火针放血治疗下肢静脉曲张疗效观察及机制研究

Efficacy and mechanism of fire needling bloodletting for lower extremity varicose veins

目的:比较火针放血与手术治疗下肢静脉曲张的临床疗效,并探讨其可能的作用机制。方法:将60例患者随机分为观察组及对照组,每组30例。对照组采用手术治疗;观察组给予火针放血治疗,每周2次,共治疗4周。分别于治疗前后记录两组患者临床表现程度评分(VCSS)和静脉功能损害程度评分(VDS);检测两组患者治疗前后血液流变学相关指标[全血黏度、血浆黏度、红细胞比容、纤维蛋白原及红细胞沉降率(ESR)]、免疫炎性反应相关指标[血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、血管内皮细胞功能相关指标[循环内皮细胞(CEC)数量及血浆血内皮素-1(ET-1)、一氧化氮(NO)]以及细胞凋亡相关指标[血清B淋巴细胞瘤-2(Bcl-2)、B淋巴细胞瘤因子相关X蛋白(Bax)和半胱氨酸天冬安氨酸蛋白酶-3(Caspase-3)]变化。结果:与治疗前比较,两组患者治疗后VCSS及VDS评分、血液流变学指标、免疫炎性反应指标及血浆NO水平均下降(P<0.05),观察组患者血清Bax水平亦较治疗前下降(P<0.05);两组患者治疗后CEC数量及血浆ET-1水平均上升(P<0.05),观察组血清Bcl-2、Caspase-3水平亦较治疗前上升(P<0.05)。观察组患者治疗后VCSS及VDS评分、血液流变学指标、免疫炎性反应指标、血管内皮功能指标及血清Bax水平均低于对照组(P<0.05),血清Bcl-2、Caspase-3水平均高于对照组(P<0.05)。结论:火针放血疗法可有效治疗下肢静脉曲张,其作用机制可能与改善患者血液流变学、下调免疫炎性反应、提高血管内皮细胞功能及抑制细胞凋亡有关。

Objective To compare the clinical effect of lower extremity varicose veins between fire needling bloodletting and operation,and to explore the possible mechanism.Methods A total of 60 patients were randomized into an observation group and a control group,30 cases in each one.In the control group,the operation was adopted.The fire needling bloodletting was applied in the observation group,twice a week for 4 weeks.Before and after treatment,the venous clinical severity score(VCSS)and venous disability score(VDS)were recorded,the hemorheological indexes[blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte sedimentation rate(ESR)],immune inflammatory response indexes[serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)],vascular endothelial cell function indexes[the number of circulatingendothelial cell(CEC),plasma endothelin(ET-1)and NO)]and apoptosis indexes(Bcl-2,Bax and Caspase-3)were detected in the two groups.Results Compared before treatment,the scores of VCSS and VDS,hemorheological indexes,immune inflammatory response indexes and levels of plasma NO after treatment were reduced in the two groups(P<0.05).The level of serum Bax after treatment was reduced in the observation group(P<0.05).The number of CEC and levels of plasma ET-1 after treatment were increased in the two groups(P<0.05).The levels of serum Bcl-2 and Caspase-3 after treatment were increased in the observation group(P<0.05).In the observation group,the scores of VCSS and VDS,hemorheological indexes,immune inflammatory response indexes,vascular endothelial cell function indexes and level of serum Bax after treatment were lower than the control group(P<0.05),and the levels of Bcl-2 and Caspase-3 were higher than the control group(P<0.05).Conclusion Fire needling bloodletting could effectively treat lower extremity varicose veins,and the mechanism may be related to the improvement of hemorheology,downregulation of immune inflammatory response,improvement of vascular endothelial cell function and inhibition of apoptosis.