Efficacy and safety of activating blood circulation and removing blood stasis of Traditional Chinese Medicine for managing renal fibrosis in patients with chronic kidney disease:a systematic review and Meta-analysis

OBJECTIVE:To evaluate the efficacy and safety of activating blood circulation and removing blood stasis in terms of Traditional Chinese Medicine(TCM) for managing renal fibrosis(RF) in patients with chronic kidney disease(CKD).METHODS:We searched randomized controlled trials(RCTs) from eight databases.RESULTS:Sixteen eligible studies with 1,356 participants were included in this study.Compared to treatment with Western Medicine(WM) alone,the combined treatment with activating blood circulation and removing blood stasis in terms of TCM(ARTCM) and WM to manage RF in patients with CKD significantly ameliorated type Ⅳ collagen(C-Ⅳ)(SMD:-2.17,95% CI:3.01 to-1.34),type Ⅲ procollagen(PC-Ⅲ)(SMD:-1.08,95% CI:-1.64 to-0.53),laminin(LN)(SMD:-1.28,95% CI:-1.65 to-0.90),transforming growth factor β 1(TGF-β1)(SMD:-0.65,95% CI:-1.18 to-0.12),serum creatinine(Scr)(SMD:-1.36,95% CI:-1.85 to-0.87),blood urea nitrogen(BUN)(MD:-1.51,95% CI:-2.59 to-0.43),and 24 h urine protein(24h Upro)(SMD:-1.23;95% CI:-1.96 to-0.50).The level of hyaluronic acid(HA) was similar in both types of treatment(SMD:-0.74,95% CI:-1.91 to 0.44).The subgroup analysis showed that the duration of 8 weeks might affect the concentration of C-Ⅳ,PC-Ⅲ,and LN(P < 0.05).The effectiveness of the longer duration to C-Ⅳ,PC-Ⅲ,and LN was not certain.However,the result should be interpreted in care.The safety of the treatment using ARTCM and WM could not be evaluated because a few studies had reported adverse effects.The results of the Meta-analysis were not stable enough.There was publication bias for the reports on Scr(P = 0.001),C-Ⅳ(P = 0.001),PC-Ⅲ(P = 0.026),and LN(P = 0.030) and no publication bias for the reports on BUN(P = 0.293).The quality of evidence varied from low to very low.CONCLUSIONS:The combined treatment using ARTCM and WM to manage RF in patients with CKD has some advantages over treatment with WM alone.High-quality RCTs need to be conducted for the strong support.

活血化瘀中药联合富血小板血浆改善激素性股骨头坏死的作用机制

背景:目前发现活血化瘀中药、富血小板血浆技术都能够修复受损血管,促进血管再生,重建股骨头内血运,恢复正常血供,进一步促进成骨作用,在早期干预激素性股骨头坏死方面均表现出一定的优势,可更加深入了解活血化瘀中药及富血小板血浆技术改善激素性股骨头坏死的作用机制,为今后治疗提供新思路。目的:根据国内外相关文献,综述活血化瘀中药联合富血小板血浆技术改善激素性股骨头坏死作用机制的研究进展。方法:检索PubMed、Web of Science、Metstr、中国知网及万方数据库收录的相关文献。以“中药、信号通路、激素性股骨头坏死、血管内皮生长因子、富血小板血浆”及“traditional Chinese medicine、signal pathways、steroid induced necrosis of femoral head、vascular endothelial growth factor、platelet rich plasma”分别作为中、英文检索词,检索文献时限为2000年1月至2022年7月,最终纳入相关文献75篇。结果与结论:活血化瘀中药及富血小板血浆技术在干预早期激素性股骨头坏死方面均表现出一定的优势。对于中医药而言,无论是活血化瘀单体药还是复方药都可以有效缓解激素性股骨头坏死疾病进一步发展,具体作用机制如下:①活血化瘀中药有显著抗凝作用,可以拮抗激素药物造成的血液异常(高凝)状态,进一步恢复股骨头内的正常血供;②活血化瘀中药可修复受损的血管内皮,通过激活血管内皮生长因子,使血管再生,重塑股骨头内血运;③活血化瘀中药祛瘀效果明显,可减少骨髓腔内的脂肪细胞堆积,缓解股骨头内压力;④活血化瘀中药可调控相关信号通路,维持骨代谢,促进成骨细胞、破骨细胞分化平衡,有效减轻激素性股骨头坏死。此外,富血小板血浆中含有大量高浓度细胞生长因子,对成骨作用及血管再生均起到正向作用,同时也可改善血液异常状态。活血化瘀中药联合富血小板血浆技术可发挥二者自身生物作用,干预效果更加显著。

基于虚实辨证的大肠癌血瘀证中医药治疗和作用机制研究进展

血瘀证是大肠癌患者常见的中医证型,血瘀贯穿于大肠癌发生发展的各个阶段,活血化瘀法是临床治疗大肠癌的常用方法。从因虚致瘀、由实成瘀两个角度探讨大肠癌血瘀证的病因病机和临床治疗,并从增殖凋亡、血管新生、细胞自噬、侵袭转移、免疫调节、微循环障碍等方面综述活血化瘀中药治疗大肠癌血瘀证的作用机制,以期为临床使用活血化瘀法治疗大肠癌提供依据。

蔡平平基于八纲辨证治疗绒毛膜下血肿经验采撷

介绍蔡平平教授基于八纲辨证治疗绒毛膜下血肿(SCH)的临床经验。在SCH的诊疗中,以八纲辨证为指导,强调阴阳辨证,灵活使用活血化瘀法;以“活血不留瘀、不动血、不动胎、不碍胎”为原则,提出“急则止血,缓则消瘀,澄源安胎为本”的治疗方法,同时宏观和微观相结合,重视脉诊。

甲磺酸倍他司汀片结合活血化瘀法治疗感应神经性耳聋的临床探讨

目的研究甲磺酸倍他司汀片和活血化瘀法联合应用于感应神经性耳聋治疗中的临床疗效。方法选取2020年8月—2022年8月张家港市中医医院收治的48例感应神经性耳聋患者作为研究对象,按随机数表法分为两组,对照组(n=24)使用甲磺酸倍他司汀片治疗,观察组(n=24)使用甲磺酸倍他司汀片联合活血化瘀法治疗。比较两组患者的疗效和不良反应发生情况。结果治疗后,观察组的耳鸣评分(0.39±0.08)分、耳胀闷感评分(0.26±0.07)分、恶心呕吐评分(0.49±0.08)分以及眩晕评分(0.38±0.07)分均低于对照组,差异有统计学意义(t=25.648、25.390、14.176、26.301,P均<0.05);治疗后,观察组的听力测试值低于对照组,差异有统计学意义(P<0.05);两组患者的不良反应发生率对比,差异无统计学意义(P>0.05)。结论感应神经性耳聋患者应用甲磺酸倍他司汀片和活血化瘀法治疗可有效改善疾病症状,提升听力水平,且具有较高的安全性。

腹泻型肠易激综合征发病机制及治则探析:基于“血活津门无挡,水出泻止”理论

腹泻型肠易激综合征(IBS-D)是临床上常见的一种功能性肠病,其病程迁延且易反复发作,对患者的心理及生活都造成了极大困扰。IBS-D的病因与发病机制较为复杂,目前尚未完全明确,治疗上尚无可以全面治疗IBS-D的特效药。因IBS-D病程多迁延,久病不愈,水湿痰浊易阻滞肠络,致气机升降失调,血液运行不畅,瘀血阻滞肠络,纳运失常,水谷停滞,清浊不分,混杂而下致泄泻。故以“血活津门无挡,水出泻止”为理论基础,以活血化瘀通络法为治则,探讨IBS-D的发病机制及如何在辨证论治基础上加用活血化瘀通络药,为临床中医治疗IBS-D提供新思路。

平性活血化瘀中药及其化学成分抗血小板聚集作用机制的研究进展

文章在调研2014年版《江西省中药材标准》、2020年版《中华人民共和国药典》和相关文献的基础上,从抑制花生四烯酸代谢途径、抑制血小板内含物释放、血小板膜蛋白受体拮抗和影响核苷酸系统四个方面综述了苏木、桃仁、红景天等8味平性活血化瘀中药抗血小板聚集的作用机制,为抗血小板聚集中药的临床应用提供了一定的理论参考。

经典名方中应用下瘀血法方剂探析

对于瘀血导致的疾病,名医张仲景善用下瘀血法进行治疗,故将其所创10首下瘀血方剂分为缓下和急下两类进行辨析。温经汤、桂枝茯苓丸、大黄䗪虫丸归于缓下,下瘀血汤、桃核承气汤、抵当汤、抵当丸、大黄甘遂汤、大黄牡丹汤、鳖甲煎丸归于急下。总结缓下和急下两类方剂各自的组方用药特点、临床应用指征,并认为凡能使瘀血从下排出者皆可归于下瘀血方剂之列;提出不仅要治血,还要治气;认为着眼瘀血之时亦需顾及兼邪,一并下之;对于瘀血证应知机审时,尽早医治,防止其迁延而成癥瘕。

活血化瘀中药临床试验注册现状分析

目的:基于中国临床试验注册中心和美国临床试验注册中心数据库,分析活血化瘀中药临床试验的注册现状。方法:检索中国临床试验注册中心和美国临床试验注册中心从建库至2022年12月31日注册的活血化瘀中药相关的临床试验,进行总结分析。结果:最终纳入752项活血化瘀中药临床试验,包括662项干预性研究、82项观察性研究。地域覆盖中国、新加坡和巴基斯坦3个国家,中药类型包括自拟方/经验方、中成药和中药注射液等。研究设计多为随机平行对照研究(587项,占78.06%)。结论:当前活血化瘀中药临床试验注册存在地域分布不均衡、研究设计欠规范、注册信息填写不完整和不规范的问题,研究者应规范临床试验设计,加强临床试验注册理念,提高临床研究质量。

Activating Blood Circulation to Remove Stasis Treatment of Hypertensive Intracerebral Hemorrhage:A Multi-Center Prospective Randomized Open-Label Blinded-Endpoint Trial

Objective： To investigate the efficacy and safety of the Chinese herbal therapeutic regimen of activating blood circulation （TRABC） in treatment of hypertensive intracerebral hemorrhage （HICH）. Methods： This was a multi-center prospective randomized open-label blinded-endpoint （PROBE） trial with HICH admitted to 12 hospitals. Totally 240 participants were randomized to the treatment group treated with TRABC in addition to conventional Western treatment or the control group with conventional Western treatment equally for 3 months. Primary outcome was degree of disability as measured by modified Rankin Scale （mRS）. Secondary outcomes were the absorption of hematoma and edema, National Institutes of Health Stroke Scale （NIHSS） scores and patient-reported outcome measures for stroke and Barthel activities of daily living index. Adverse events and mortality were also recorded. Results： After 3 months of treatment, the rate of mRS 0-1 and mRS 0-2 in the treatment group was 72.5% and 80.4%, respectively, and in the control group 48.1% and 63.9%, respectively, with a significant difference between groups （P〈0.01）. Hematoma volume decreased significantly at day 7 of treatment in the treatment group than the control group （P=0.038）. Average Barthel scores in the treatment group after treatment was 89.11 ＋ 19.93, and in the control group 82.18 ＋ 24.02 （P=0.003）. NIHSS scores of the two groups after treatment decreased significantly compared with before treatment （P=0.001）. Patient-reported outcomes in the treatment group were lower than the control group at day 21 and 3 months of treatment （P〈0.05）. There were 4 deaths, 2 in each group, and 11 adverse events, 6 in the treatment group and 5 in the control group. Conclusion： The integrative therapy combined TRABC with conventional Western treatment for HICH could promote hematoma absorption thus minimize neurologic impairment, without increasing intracerebral hematoma expansion and re-bleeding.

Effect on platelet aggregation activity: extracts from 31 Traditional Chinese Medicines with the property of activating blood and resolving stasis

OBJECTIVE: To evaluate the anti-platelet aggregation effects of extracts from 31 Traditional Chinese Medicines(TCM) with the property of activating blood and resolving stasis in terms of TCM theory.METHODS: The 31 TCMs extracts were prepared using water, 90% ethanol and ethyl acetate., and the effects on anti-platelet aggregation were tested on a platelet aggregation analyzer in vitro with adenosine 5'-diphosphate, bovine thrombin and arachi-donic acid(AA) as aggregation inducers, respectively. Aspirin was the positive control.RESULTS: Lots of the tested TCMs had inhibitory effects with concentration-dependent manner on platelet aggregations induced by various agonists.Especially, some of the TCMs such as Chuanxiong(Rhizoma Chuanxiong), Yanhusuo(Rhizoma Corydalis Yanhusuo) and Danshen(Radix Salviae Miltiorrhizae) showed good anti-platelet aggregation effect similar or higher than that in positive control group.CONCLUSION: The study provided scientific references that several TCMs such as Chuanxiong(Rhizoma Chuanxiong), Yanhusuo(Rhizoma Corydalis Yanhusuo) and Danshen(Radix Salviae Miltiorrhizae),possess the property of anti-platelet aggregation.

国医大师周仲瑛运用全草类中药经验

周仲瑛教授临证用药属类丰富,并擅长运用全草类中药,此类药物多质地轻脆,气味甘香淡雅。收集整理周老常用全草类中药22味,以功效为经,分为清热药、活血药、止血药、祛风湿药、化痰止咳药及补益药;以临证应用为纬,汇总归纳周老对全草类中药的使用特色及配伍经验,彰显周老临证用药“药随法取、法应病机、机中症情”的原则。

活血化瘀中药注射剂超说明书应用合理性评价

目的 评价活血化瘀中药注射剂超说明书应用合理性。方法 采用回顾性分析方法,利用医院HIS系统调取2021年10月~2022年03月于盐城市第一人民医院住院出院使用活血化瘀中药注射剂的病历信息,统计超说明书用药情况,参考相关指南共识对超说明书应用的合理性进行评价分析。结果 超说明书用药共计442例(77.70%),超说明书用药使用率排名前三的药品为大株红景天注射液97.96%、注射用红花黄色素91.84%、注射用血栓通90.82%;超说明书用药类型主要表现为超适应症、超溶媒、超剂量、超疗程、超给药禁忌、超配伍禁忌6个方面;仅126例超适应症用药符合《中医诊疗方案》或有相关指南共识推荐。结论 活血化瘀中药注射剂超说明书用药现象严重,不合理问题较多,应加强管理,保障临床用药安全。

Platelet proteomics and its advanced application for research of blood stasis syndrome and activated blood circulation herbs of Chinese medicine

The development of novel and efficient antiplatelet agents that have few adverse effects and methods that improve antiplatelet resistance has long been the focus of international research on the prevention and treatment of cardiovascular and cerebrovascular diseases.Recent advances in platelet proteomics have provided a technology platform for high-quality research of platelet pathophysiology and the development of new antiplatelet drugs.The study of blood stasis syndrome(BSS)and activated blood circulation of traditional Chinese medicine(TCM)is one of the most active fields where the integration of TCM and western medicine in China has been successful.Activated blood circulation herbs(ABC herbs)of Chinese medicine are often used in the treatment of BSS.Most ABC herbs have antiplatelet and anti-atherosclerosis activity,but knowledge about their targets is lacking.Coronary heart disease(CHD),BSS,and platelet activation are closely related.By screening and identifying activated platelet proteins that are differentially expressed in BSS of CHD,platelet proteomics has helped researchers interpret the antiplatelet mechanism of action of ABC herbs and provided many potential biomarkers for BSS that could be used to evaluate the clinical curative effect of new antiplatelet drugs.In this article the progress of platelet proteomics and its advanced application for research of BSS and ABC herbs of Chinese medicine are reviewed.

Effect of Yang-activating and stasis-eliminating decoction from Traditional Chinese Medicine on intestinal mucosal permeability in rats with ulcerative colitis induced by dextran sulfate sodium

OBJECTIVE: To evaluate the effect of decoction prepared with Yang-activating and stasis-eliminating medicinals from Traditional Chinese Medicine(TCM) on the intestinal mucosal permeability in rats with ulcerative colitis induced by dextran sulfate sodium(DSS).METHODS: Totally 55 male Wistar rats(body weight of 170-190 g) were randomly divided into the blank group(n = 10) and the model duplication group(n = 45). The blank group was not intervened, while the other was modeled with 5% dextran sulfate sodium by gavaging in a dosage of4 m L per day to induce ulcerative colitis, a total of7 days. Then, the model rats were divided into model blank group, mesalazine group and TCM group,and each group was consisted of 15 rats. They were given retention enema 10 min with normal saline,mesalazine enema(0.036 g/m L), and Yang-activating and stasis-eliminating decoction [0.54 g/m L of a decoction boiled by Puhuang(Pollen Typhae), Xiebai(Bulbus Allii Macrostemonis) and Wulingzhi(Faeces Trogopteri)] for 10 days respectively. Afterwards,all of the rats were evaluated by disease activity index(DAI), histological changes of distal colon, expression of occludin protein and ultrastructure of intestinal epithelial cells. Furthermore, ratio of lactulose to mannitol(L/M) discharged in urine was evaluated.RESULTS: Comparing the results between TCM and model control groups, scores of DAI and histological lesions decreased significantly(P = 0.000 <0.01), ultrastructures of intestinal epithelial cells and tight junctions were more complete. The expression of occludin protein(P = 0.001 < 0.01) increased while the L/M value decreased significantly(P = 0.000 < 0.01) in TCM group. There was no statistical difference between the TCM and mesalazine groups in results of each item(P > 0.05).CONCLUSION: The decoction prepared with Yang-activating and stasis-eliminating TCM medicianls can restore intestinal mucosal epithelial cells and tight junctions the model rats with ulcerative colitis; it can reduce histological lesions and protect the permeability of intestinal mucosa barrier in the rats as well.

益气活血化瘀汤治疗冠心病气虚血瘀证临床研究

目的:观察益气活血化瘀汤对冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)气虚血瘀证患者血清超氧化物歧化酶(superoxide dismutase,SOD)、血脂水平以及血小板相关参数的影响。方法:将100例CHD气虚血瘀证患者按照随机数字表法分为对照组和观察组,每组各50例。对照组给予常规西药治疗,观察组在对照组治疗的基础上加用益气活血化瘀汤。比较两组患者的临床疗效及治疗前后中医证候积分、心绞痛发作情况、SOD、血脂水平[三酰甘油(triacylglycerol,TG)、血清总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白(high density lipoprotein cholesterol,HDL-C)]、血小板各参数[血小板压积(platelet crit,PCT)、大血小板比率(platelet-large cell ratio,P-LCR)、血小板体积分布宽度(platelet distribution width,PDW)、平均血小板体积(mean platelet volume,MPV)]、心功能[左心室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、每搏输出量(stroke volume,SV)]及西雅图心绞痛调查量表(seattle angina questionaire,SAQ)评分变化情况。结果:观察组有效率为92.00%,对照组有效率为76.00%,两组患者有效率比较,差异具有统计学意义(P<0.05)。两组患者治疗后各项中医证候积分、心绞痛每周发作频率、每次持续时间、硝酸甘油每日消耗量、PCT、P-LCR、PDW及MPV低于本组治疗前,且治疗后观察组低于对照组(P<0.05)。两组患者治疗后SAQ各维度评分及SOD水平高于本组治疗前,且治疗后观察组高于对照组(P<0.05)。两组患者治疗后HDL-C、LVEF、SV高于本组治疗前,TC、TG、LDL-C、LVEDD均低于本组治疗前,且治疗后组间比较,差异具有统计学意义(P<0.05)。结论:益气活血化瘀汤治疗CHD气虚血瘀证,可显著缓解患者心绞痛症状,调节SOD及血脂水平,改善血小板参数及心功能情况,提高患者生活质量。

Chinese patent medicine for chronic obstructive pulmonary disease based on principles of tonifying Qi, promoting blood circulation by removing blood stasis, and resolving phlegm: a systematic review of randomized controlled trials

OBJECTIVE: To assess the efficacy and safety of Chinese patent medicine(CPM) with the principle of tonifying Qi, promoting blood circulation by removing blood stasis, and resolving phlegm(TQ-PBC-RP)in the management of stable chronic obstructive pulmonary disease(COPD).METHODS: A systematic review of randomized controlled trials(RCTs) identified from electronic databases and print was conducted. RCTs testing CPMs with TQ-PBC-RP against any type of controlled intervention in patients with stable COPD and assessing clinically relevant outcomes were included. Methodological quality was evaluated with the risk of bias tool according to systematic review handbook 5.0.2. Quality of evidence was estimatedby the rating approach developed by the Grading of Recommendations, Assessment, Development,and Evaluation Working Group.RESULTS: Thirteen eligible RCTs with 12 oral CPMs were tested. Significant differences between groups in favor of CPMs were not reported in all trials. Most trials included were deemed to be of low methodological quality with poor evidence quality.Because of large data heterogeneity, statistical pooling was not performed for all outcomes.CONCLUSION: The effectiveness of CPM in the treatment of stable COPD is not supported by evidence. Currently, evidence from RCTs is scarce and methodologically weak. Considering the popularity of CPMs among patients undergoing COPD, rigorously designed trials are warranted.

活血化瘀中药对鸡胚绒毛尿囊膜血管生成的影响

目的观察常用活血化瘀中药赤芍、当归、红花、川芎、丹参、黄芪及复方当归补血汤、血府逐瘀汤、芎芍胶囊等对鸡胚绒毛尿囊膜(chorioall antoic membrane,CAM)新生血管生成的影响。方法制备CAM模型,分别应用赤芍、当归、红花、川芎、丹参、黄芪及当归补血汤、血府逐瘀汤、芎芍胶囊的含药血清,观察CAM血管生成的情况,同时,设立生理盐水对照组、空白血清对照组、空白对照组及碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)阳性对照组。结果所选药物及bFGF皆有促进CAM新生血管生成的作用,其中,丹参及当归补血汤、血府逐瘀汤、芎芍胶囊等复方在血管生成及血管计数方面,均明显优于生理盐水对照组、空白血清对照组及空白对照组,与阳性对照药bFGF的作用相当;中药复方的作用优于丹参之外的其他单味中药。结论活血化瘀中药丹参及当归补血汤、血府逐瘀汤、芎芍胶囊具有较好的促进CAM新生血管生成的作用。本实验从一个侧面阐明了活血化瘀中药及方剂治疗缺血性疾病的作用机理,同时,研究也体现了中药复方应用的科学依据。

活血化瘀中药对内毒素性休克内皮细胞的保护作用

目的 :探讨活血化瘀中药对内毒素性休克大鼠肺微血管内皮细胞的保护作用。方法 :选 Wistar大鼠 ,随机平分为对照组、模型组 (L PS)、地塞米松治疗组 (Dex)和活血化瘀中药治疗组 (AMRS)。电镜观察内皮细胞的超微结构改变 ,用电脑图像分析系统进行形态计测及肺微血管通透性指数 (PMPI)和循环内皮细胞 (CEC)数量的测定。结果 :AMRS组与 L PS组比较内皮细胞厚度极明显减小 (P<0 .0 0 1) ,胞饮泡体密度、细胞表面破损线密度、PMPI及 CEC数量均有明显差异 (P<0 .0 1或 P<0 .0 5 )。 AMRS组与 Dex组比 ,上述大多数指标有显著差异 (P均 <0 .0 5 ) ,微血管内血小板聚集、纤维素沉着和白细胞粘附内皮细胞现象也明显减少。结论 :在内毒素性休克中 ,活血化瘀中药在超微结构水平上能够改善、修复受损的内皮细胞 。

活血化瘀药对内毒素休克大鼠细胞因子释放的影响

目的 :探讨活血化瘀药对内毒素休克大鼠细胞因子释放的影响。方法 :Wistar大鼠 40只 ,随机平分为对照组 (NS)、内毒素休克组 (L PS)、地塞米松治疗组 (Dex)和活血化瘀药治疗组 (AMRS) 4组 ,分别检测各组血中内皮素 1(ET 1)、一氧化氮 (NO)、肿瘤坏死因子α(TNFα)和超氧化物歧化酶 (SOD)的浓度变化。结果 :在 L PS刺激下 ,血中 ET 1、NO和 TNFα的浓度与 NS组比较显著增加 (P均 <0 .0 1) ,而 SOD较 NS组浓度降低 (P<0 .0 5 )。 Dex组与 L PS组比有不同程度的恢复 ,但只有 ET 1降低明显 (P<0 .0 5 )。 AMRS组的各项指标均与 L PS组比有显著差异 (P均 <0 .0 5 )。结论 :AMRS影响 L PS刺激所诱导的血中 ET 1、NO、TNFα和 SOD浓度的改变 ,其在内毒素休克过程中对内皮细胞等靶细胞释放细胞因子具有重要的调节作用。