加味黄芪桂枝五物汤治疗老年2型糖尿病下肢血管病变的临床观察
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摘要
目的:观察加味黄芪桂枝五物汤治疗老年2型糖尿病下肢血管病变(LEAD)气阴两虚兼血瘀症患者的临床疗效及抗炎和抗氧化作用机制。方法:将128例患者随机按数字表法分为对照组和观察组各64例。对照组给予生活方式干预和控制血糖、血压、血脂等药物治疗;口服普罗布考片,0. 5 g/次,2次/d,早、晚餐时服用;口服拜阿司匹林肠溶片,100 mg·d~(-1),连续治疗3个月;前列地尔注射液,10μg·d~(-1),加生理盐水10 mL,静注,1次/d。连续注射15 d,休息15 d为1个疗程,共治疗3个疗程。观察组在对照组治疗的基础上内服加味黄芪桂枝五物汤,1剂/d。两组疗程均连续治疗3个月。测量治疗前后踝肱指数(ABI),趾肱指数(TBI),以彩色多普勒超声检测治疗前后足背动脉血管内径、峰值流速、血流量,进行治疗前后主要症状和体征评分,检测治疗前后血清白细胞介素-1(IL-1),同型半胱氨酸(Hcy),肿瘤坏死因子-α(TNF-α),高敏C反应蛋白(hsCRP),胱抑素-C(CysC),丙二醛(MDA),超氧化物歧化酶(SOD)和氧化型低密度脂蛋白(OX-LDL)水平。结果:经秩和检验,观察组患者临床疗效优于对照组(P <0. 05);观察组ABI和TBI指数均高于对照组(P <0. 01);观察组患者足背动脉血管内径、峰值流速、血流量改善均好于对照组(P <0. 01);观察组间歇性跋行、下肢疼痛、足背动脉搏动、皮肤色泽、皮肤温度、肢体麻木、肢体酸胀等主要症状、体征评分均低于对照组(P <0. 01);治疗后观察组血清IL-1,Hcy,TNF-α,hs-CRP和CysC水平均低于对照组(P <0. 01);观察组MDA,Ox-LDL水平均低于对照组,SOD水平高于对照组(P <0. 01)。结论:采用加味黄芪桂枝五物汤结合西医治疗LEAD患者,能减轻临床症状及体征,并改善了下肢血管功能和血流动力情况,具有一定的抗炎症反应和氧化应激效应,减轻血管内皮细胞损伤,对于LEAD进展起到减轻或延缓作用。
Objective: To observe the clinical effect of modified Huangqi Guizhi Wuwu Tang on patient with lower-extremity arterial disease(LEAD) with deficiency of Qi and Yin and blood stasis syndrome,and study the antioxidant mechanism. Method: One hundred and twenty-eight patients were randomly divided into control group(64 cases) and observation group(64 cases) by random number table. Patients in control group was treated for controlling blood sugar, blood pressure and blood fat, and got probucol in the morning and evening,0. 5 g/time,2 times/days,aspirin enteric-coated tablets for 3 months,100 mg·d~(-1),and alprostadil injection diluted with 10 m L normal saline for 15 days,10 μg·d~(-1),1 time/day. A course of the treatment in control group was 15 days,and there were 4 courses. In addition to the therapy of control group,patients in observation group were additionally given modified Huangqi Guizhi Wuwu Tang,1 dose/day,for 3 months. Before and after treatment,ankle brachial index(ABI) and toe branch index(TBI) were detected,and internal diameter of dorsal artery of foot,peak velocity and blood flow were detected by color Doppler ultrasound. Main symptoms and sign were scored. And levels of interleukin-1(IL-1),Homocysteine(Hcy),tumor necrosis factor-α(TNF-α),high sensitive C reactive protein(hs-CRP),cystatin C(CysC),malondialdehyde(MDA),superoxide dismutase(SOD) and oxidized low density lipoprotein(OX-LDL) were detected. Result: According to the rank test,clinical effect in observation group was better than that in control group(P < 0. 05). And levels of ABI,TBI and SOD were higher than those in control group(P < 0. 01). The ameliorate of internal diameter of dorsal artery of foot,peak velocity and blood flow were better than those in control group,and scores of intermittent postscript,lower extremity pain,dorsalis pedis artery pulsation,skin color,skin temperature,numbness of limbs,swelling of extremities and the sign and levels of IL-1,Hcy TNF-α,hs-CRP,Cys-C and Ox-LDL were lower than those in control group(P < 0. 01). Conclusion: Modified Huangqi Guizhi Wuwu Tang can relieve symptoms and signs,lower limb vascular function and hemodynamic,with certain anti-inflammatory effect and oxidative stress. It can also reduce vascular endothelial cell injury,and relieve and postpone the progress of LEAD
Objective: To observe the clinical effect of modified Huangqi Guizhi Wuwu Tang on patient with lower-extremity arterial disease(LEAD) with deficiency of Qi and Yin and blood stasis syndrome,and study the antioxidant mechanism. Method: One hundred and twenty-eight patients were randomly divided into control group(64 cases) and observation group(64 cases) by random number table. Patients in control group was treated for controlling blood sugar, blood pressure and blood fat, and got probucol in the morning and evening,0. 5 g/time,2 times/days,aspirin enteric-coated tablets for 3 months,100 mg·d~(-1),and alprostadil injection diluted with 10 m L normal saline for 15 days,10 μg·d~(-1),1 time/day. A course of the treatment in control group was 15 days,and there were 4 courses. In addition to the therapy of control group,patients in observation group were additionally given modified Huangqi Guizhi Wuwu Tang,1 dose/day,for 3 months. Before and after treatment,ankle brachial index(ABI) and toe branch index(TBI) were detected,and internal diameter of dorsal artery of foot,peak velocity and blood flow were detected by color Doppler ultrasound. Main symptoms and sign were scored. And levels of interleukin-1(IL-1),Homocysteine(Hcy),tumor necrosis factor-α(TNF-α),high sensitive C reactive protein(hs-CRP),cystatin C(CysC),malondialdehyde(MDA),superoxide dismutase(SOD) and oxidized low density lipoprotein(OX-LDL) were detected. Result: According to the rank test,clinical effect in observation group was better than that in control group(P < 0. 05). And levels of ABI,TBI and SOD were higher than those in control group(P < 0. 01). The ameliorate of internal diameter of dorsal artery of foot,peak velocity and blood flow were better than those in control group,and scores of intermittent postscript,lower extremity pain,dorsalis pedis artery pulsation,skin color,skin temperature,numbness of limbs,swelling of extremities and the sign and levels of IL-1,Hcy TNF-α,hs-CRP,Cys-C and Ox-LDL were lower than those in control group(P < 0. 01). Conclusion: Modified Huangqi Guizhi Wuwu Tang can relieve symptoms and signs,lower limb vascular function and hemodynamic,with certain anti-inflammatory effect and oxidative stress. It can also reduce vascular endothelial cell injury,and relieve and postpone the progress of LEAD
引文
[1]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.
[2]高林英,任文霞,冯永亮.2型糖尿病下肢血管病变的临床流行病学分析[J].中华疾病控制杂志,2014,18(4):308-311.
[3]张杨,蔡念,李辉,等.糖尿病足患者下肢血管病变及诊疗现状[J].中国血管外科杂志:电子版,2018,10(1):61-64.
[4]刘仲书,付丽媛,杨进.2型糖尿病大血管病变机制的中西医研究进展[J].世界科学技术-中医药现代化,2015,17(10):2125-2129.
[5]周静,高晟,吴深涛.糖尿病周围血管病变中医证候规律探析[J].中国实验方剂学杂志,2016,22(17):136-140.
[6]李冀,孙新雨,毕珺辉.黄芪桂枝五物汤的临证应用及实验研究进展[J].中医药学报,2014,16(5):108-111.
[7]胡海兵,田文红,秦艳,等.加减黄芪桂枝五物汤治疗糖尿病下肢血管病变的临床疗效[J].临床医学研究与实践,2018,12(9):109-110.
[8]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南[J].中华医学杂志,2015,95(24):145-151.
[9]中华中医药学会.糖尿病中医防治指南[J].中国中医药现代远程教育,2011,9(4):148-151.
[10]崔公让.糖尿病肢体动脉闭塞症诊断及疗效标准(草案)[J].中国中西医结合外科杂志,2003,2(2):352-352.
[11]刘畅,王英南,王旭泽,等.老年2型糖尿病患者下肢血管病变的危险因素分析[J].中国医药导报,2018,15(24):51-54.
[12]易兰,王莉,付阿丹,等.丹参注射液对糖尿病合并下肢血管病变患者血管舒张功能及炎症指标的影响[J].中国实验方剂学杂志,2018,24(23):183-188.
[13]黄静,倪青.糖尿病下肢血管病病证结合诊疗思路与方法[J].中国中医基础医学杂志,2014,20(5):583-585.
[14]王全兴,郑晓军,白雅彬.糖尿病下肢大血管病变中医辩证分型及其相关因素分析[J].齐齐哈尔医学院学报,2016,37(32):4045-4046.
[15]刘松岩,杜梁,王镁.糖尿病下肢动脉硬化闭塞症的中医证型分布规律浅探[J].世界中医药,2014(5):642-645.
[16]Gazzaruso C,Montalcini T,Baffero E,et al.Lipoprotein(a)and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2diabetes mellitus[J].Endocrine,2012,41(1):89-95.
[17]宋琪新,崔德芝.糖尿病下肢血管病变发病机制研究进展[J].中国老年保健医学,2016,14(1):82-84.
[2]高林英,任文霞,冯永亮.2型糖尿病下肢血管病变的临床流行病学分析[J].中华疾病控制杂志,2014,18(4):308-311.
[3]张杨,蔡念,李辉,等.糖尿病足患者下肢血管病变及诊疗现状[J].中国血管外科杂志:电子版,2018,10(1):61-64.
[4]刘仲书,付丽媛,杨进.2型糖尿病大血管病变机制的中西医研究进展[J].世界科学技术-中医药现代化,2015,17(10):2125-2129.
[5]周静,高晟,吴深涛.糖尿病周围血管病变中医证候规律探析[J].中国实验方剂学杂志,2016,22(17):136-140.
[6]李冀,孙新雨,毕珺辉.黄芪桂枝五物汤的临证应用及实验研究进展[J].中医药学报,2014,16(5):108-111.
[7]胡海兵,田文红,秦艳,等.加减黄芪桂枝五物汤治疗糖尿病下肢血管病变的临床疗效[J].临床医学研究与实践,2018,12(9):109-110.
[8]中华医学会外科学分会血管外科学组.下肢动脉硬化闭塞症诊治指南[J].中华医学杂志,2015,95(24):145-151.
[9]中华中医药学会.糖尿病中医防治指南[J].中国中医药现代远程教育,2011,9(4):148-151.
[10]崔公让.糖尿病肢体动脉闭塞症诊断及疗效标准(草案)[J].中国中西医结合外科杂志,2003,2(2):352-352.
[11]刘畅,王英南,王旭泽,等.老年2型糖尿病患者下肢血管病变的危险因素分析[J].中国医药导报,2018,15(24):51-54.
[12]易兰,王莉,付阿丹,等.丹参注射液对糖尿病合并下肢血管病变患者血管舒张功能及炎症指标的影响[J].中国实验方剂学杂志,2018,24(23):183-188.
[13]黄静,倪青.糖尿病下肢血管病病证结合诊疗思路与方法[J].中国中医基础医学杂志,2014,20(5):583-585.
[14]王全兴,郑晓军,白雅彬.糖尿病下肢大血管病变中医辩证分型及其相关因素分析[J].齐齐哈尔医学院学报,2016,37(32):4045-4046.
[15]刘松岩,杜梁,王镁.糖尿病下肢动脉硬化闭塞症的中医证型分布规律浅探[J].世界中医药,2014(5):642-645.
[16]Gazzaruso C,Montalcini T,Baffero E,et al.Lipoprotein(a)and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2diabetes mellitus[J].Endocrine,2012,41(1):89-95.
[17]宋琪新,崔德芝.糖尿病下肢血管病变发病机制研究进展[J].中国老年保健医学,2016,14(1):82-84.
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