中西医结合治疗脑小血管病  

Combination of Chinese and Western Medicine in Treating Cerebral Small Vessel Disease

作　　者：刘长英[1] 周莉[2] 刘博文 孔静敏 张根明[2] LIU Changying;ZHOU Li;LIU Bowen;KONG Jingmin;ZHANG Genming(Beijing University of Chinese Medicine,Beijing China 100029;Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing China 100700)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东直门医院,北京100700

出　　处：《中医学报》2020年第5期998-1001,共4页Acta Chinese Medicine

基　　金：国家中医药管理局中医临床研究基地科研专项项目(JDZX2015050).

摘　　要：脑小血管病多为络病,病发于脑,属本虚标实之疾。痰瘀是本病重要的病理因素,痰瘀沉积于血脉导致斑块生成,附着于血管壁则易损伤血管内皮细胞。同时,正气不足也使得内皮细胞更易受到邪气的侵害,影响细胞间的紧密连接,导致功能障碍。因此,本病的基本治则为扶正祛邪。目前,西医治疗本病主要为二级预防,阿司匹林及他汀类药物具有抗血小板聚集和降脂的作用,类似于中药的活血化瘀及祛痰作用,针对痰、瘀等病理因素,发挥祛邪的作用;三七、薤白分别为中成药血塞通胶囊及血滞通胶囊的主要成分,一方面可与阿司匹林、他汀类药物协同作用增强其抗血小板聚集及降脂的作用;另一方面还能发挥扶正的作用,增强内皮细胞的抗损伤能力。在西医规范二级预防的基础上联合中药进一步优化脑小血管病的二级预防方案,扶正与祛邪并举,标本兼顾,可能是未来解决脑小血管病的新途径。Cerebral small vessel disease is mostly collateral disease,which occurs in the brain and belongs to the disease of deficiency in origin and excess in superficiality.Phlegm and blood stasis is an important pathological factor of this disease.Phlegm and blood stasis deposit in blood vessels leads to plaque formation,and adhesion to blood vessel walls is easy to damage vascular endothelial cells.At the same time,lack of healthy qi also makes endothelial cells more vulnerable to pathogens,affecting the tight connection between cells,leading to dysfunction.Therefore,the basic therapeutic principle of this disease is strengthening body resistance and eliminating pathogenic factors.At present,western medicine mainly treats the disease as secondary prevention.Aspirin and statins have the effects of anti-platelet aggregation and lipid-lowering,which are similar to the effects of promoting blood circulation,removing blood stasis and eliminating phlegm of Chinese medicine,and play the role of eliminating pathogenic factors against pathological factors such as phlegm and blood stasis.Sanqi(Notoginseng)and Xiebai(Allium macrostemon)are the main components of Chinese patent medicine Xuesaitong capsule and Xuezhitong capsule respectively.On the one hand,they can cooperate with aspirin and statins to enhance their anti-platelet aggregation and lipid-lowering and plaque-stabilizing effects.On the other hand,it can also play the role of strengthening body resistance and enhance the anti-injury ability of endothelial cells.On the basis of standardizing the secondary prevention in western medicine,combined with Chinese medicine to further optimize the secondary prevention scheme of cerebral small vessel disease,strengthening body resistance and eliminating pathogenic factors simultaneously,and taking both symptoms and root causes into consideration,may be a new way to solve cerebral small vessel disease in the future.

关 键 词：脑小血管病 络病 血塞通胶囊 血滞通胶囊 三七 薤白 阿司匹林 他汀类药物 中西医结合 

分 类 号：R2-031[医药卫生—中西医结合]