益气活血解毒法对溃疡性结肠炎血浆血小板活化的临床及实验研究

Clinical study and animal experiment on benefiting vital Qi,activating blood flow and detoxication on plasma platelet activation during ulcerative colitis

[目的]探讨益气活血解毒法对溃疡性结肠炎(UC)血浆血小板活化的影响。[方法]分临床研究及动物实验两部分;临床研究以90例溃疡性结肠炎复发患者按随机数字表法随机分为2组,中药治疗组45例,西药对照组45例。治疗3个月后对完全缓解及有效病例(其中治疗组39例,对照组32例)进行为期6个月的随访。治疗组给予益气活血解毒立法的中药汤剂,对照组给予柳氮磺胺吡啶治疗,并各与20例作正常对照。动物实验用三硝基苯磺酸(TNBS)复制实验性大鼠UC模型,将其随机分为模型组、西药对照组、中药治疗组,并设正常对照组。进行反映血小板活化程度的特异性标志物P-选择素的检测。[结果]临床研究中,治疗前UC患者血浆P-选择素水平明显高于正常健康人(P<0.01);治疗组治疗后及随访时含量明显低于西药对照组(P<0.05或P<0.01)。动物实验中,在治疗10 d时,两治疗组皆可降低血浆P-选择素水平,西药组水平明显低于中药组(P<0.05);治疗30 d时中药组与西药组相比无显著差异(P>0.05);停药10 d时,中药组明显低于西药组(P<0.05)。[结论]以益气活血解毒立法的中药溃结复发方与西药比较,可有效降低血浆P-选择素水平,从而阻抑血小板活化,可能是抗溃结复发作用机制之一。

[Objective] To investigate the influence of benefiting vital QI,activating blood flow and detoxication on plasma platelet activation during ulcerative colitis（UC）.[Methods] The study included clinical study and animal experiment.In clinical study,90 cases with recurrent UC were randomly divided into the treatment group（n=45） and the control group（n=45） according to the random table.Three months after treatment,the cases of complete remission and effective cases were followed-up for 6 months（39 cases in treatment group,32 in control group）.The patients of treatment group received medicinal decoction of TCM consisting of herbs with benefiting vital Qi,activating blood flow and detoxication;the control group was treated with salazosulfapyridine.In animal experiment,UC was induced with TNBS in rats and then randomly divided into model control group,western medicine group,the traditional Chinese medicine group,and normal control group.P-selectin,a specific marker reflecting the activation level of platelet was determined.[Results] In clinical study,before treatment the plasma P-selectin level in patients with UC was significantly higher than normol healthy persons（P0.01）;the level of P-selectin in recurrent group was significantly higher than those patients without recurrence（P0.01）;After treatment and during the follow-up period the level of plasma P-selectin in treatment group was markedly lower than those in control group with western medicine（P0.05 or P0.01）.In animal experiment,plasma P-selectin level of western medicine group were markedly lower than that of the traditional Chinese medicine group 10 days after treatment（P0.05）.30 days after treatment,there was no significant difference between TCM group and western medicine group（P0.05）.After withdrawing medicine for 10 days the P-selectin level in traditional Chinese medicine group was markedly lower than that in western medicine group（P0.05）.[Conclusion] The study shows that the Kuijiefufafang（prescription preventing recurrence of UC,PPRUC） consisting of medicine with benefiting vital Qi,activating blood flow and detoxication can effectively decrease the P-selectin level compared with western medicine.Accordingly the activation of platelet is inhibited.That probably is one of the therapeutic mechanism of PPRUC.