四妙活血汤联合西药治疗2型糖尿病下肢血管病变疗效观察

Curative Effect Observation of Using Simiao Huoxue Decoction Combined with Western Medicine in the Treatment of Type 2 Diabetic Lower-extremity Arterial Disease

目的:观察四妙活血汤联合西药治疗2型糖尿病下肢血管病变(LEAD)(气阴两虚兼血瘀证)患者临床疗效及对患者血液流变学、血小板参数及血清总胆红素水平的影响。方法:选取2020年1月—2021年1月本院诊治的78例2型LEAD(气阴两虚兼血瘀证)患者进行研究。将上述78例患者采用简单随机分组法分为对照组(39例)和观察组(39例),对照组采用常规西医治疗,观察组在对照组基础上加用四妙活血汤治疗。比较两组患者的临床疗效和治疗前后的踝肱指数(ABI)、电流感觉阈值(CPT)、血液流变学指标[红细胞聚集指数(AI)、红细胞压积(PCV)、血浆黏度(PV)、纤维蛋白原(FIB)]水平、血小板参数[血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板计数(PLT)、血小板压积(PCT)]水平、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)]水平、血清总胆红素(TBil)水平以及药物不良反应情况。结果:观察组的临床治疗总有效率为87.18%,高于对照组66.67%(P<0.05);观察组治疗后ABI高于对照组(P<0.05),双侧腓肠神经2000Hz、250Hz、5Hz的CPT值低于对照组(P<0.05);观察组治疗后AI、PCV、PV、FIB均低于对照组(P<0.05);观察组治疗后的MPV、PDW、PLT、PCT均低于对照组(P<0.05);观察组治疗后的TBil高于对照组(P<0.05),IL-6、TNF-α、hs-CRP低于对照组(P<0.05);观察组和对照组的药物不良反应总发生率比较差异无统计学意义(P>0.05)。结论:四妙活血汤联合西药治疗2型LEAD(气阴两虚兼血瘀证)患者的疗效确切,可以显著改善血液流变性和血小板参数,升高血清TBil水平,减轻炎症反应。

Objective:To observe the clinical curative effect of Simiao Huoxue Decoction combined with western medicine for patients with type 2 diabetic lower-extremity arterial disease(LEAD)(Qi-Yin deficiency combined with blood stasis)and its influences on hemorheology,platelet parameters and serum total bilirubin(TBil).Methods:A total of 78 patients with type 2 diabetic LEAD(Qi-Yin deficiency combined with blood stasis)treated in the hospital from January 2020 to January 2021 were enrolled and divided into a controlled group(39 cases)and an observation group(39 cases)by simple random grouping method.The controlled group was treated with routine western medicine,while the observation group was treated with Simiao Huoxue Decoction on the basis of the controlled group.The clinical curative effect,ankle-brachial index(ABI),current perception threshold(CPT),levels of hemorheology indexes[erythrocyte aggregation index(AI),packed cell volume(PCV),plasma viscosity(PV),fibrinogen(FIB)],platelet parameters[mean platelet volume(MPV),platelet distribution width(PDW),platelet count(PLT),thrombocytocrit(PCT)],inflammatory factors[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP)]and serum TBil,and adverse drug reactions before and after treatment were compared between the two groups.Results:The total response rate of clinical treatment in the observation group was higher than that in the controlled group(87.18%vs 66.67%)(P<0.05).After treatment,ABI in the observation group was higher than that in the controlled group(P<0.05),CPT values of bilateral sural nervesat 2000Hz,250Hz and 5Hz were lower than those in the controlled group(P<0.05).After treatment,AI,PCV,PVand FIB in the observation group were lower than those in the controlled group(P<0.05),MPV,PDW,PLT and PCT were lower than those in the controlled group(P<0.05),TBil was higher than that in the controlled group(P<0.05),IL-6,TNF-αand hs-CRP were lower than those in the controlled group(P<0.05).There was no significant difference in the total incidence of adverse drug reactions between the two groups(P>0.05).Conclusion:Curative effect of Simiao Huoxue Decoction combined with western medicine is significant on patients with type 2 diabetic LEAD(Qi-Yin deficiency combined with blood stasis).It can significantly improve hemorheology and platelet parameters,increase level of serum TBil and relieve inflammation response.