凉血活血法对病毒性肝炎瘀热型黄疸退黄作用及机理

Mechanism of Anti-icteric Effect of Blood Cooling and Activating Therapy for Virus Hepatitis with Stagnant-heat Jaundice

本文以凉血活血法治疗23例病毒性肝炎瘀热型费疸患者,总有效率86.9％。为探讨凉血活血法退黄机理,用紫外分光法测定瘀热黄疸组治疗前后血清血管紧张素I转化酶(ACE)改变,并设湿热黄疸及正常人对照组。结果发现,治前瘀热黄疸组(血清总胆红素350.6±145.4μmol/L)、湿热黄疸组(血清总胆红素136.8±39.3μmol/L),ACE分别为63.3±12.7u、44.5±5.4u,正常人为38.5±9.3u,瘀热黄疸组ACE高于湿热黄疸组及正常人组(P值均<0.01)。瘀热黄疸组,经凉血活血法治后,血清总胆红素降至25.7±15.4μmol/L,ACE亦降至47.4±10.9u(与治前比较P<0.01)。而湿热黄疸组经清热利湿对证治疗,血清总胆红素降至18.8±5.1μmol/L,ACE仍为40.7±4.8u,维持正常(与治前比较P>0.05)。结果表明,凉血活血法退黄与降低ACE同步,而清热利湿法退黄与ACE作用关系不大。结合瘀热黄疸组部分病例肝活检复查,肝血窦等微小血管病理改善,提示ACE可能是瘀热型黄疸物质基础之一,凉血活血法退黄,可能通过抑制ACE活性,扩张微小血管等改善肝脏微循环起作用。

Twenty-three patients of virus hepatitis with stagnant-heat jaundice were treated with the method of clooing and activating blood, the total effective rate being 86.9 %. In order to study the mechanism of anti-icteric effect of cooling and activating blood, ultraviolet spectrometry was used to measure the angiotensin I converting emzyme (ACE) before and after treatment, and a damp-heat jaundice group and a healthy person group were established as control. The results showed that before treatment, in the stagnant-blood jaundice(SBJ) group, the serum total bilirubin (STB) was 350.6±1454μ mol/L and the ACE was 63.3±12.7u; in the damp-heat jaundice (DHJ) group, the STB was 136.8±39.3μmol/L and the ACE was44.5±5.4u. But in the healthy person (HP) group, the ACE was 38.5±9.3u. Compared with the DHJ and HP groups, ACE in SBJ group was higher (P<0.01). After the treatment of cooling and activating blood, in SBJ group the STB and ACE decreased to 25.7±15.4μ mol/L and 47.4±10.9u respectively (compared with those before treatment, P<0.01); but in DHJ group, after the treatment of clearing away heat and promoting diuresis, the STB decreased to 18.8±5. 1μ mol/L while ACE was 40.7±4.8u (still being in a normal state, P>0.05). This indicated that the method of cooling and activating blood is effective for anti-icterus as well as decresaing ACE, but the method of clearing heat and promoting diuresis is only effective for anti-icterus. It is thus suggested that ACE is likely one of the material bases of stagnant-heat jaundice and the method of cooling and activating blood probably exerts its anti-icteric effect by inhibiting ACE activity and dilating the capillaries to improve the microcirculation of the liver.