活血化瘀方药对慢性阻塞性肺疾病急性加重期血瘀证患者细胞因子及内皮素的影响

Effects of traditional Chinese medicinal herbs for promoting blood circulation and removing blood stasis （活血化瘀） on cytokines and endothelin in patients with acute exacerbation of chronic obstructive pulmonary disease and blood stasis syndrome （血瘀证）

目的从细胞因子及内皮素-1（ET-1）水平变化，探讨活血化瘀方药治疗慢性阻塞性肺疾病急性加重期（AECOPD）血瘀证的作用机制。方法采用随机、双盲、安慰剂对照的临床设计，选取符合入选标准的AECOPD患者65例，按随机数字表法分为试验组（34例，血瘀兼痰热证19例，血瘀兼痰湿证15例）和对照组（31例，血瘀兼痰热证21例，血瘀兼痰湿证10例）。两组均给予常规治疗，试验组加用活血化瘀方药、每日1剂，对照组给予安慰剂，7d为1个疗程，共观察2个疗程。于治疗前后采用放射免疫分析法测定外周血肿瘤坏死因子-α（TNF—α）、细胞间黏附分子1（ICAM—1）、白细胞介素-8（IL-8）、ET-1、降钙素基因相关肽（CGRP）水平；并且以50例健康体检者作为健康对照。结果与健康组比较，AECOPD组TNF—α、ICAM-1、IL-8及ET-1水平均明显升高（均P〈0．01），CGRP水平明显降低（P〈0．01）。两组治疗后TNF—α、ICAM-1、IL-8及ET-1水平均较治疗前明显降低（P〈0．05或P〈0．01），CGRP水平均明显升高（均P〈0．01）；且试验组较对照组改善显著（均P〈0．05）。结论TNF—α、ICAM-1、IL-8、ET-1和CGRP等参与了AECOPD的病理过程，活血化瘀方药可能通过降低TNF—α、ICAM-1、IL-8和ET-1水平，升高CGRP水平，对AECOPD血瘀证发挥治疗作用。

Objective To explore the mechanism of herbs for promoting blood circulation and removing blood stasis （活血化瘀） in treatment of patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and blood stasis syndrome （血瘀证） by detecting changes of cytokines and endothelin-1 （ET-1） levels. Methods The research was designed with randomized double-blind placebo control methods. Sixty-five patients who met the inclusion criteria were randomly divided into control group [31 cases, 21 cases with blood stasis and phlegm-heat syndrome （血瘀兼痰热证）, 10 cases with blood stasis and phlegm damp syndrome （血瘀兼湿证）] and experimental group （34 cases, 19 cases with blood stasis and phlegm-heat syndrome, 15 cases with blood stasis and phlegm damp syndrome）. The patients in the two groups were both treated with a conventional therapy. The experimental group was additionally given herbal decoction for promoting blood circulation and removing blood stasis, one dose daily for two weeks, while the patients in the control group were given a placebo for the same period. Before and after treatment, the peripheral blood was collected to detect the levels of tumor necrosis factor-α （TNF-α）, intercellular adhesion molecule-1 （ICAM-1）, interleukin-8 （IL-8）, ET-1, calcitonin gene-related peptide （CGRP）, and the results were compared with those of the healthy people （n= 50）. Results Compared with the healthy people, the levels of the TNF-α, ICAM-1, IL-8 and ET-1 were markedly higher, and the level of the CGRP was significantly lower （all P〈0.01） in AECOPD patients. The levels of the TNF-α, ICAM-1, IL-8 and ET-1 were obviously decreased, and the level of the CGRP was remarkably increased after treatment in both groups （P〈0.05 or P〈0.01）. The improvement in the above level changes in the experimental group was more significant than that in the control group （all P〈0.05）. Conclusion The cytokines of TNF-α, ICAM-1, IL-8, ET-1 and CGRP are involved in the pathological process of AECOPD. Herbs for promoting blood circulation and removing blood stasis can decrease the levels of TNF-α, ICAM-1, IL-8, ET-1 and increase the level of CGRP. That might play a role in the mechanism for the herbs in treatment of patients with AECOPD and blood stasis syndrome.