活血解毒方对老年原发性干燥综合征高凝状态的改善作用

Improvement of High Coagulation State of Senile Primary Dryness Syndrome Treated by Huoxue Jiedu Decoction

目的:探讨活血解毒方对老年原发性干燥综合征高凝状态的改善作用。方法:选取符合纳入标准的老年原发性干燥综合征患者200例,依据随机数表法随机分为活血解毒组和甲氨氯喹组,每组100例。甲氨氯喹组患者给予3个月的7.5 mg甲氨蝶呤(1次/周)和0.2 g硫酸羟氯喹(2次/d)口服治疗;活血解毒组患者在此基础上给予3个月的活血解毒方治疗,2次/d。采用免疫比浊法检测血浆中免疫球蛋白A(Ig-A)、免疫球蛋白G(Ig-G)、免疫球蛋白M(Ig-M)水平;采用酶联免疫吸附法(ELISA)检测NF-κB信号通路蛋白(p65、p50、IκB)和C反应蛋白(CRP)水平;采用魏氏法测定血沉(ESR)水平;采用Schirmer试验检查泪腺分泌功能。随访6个月,统计分析所有患者治疗前后血浆中D-二聚体(D-D)、血浆纤维蛋白原(FIB)、凝血酶原时间(TT)、活化部分凝血酶时间(APTT)、血浆凝血酶时间(PT)、血浆中Ig-A、Ig-G、Ig-M、p65、p50、IκBα、CRP、ESR水平和治疗前、治疗后1、3、6个月的Schirmer试验结果、唾液流率及治疗期间不良反应发生情况。结果:活血解毒组患者治疗后血浆中D-D、FIB、TT、APTT、PT水平明显低于甲氨氯喹组,有统计学差异(P<0.05);活血解毒组患者治疗后血浆中Ig-A、Ig-G、Ig-M水平明显低于甲氨氯喹组,有统计学差异(P<0.05);活血解毒组患者治疗后p65、p50、IκB、CRP、ESR水平明显低于甲氨氯喹组,有统计学差异(P<0.05);活血解毒组患者治疗后1、3、6个月的Schirmer试验结果明显高于甲氨氯喹组,有统计学差异(P<0.05);活血解毒组患者治疗后1、3、6个月的唾液流率明显高于甲氨氯喹组,有统计学差异(P<0.05);活血解毒组和甲氨氯喹组患者治疗期间不良反应发生率基本相同,无显著性差异(P>0.05)。结论:活血解毒方可有效抑制老年原发性干燥综合征患者NF-κB信号通路的活化,改善患者的高凝状态,有利于减少对血管内皮细胞的损伤,同时可有效调节机体的免疫功能,进一步缓解患者眼干和口干的症状,且具有良好的安全性,值得临床作进一步推广。

Objective: To discuss the improvement of high coagulation state due to primary dryness syndrome in the elderly with Huoxue Jiedu decoction. Methods: 200 patients were randomly divided into the Chinese medicine group and the western medicine group,with 100 cases in each group. The western medicine group was treated with 7. 5 mg Methotrexate( once per week) and 0. 2 g Hydroxychloroquine Sulfate( twice per day); on which basis,the Chinese medicine group was treated with Huoxue Jiedu decoction( twice per day); the treatment course was three months. The levels of Ig-A,Ig-G,and Ig-M were tested with the method of turbidmetric inhibition immuno assay; proteins of P65,P50,I κβ,and CRP of NF-κβ signal pathway were detected with ELISA method; ESR level was evaluated with Westergren method; and lacrimal gland secretion was checked with Schirmer test. Plasma D-dimer( D-D),plasma fibrinogen( FIB),prothrombin time( TT),activated partial thrombin time( APTT),plasma prothrombin time( PT),as well as the above parameters were detected and analyzed before and after the treatment. Schirmer test result,saliva flow rate and adverse reaction were observed and compared among 1 m,3 m,and 6 m after the treatment. Results: After the treatment,plasma levels of D-D,FIB,TT,APTT,and PT in the Chinese medicine group were lower than those in the western medicine group,which were statistically significant( P < 0. 05); Plasma levels of Ig-A,Ig-G,and Ig-M in the Chinese medicine group were lower than those in the western medicine group,with statistically significant difference( P < 0. 05); expressions of p65,p50,I κβ,CRP,and ESR in the Chinese medicine group were significantly lower than those in the western medicine group( P < 0. 05); results of Schirmer test and saliva flow rate 1 m,3 m,6 m after treatment in the Chinese medicine group were significantly higher than those in the western medicine group with statistical differences( P < 0. 05); incidence of adverse reactions of the two groups were similar,which had no significant difference( P > 0. 05). Conclusions: The therapy of Huoxue Jiedu decoction can effectively inhibit the activation of NF-κβ signal pathway in the patients with senile primary dryness syndrome,it can improve the high coagulation state,which is beneficial to reducing the damage of vascular endothelial cells,and it can effectively regulate immune function,which is conducive to further alleviating symptoms of dry eyes and dry mouth; the therapy has good security,it 's worth of further clinical promotion.