归龙汤联合西药治疗糖尿病足对患者血液流变学及血管内皮细胞功能的影响

Effect of Guilong Tang Combined with Western Medicine Therapy for Diabetic Foot on Hemorheology and Vascular Endothelial Cell Function

目的:观察归龙汤联合西药治疗糖尿病足患者的临床疗效以及对血液流变学及血管内皮细胞功能的影响。方法:以随机数字表法将160例阳虚血瘀型糖尿病足患者分为A、B、C组,分别在常规治疗基础上采用归龙汤、西药及归龙汤联合西药治疗。比较3组治疗3月后的临床疗效和治疗期间的不良反应发生率,观察治疗前后血液流变学指标[全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)、全血还原黏度(WBRV)、红细胞压积(HCT)]及血管内皮细胞功能指标[可溶性血管内皮细胞蛋白C受体(s EPCR)、血管性血友病因子(v WF)]的变化。结果:治疗后,A、B组总有效率比较,差异无统计学意义(P>0.05);C组总有效率高于A、B组,差异均有统计学意义(P<0.05)。A、B组HBV、LBV、PV、WBRV、HCT比较,差异均无统计学意义(P>0.05);C组HBV、LBV、PV、WBRV、HCT均低于A、B组,差异均有统计学意义(P<0.05)。C组s EPCR、v WF均低于A、B组,差异均有统计学意义(P<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在常规治疗基础上予归龙汤联合西药治疗阳虚血瘀型糖尿病足疗效确切,较西药治疗具有显著增效作用,其机制可能与改善血液流变学、血管内皮细胞功能有关,且不良反应未见增多,具有较高的临床价值。

Objective：To observe the clinical effect of Guilong tang combined with western medicine in treating patients with diabetic foot and its influence on hemorheology and vascular endothelial cell function. Methods：Divided 160 cases of patients with diabetic foot of yang deficiency and blood-stasis type into group A,B and C randomly,and each group received Guilong tang,western medicine and Guilong tang combined with western medicine respectively for treatment. Compared the clinical effect of the three groups 3 months after treatment and the incidence of adverse reaction during the treatment,and observed the changes of hemorheological indexes [high shearrate blood viscosity（HBV）,low shearrate blood viscosity（LBV）,plasma viscosity（PV）,whole blood reduction viscosity（WBRV）,hematocrit（HCT）] and functional indexes of vascular endothelial cell function[soluble endothelial protein C receptor（sEPCR）,von Willebrand factor（vWF）]. Results：After treatment,the total effective rate of group A and B was compared,differences being insignificant（P〈0.05）;the total effective rate in group C was higher than that in group A and B,differences being significant（P〈0.05）. HBV,LBV,PV,WBRV and HCT of group A and B were compared,differences being insignificant（P〉0.05）;HBV,LBV,PV,WBRV and HCT of group C were all lower than those in group A and B,differences being significant（P〈0.05）. sEPCR and vWF in group C were both lower than those in group A and B,differences being significant（P〈0.05）. The incidence of adverse reaction in the three groups were compared,differences being insignificant（P〉0.05）. Conclusion：Guilong tang combined with western medicine has definite clinical effect in treating diabetic foot of yang deficiency and blood-stasis type,and has significant synergistic function when comparing with western medicine treatment. Its mechanism may be related to the improvement of hemorheology and vascular endothelial cell function. Without increasing adverse reaction,it has a high clinical value.