血府逐瘀汤对终末期肾病维持性血液透析患者血液高凝状态的影响

Influence of Treatment of Xuefu Zhuyu Tang to Hypercoagulable State of Patients with End-stage Renal Disease During Hemodialysis

目的:探讨血府逐瘀汤对终末期肾病(ESRD)维持性血液透析患者血液高凝状态的影响。方法:采用随机按数字表法将90例患者分为对照组和观察组各45例。两组均进行血液透析,给予西医综合对症处理措施。对照组口服肾炎四味胶囊,6粒/次,3次/d。观察组内服血府逐瘀汤,1剂/d。两组疗程均为12周。观察治疗前后纤维蛋白原(FIB),D-二聚体(DD),血管假性血友病因子(v WF),同型半胱氨酸(Hcy)和血栓前体蛋白(Tp P),血液流变学,血浆组织纤溶酶原激活物(t-PA)和组织纤溶酶原抑制物(PAI)等指标的变化情况。结果:治疗后观察组D-D,FIB,v WF,Hcy和Tp P水平均低于对照组(P<0.01);治疗后观察组全血黏度(高切、低切)、血浆黏度、红细胞压积、血小板聚集率等指标均较治疗前明显改善(P<0.01),并优于治疗后对照组(P<0.01);两组治疗后t-PA水平较治疗前升高,观察组上升更为显著(P<0.01);治疗后观察组PAI水平下降,并低于对照组(P<0.01)。结论:血府逐瘀汤能降低ESRD维持血液透析患者促凝血因子水平,抑制血小板活性,改善微循环,从而改善了患者血液高凝状态,有利于防止血栓的形成,减少血栓栓塞性疾病的发生。

Objective： To discuss the influence of treatment of Xuefu Zhuyu tang to hypercoagulable state of patients with hemodialysis in treating end-stage renal disease （ESRD）. Method： Ninety patients were randomly divided into control group （45 cases） and observation group （45 cases） by random number table. Both group＇s patients received hemodialysis of western medicine symptomatic treatment. Patients in control group received Shenyan Siwei capsules, 6 grains/time, 3 times/day. Patients in observation received treatment of Xuefu Zhuyu tang, 1 dose/day. Course of treatment in two groups lasted 12 weeks. Before and after treatment, the change of fibrinogen （FIB） , D-dimer （D-D） ,von willebrand factor （vWF） , homocysteine （Hcy） , thrombus precursor protein （TpP）, hemorheology, tissue plasminogen activator （t-PA） and plasminogen activator inhibitor （PAI） were observed. Result： After treatment, levels of D-D, FIB, vWF, Hcy and TpP in observation group were lower than those in control group （P 〈 0.01 ）. Compared with before treatment, amelioration of whole blood viscosity （low shear and high shear） , plasma viscosity, hematokrit, platelet aggregation rate were obviously （P 〈 0.01 ） , and it was superior to those in control group （P 〈 0.01 ）. Both group＇s levels of t-PA increased, and it was more obviously in observation group （P 〈0.01 ）. Level of PAI in observation group decreased and lower than those in control group （ P 〈 0.01 ）. Conclusion： Treatment of Xuefu Zhuyu tang can reduce levels of prothrombin factors of patients with hemodialysis in treating ESRD, restrain platelet aggregation, ameliorate microcirculation and hypercoagulable state, and it can prevent the development of thrombus and reduce the happening of thrombosis disease.