分及总分均低于对照组;治疗后观察组ABI高于对照组,ABI升高幅度多于对照组(P<0.01),观察组气阴两虚、脉络闭阻证低于对照组,气阴两虚、脉络闭阻证下降幅度多于对照组(P<0.01);观察组内脂素和ET-1水平均低于对照组(P<0.01),NO水平高于对照组(P<0.01);观察组患者MDA,ICAM-1,CRP和IL-6水平均低于对照组,SOD水平高于对照组(P<0.01)。结论:活血生肌汤内服和沐足治疗早期DF气阴两虚、脉络闭阻证患者,能改善患者的周围血管病变和神经病变,减轻临床症状和体征,疗效优于单纯的西医治疗,并能调节血管内皮功能,减轻氧化应激反应和炎症反应,起到改善病情的作用。Objective： To observe the effect of oral Huoxue Shengji decoction and foot massage on early diabetic foot （DF） with Qi and Yin deficiency and syndrome of obstruction of choroid, and investigate its action mechanism from vascular endothelial function, oxidative stress and inflammation reaction. Method： One hundred and ten patients with DF were randomly divided into control group and observation group by random number table, 55 cases in each group. Patients in control group got mecobalamin injection at the place of protective measures, 0.5 mg/time, 3 times/week by intramuscular injection. Aspirin enteric-coated tablets, 100 mg/time, 1 time/day. Based on the treatment in control group, patients in observation group added oral Huoxue Shengji decoction and foot massage. The treatment course was 12 weeks in both groups. Peroneal nerve, motor nerve conduction velocity （MNCV）, sensory nerve conduction velocity （SNCV） , and ankle brachial index （ABI） were detected. Scores of Qi and Yin deficiency, syndrome of obstruction of choroid and toronto clinical neuropathy （TCSS） were graded. And levels of nitric oxide （NO） , visfatin and endothelin-1 （ ET-1 ） , malondialdehyde （MDA） , superoxide dismutase （SOD）, intercellular adhesion molecule-1 （ICAM-1）, C-reactive protein （CRP） and interleukin 6 （IL-6） were detected. Result： The total effective rate was 84. % in observation group, higher than 66.67% in control group （X2 =4. 072, P 〈 0.05）. Peroneal nerve, motor nerve conduction velocity （MNCV） and （SNCV） in observation group were all faster than those in control group （P 〈 0.01 ）. Dimensional scores of TCSS scale and the total score in observation group were lower than those in control group. After treatment, ABI level and ascending range in observation group were higher than those in control group （P 〈 0.01 ）. Scores of Qi and Yin deficiency and closed choroid obstruction in observation group were lower than those in control group, and degree of dec

关 键 词：糖尿病足 气阴两虚、脉络闭阻证 活血生肌汤 氧化应激 炎症反应 内皮功能 

分 类 号：R287[医药卫生—中药学]