活血通脉汤加减治疗血脉瘀阻型下肢动脉硬化闭塞症的临床研究

Clinical study on modified Huoxue Tongmai Decoction for lower extremity arteriosclerosis obliterans of blood stasis

目的观察活血通脉汤加减治疗血脉瘀阻型下肢动脉硬化闭塞症(ASO)的临床疗效。方法将96例血脉瘀阻型ASO患者按照随机数字表法分为2组,对照组49例予贝前列素钠片口服,治疗组47例在对照组治疗基础上联合活血通脉汤加减治疗。2组均治疗2个月。比较2组治疗前后中医证候评分、血管内皮功能指标[内皮素-1(ET-1)、血管内皮生长因子(VEGF)、一氧化氮(NO)]、血液流变学及足背动脉血液循环情况变化,并统计2组疗效。结果治疗组总有效率97.87%(46/47),对照组总有效率83.67%(41/49),治疗组疗效优于对照组(P<0.05)。2组治疗后中医证候各项评分及总分均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后VEGF、ET-1水平均较本组治疗前降低(P<0.05),NO水平均升高(P<0.05),且治疗组治疗后VEGF、ET-1水平均低于对照组(P<0.05),NO水平高于对照组(P<0.05)。2组治疗后血浆黏度、全血黏度(高切)、全血黏度(低切)及红细胞聚集指数均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后足背动脉血管内径、血流量均较本组治疗前升高(P<0.05),足背动脉峰值流速均降低(P<0.05),且治疗组治疗后足背动脉血管内径、血流量均高于对照组(P<0.05),足背动脉峰值流速低于对照组(P<0.05)。结论活血通脉汤加减能促进血脉瘀阻型ASO患者血管内皮功能恢复,改善其血液流变学状态及足背动脉血液循环,缓解患者临床不适症状,提高临床疗效。

Objective To observe the clinical efficacy of modified Huoxue Tongmai Decoction for lower extremity arteriosclerosis obliterans(ASO)of blood stasis.Methods Totally 96 patients with lower extremity ASO(blood stasis)were randomly divided into the treatment group(n=47)and the control group(n=49);apart from oral beraprost sodium tablets,and the treatment group additionally received modified Huoxue Tongmai Decoction.A 2-month treatment was performed to compare traditional Chinese medicine(TCM)syndrome score,vascular endothelial function(endothelin-1[ET-1],vascular endothelial growth factor[VEGF],nitric oxide[NO]),blood flow index(BFI)of dorsal pedis artery and hemorheology;the curative effect was assessed.Results The overall effective rate in treatment group was better than that in control group(97.87%[46/47]vs 83.67%[41/49],[P<0.05],respectively).After treatment,TCM syndromes scores were decreased in groups(P<0.05),and which in the treatment group were lower than those in the control group(P<0.05);the levels of VEGF and ET-1 in groups were decreased(P<0.05),the treatment group was decreased in comparison with the control group(P<0.05);the NO level in groups was increased(P<0.05),the treatment group was more common(P<0.05);the plasma viscosity,whole blood viscosity(WBV)(high shearing),WBV(low shearing),red cell aggregation index in groups were decreased(P<0.05),improvement of which in the treatment group were significantly better(P<0.05);the diameter and blood flow of dorsalis pedis artery in groups were increased,the treatment group was higher than the control group(P<0.05);the peak velocity of dorsalis pedis artery was decreased(P<0.05),the treatment group was more prevalent(P<0.05).Conclusion For patients with lower extremity ASO(blood stasis),modified Huoxue Tongmai Decoction can promote the functional recovery of vascular endothelium,improve BFI of dorsal pedis artery and hemorheology,relieve uncomfortable symptoms,with the improvement of clinical efficacy.