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  

Effect and Mechanism of Dialectical Treatment of Modified Yiqi Huoxue Tongmai Decoction on Recanalization Post-thrombotic Syndrome of Lower Limbs

作　　者：李彦丽 武如冰 于健[1] 徐国华[1] 

机构地区：[1]河北省中医院

出　　处：《中国实验方剂学杂志》2018年第3期202-207,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(2016165)

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�

关 键 词：下肢深静脉血栓形成后综合征 益气活血通脉汤 血栓机化 血小板内皮细胞黏附因子-1 血管细胞黏附分子-1 

分 类 号：R22[医药卫生—中医基础理论]