凉血和营方治疗血栓闭塞性脉管炎临床疗效及对内皮细胞活化的影响  

Clinical Efficacy of Liangxue Heying(凉血和营)Formula in the Treatment of Thromboangiitis Obliterans and Its Effect on Endothelial Cells

作　　者：冯夏 梁新雨 祝艳丹 王御震 杨建飞 曹烨民 FENG Xia;LIANG Xinyu;ZHU Yandan;WANG Yuzhen;YANG Jianfei;CAO Yemin(Shanghai University of Traditional Chinese Medicine,Shanghai 201203;Department of Vascular Medicine,Shanghai TCM-Integrated Hospital,Shanghai University of TCM,Shanghai 200082)

机构地区：[1]上海中医药大学,上海201203 [2]上海中医药大学附属上海市中西医结合医院脉管科,上海200082

出　　处：《中药药理与临床》2025年第2期60-64,共5页Pharmacology and Clinics of Chinese Materia Medica

基　　金：国家自然科学基金(编号:82174382、82104486);国家科技重大专项(编号:2019ZX09201004-002-091);上海市2020年度科技创新行动计划项目(编号:20Z21900200);上海市十三五临床重点专科(中医外科);上海市卫生健康委员会中医药科研项目(编号:2024QN010)。

摘　　要：目的:观察凉血和营方治疗血栓闭塞性脉管炎(Thromboangiitis obliterans,TAO)的临床疗效以及对内皮细胞活化的影响。方法:选取70例于2020年12月-2023年1月在上海中医药大学附属上海市中西医结合医院脉管科门诊、住院部接受治疗的Ⅱ期及以上的TAO湿热毒盛证患者作为研究对象,随机分为对照组与治疗组,每组35例,两组患者使用常规基础治疗方法,治疗组在基础治疗上加用凉血和营方,共治疗28 d,通过分析临床疗效、症状体征评分、实验室检查(炎症指标、血管内皮细胞功能、凝血功能)、安全指标及不良影响,评价凉血和营方治疗TAO的临床疗效。结果:研究过程中脱落5例患者,最终纳入统计分析患者为对照组33例,治疗组32例。与治疗前相比,治疗后对照组与治疗组均可显著改善患者症状评分(P<0.01);治疗后,与对照组相比,治疗组的临床疗效优于对照组(P<0.01),凉血和营方可以提高TAO临床治疗有效率(P<0.05),促进临床症状改善,对于患肢发凉、麻木、静息痛均有更明显的改善作用(P<0.05或P<0.01)。与治疗前相比,治疗后两组外周血炎症指标WBC、NEUT、ESR、hs-CRP、FIB、IL-6、VCAM-1水平均降低(P<0.01),治疗组ICAM-1含量显著降低(P<0.01);治疗后,与对照组相比,治疗组可明显降低WBC、NEUT、ESR、hs-CRP、FIB、IL-6以及黏附分子ICAM-1、VCAM-1的水平(P<0.01)。结论:凉血和营方可以抑制TAO患者内皮细胞活化,改善TAO湿热毒盛证患者临床症状。Objective:To observe the clinical efficacy of Liangxue Heying(凉血和营)Formula in treating thromboangiitis obliterans(TAO)and its impact on the activation of endothelial cells.Methods:Seventy TAO patients(stage II or higher)with the syndrome of Shire Dusheng(湿热毒盛),treated between December 2020 and January 2023 at the Department of Vascular Medicine,Shanghai TCM-Integrated Hospital,Shanghai University of TCM,were selected.They were randomly divided into a control group and a treatment group,with 35 in each group.Both groups received conventional primary treatment,and the treatment group was additionally given Liangxue Heying Formula over a 28-day period.The clinical efficacy,symptom and sign scores,laboratory tests(inflammatory markers,vascular endothelial cell function,coagulation function),safety indices,and adverse effects were analyzed to evaluate the effect of Liangxue Heying Formula in the treatment of TAO.Results:Five patients dropped out during the study,and 33 in the control group and 32 in the treatment group were finally included.Both groups showed therapeutic effects after treatment,with improved symptom scores(P<0.01),and the treatment group outperformed the control group in clinical efficacy(P<0.01).Liangxue Heying Formula significantly enhanced the effective treatment rate for TAO(P<0.05),and improved the clinical symptoms,especially limb coldness,numbness,and resting pain(P<0.05,P<0.01).Inflammatory indices such as WBC,NEUT,ESR,hs-CRP,FIB,IL-6,and VCAM-1 in peripheral blood were all reduced after treatment in both groups(P<0.01).The ICAM-1 level was unchanged in the control group but significantly decreased in the treatment group(P<0.01).Compared with the control group,the treatment group manifested marked reductions in WBC,NEUT,ESR,hs-CRP,FIB,IL-6,and adhesion molecules ICAM-1 and VCAM-1(P<0.01).Conclusion:Liangxue Heying Formula could attenuate endothelial cell activation in TAO patients and ameliorate the clinical symptoms in individuals with the syndrome of Shire Dusheng.

关 键 词：血栓闭塞性脉管炎 凉血和营方 湿热毒盛 内皮细胞活化 

分 类 号：R259[医药卫生—中西医结合]