益气活血法对2型糖尿病亚临床血管病变患者颈动脉内膜中层厚度及血浆vWF、PAI-1的影响

effect of Supplementing Qi and Activating Blood Circulation Prescription on Carotid Artery Intima Media Thickness and Plasma vWF and PAI-1 in Type 2 Diabetic Patients with Subclinical Vascular Disease

目的:研究益气活血法对2型糖尿病(Type 2 diabetes mellitus,T2DM)亚临床血管病变患者颈动脉内膜中层厚度(intimal-medial thickness,IMT)、血浆血管性假血友病因子(von Willebrand factor,v WF)、纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor 1,PAI-1)的影响。方法:采用随机、对照试验设计,将符合纳入标准的T2DM亚临床动脉粥样硬化(athero sclerosis,AS)患者180例,所有患者均采取常规口服降糖治疗,治疗用药及剂量根据患者病情选择,在此基础上,将180例患者随机分为观察组及对照组,观察组加用益气活血法干预治疗,共计90例患者,剩余90例作为对照组不加用益气活血法。疗程为6个月。治疗前后分别测量颈动脉IMT并检测血脂、血糖、v WF及PAI-1等指标。结果:治疗后,两组颈动脉IMT、斑块积分、TC、TG、LDL-C、FPG、Hb A1c均有降低,差异有统计学意义(P<0.01,P<0.05),观察组降低颈动脉IMT、斑块积分、TC、LDL-C的作用更明显(P<0.01,P<0.05)。同时,观察组的不稳定斑块检出率、v WF、PAI-1与本组治疗前及对照组治疗后比较明显降低,差异有统计学意义(P<0.01,P<0.05),对照组不稳定斑块检出率、v WF、PAI-1有下降趋势,但差异无统计学意义(P>0.05)。结论:采用益气活血法治疗2型糖尿病亚临床血管病变患者,能够减轻颈动脉内膜中层厚度,缩小和稳定斑块,改善糖脂代谢,降低炎症因子表达,抑制炎症反应,保护血管内膜的作用。

Objective：To study the effect of supplementing Qi and activating blood circulation prescription on carotid artery intima media thickness（IMT）, plasma yon Willebrand factor（vWF） and plasminogen activator inhibitor - 1 （PAI - 1 ） in patients with subclinical vascular disease（T2DM）. Methods： Using randomized and controlled trial design, there were 180 cases of patients meeting the inclusion criteria of T2DM subclinical atherosclerosis（AS）. All patients used con- ventional oral hypoglycemic therapy and the choices of therapeutic drugs and doses were according to the condition of patients. On this basis, 180 cases of patients were randomly divided into treatment group and control groups. One group had a total of 90 cases of patients which were treated with supplementing Qi and activating blood circulation prescription, but the remaining 90 cases for control groups did not use this. The course of treatment was 6 months. Before and after treatment, measure the carotid artery IMT, blood lipids, blood glucose, vWF, PAI- 1 and so on. Results ： After treatment, carotid artery IMT, plaque score, TC, TG, LDL - C, FPG and HbA1 c in both two groups were decreased and the differ- ence was statistically significant（ P 〈 0. 01 ,P 〈 0. 05 ）. Carotid artery IMT, plaque score, TC and LDL - C decreased significantly in the treatment group（P 〈0. 01 ,P 〈0. 05）. At the same time, the rate of unstable plaque, vWF and PAI- 1 in the treatment group decreased significantly compared to those before treatment and those in the control group and the difference was statistically significant（ P 〈 0. 01 ,P 〈 0. 05 ）. The rate of unstable plaque, vWF and PAI- 1 in control group decreased, but the difference was not statistically significant（ P 〉 0.05 ）. Conclusion： Supplementing Qi and activating blood circulation prescription when treating type 2 diabetic patients with subclinical vascular disease can alleviate the carotid artery intimamedia thickness, reduce and stabilize the plaque, improve glucose and lipid metabolism, decrease the expression of inflammatory cytokines, inhibit the inflammatory response and protect vascular intima.