活血化瘀治疗对慢性阻塞性肺疾病伴高凝状态患者血管内皮功能的影响

Investigation on Method of Promoting Blood Flow to Dissolve Blood Stasis on Vascular Endothelial Function of COPD Patients with Lung Kidney Qi Deficiency in State of Hypercoagulation

目的:中医药活血化瘀治疗对慢性阻塞性肺疾病(COPD)患者高凝状态的改善是否通过调整血管内皮功能实现,并进一步探讨能否通过改善高凝状态,使肺动脉压力有所下降。方法:对60例高凝状态的肺肾气虚型COPD患者随机分为两组,治疗组予活血化瘀治疗,监测D-二聚体,t PA,PAI-1,肺动脉压力数值,进行前后对比,统计学分析。结果:D-二聚体,t PA,PAI-1两组间存在交互作用(分别为P=0.029,P=0.041,P=0.043);肺动脉压力两组间无交互作用(P=0.885);治疗组治疗前后D-二聚体下降明显(P=0.008);t PA上升明显(P=0.007);PAI-1下降明显(P=0.007)。B组治疗前后无显著差异,A组治疗前后D-二聚体与t PA呈负相关(r=-0.91),与PAI-1呈正相关(r=0.89)。结论:活血化瘀治疗改善肺肾气虚型COPD患者的高凝状态可能是通过调节患者的血管内皮功能实现的。短期内活血化瘀治疗对肺肾气虚型COPD伴高凝状态患者的肺动脉压力未见明显影响。

Objective： Through investigating the hypercoagulation of the patients with COPD treated by promoting blood flow to dissolve blood stasis,the complication and mortality rate is reduced in the patients with COPD. Methods： The COPD patients were recruited by pulmonary function tests,based in 2014 guidelines for the diagnosis and treatment of COPD. Criteria for inclusion of the COPD patients： 1the concentration of plasma D-dimer above 300 μg/L. 2Lung and kidney qi deficiency of differentiation of traditional Chinese medicine. Results： 1There was no significant difference in the character of age and gender between the experimental group and the control group（P〉 0. 05）. 2The levels of the plasma D-dime,t PA,PAI-1 and pulmonary artery pressure had significant difference after treatment in the experimental group.And those of the control group had no significant difference after treatment. The level of the plasma D-dime was negatively related to t PA（P = 0. 885）. The level of the plasma D-dime was positively related to PAI-1（r = 0. 89）. Conclusion： The method of promoting blood flow to dissolve blood stasis can reduce the levels of the plasma D-dime and PAI-1 and increase PAI-1 to the COPD patients in the state of hypercoagulation. Promoting blood flow to dissolve blood stasis can regulate the state of hypercoagulation in the COPD patients by improving vascular endothelial function. But the pulmonary artery pressure can not be improved,maybe the sample size was small and the patients were mild. Pulmonary artery pressure of the COPD patients was not increased.