活血生肌汤内服沐足防治早期糖尿病足气阴两虚脉络闭阻证的作用机制

发布时间：2019-03-29 14:52

【摘要】：目的:观察活血生肌汤内服和沐足早期糖尿病足(DF)气阴两虚、脉络闭阻证的疗效,并从血管内皮功能、氧化应激和炎症反应方面探讨了其作用机制。方法:将110例DF患者采用住院先后顺序,随机按数字表法分为对照组和观察组各55例。对照组除给予防护措施处,采用甲钴胺注射液,0.5 mg/次,肌内注射,3次/周;和阿司匹林肠溶片,100 mg/次,1次/d。观察组西医处理措施同对照组,并加用活血生肌汤内服和沐足。两组疗程均为12周。检测腓总神经、腓浅神经及胫神经的运动传导速度(MNCV)和感觉传导速度(SNCV);测量治疗前后踝肱指数(ABI);进行治疗前后气阴两虚、脉络闭阻证评分和多伦多临床神经病变评分(TCSS);检测治疗前后一氧化氮(NO),内脂素和血管内皮素-1(ET-1)水平,丙二醛(MDA),超氧化物歧化酶(SOD),细胞间黏附分子-1(ICAM-1),超敏C反应蛋白(CRP)和白细胞介素-6(IL-6)水平。结果:观察组临床总有效率为84%,优于对照组的66.67%(χ2=4.072,P0.05);观察组腓总神经、腓浅神经及胫神经的MNCV和SNCV均高于对照组(P0.01);观察组TCSS量表各维度评分及总分均低于对照组;治疗后观察组ABI高于对照组,ABI升高幅度多于对照组(P0.01),观察组气阴两虚、脉络闭阻证低于对照组,气阴两虚、脉络闭阻证下降幅度多于对照组(P0.01);观察组内脂素和ET-1水平均低于对照组(P0.01),NO水平高于对照组(P0.01);观察组患者MDA,ICAM-1,CRP和IL-6水平均低于对照组,SOD水平高于对照组(P0.01)。结论:活血生肌汤内服和沐足治疗早期DF气阴两虚、脉络闭阻证患者,能改善患者的周围血管病变和神经病变,减轻临床症状和体征,疗效优于单纯的西医治疗,并能调节血管内皮功能,减轻氧化应激反应和炎症反应,起到改善病情的作用。
[Abstract]:Aim: to observe the therapeutic effect of Huoxue Shengji decoction (Huoxue Shengji decoction) on deficiency of both qi and yin in diabetic foot (DF) and choroidal obstruction in the early stage of foot bathe, and to explore its mechanism from the aspects of vascular endothelial function, oxidative stress and inflammatory reaction. Methods: 110 DF patients were randomly divided into two groups: control group (n = 55) and observation group (n = 55). In the control group, mecobalamin injection, 0.5 mg/ times, intramuscular injection, 3 times a week, and aspirin enteric solution tablets, 100 mg/ times, once a day, were used in the control group. The treatment measures of western medicine in the observation group were the same as those in the control group, and they were treated with Huoxue Shengji decoction and foot bathe. The course of treatment in both groups was 12 weeks. Measurement of motor conduction velocity (MNCV) and sensory conduction velocity (SNCV);) of common peroneal nerve, superficial peroneal nerve and tibial nerve before and after treatment of ankle-brachial index (ABI); Before and after treatment, qi-yin deficiency, choroidal obstruction syndrome score and Toronto clinical neuropathy score (TCSS); The levels of nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA), superoxide dismutase (MDA),) and intercellular adhesion molecule-1 (ICAM-1) were measured before and after treatment. The levels of high-sensitivity C-reactive protein (CRP) and interleukin-6 (IL-6) were detected. Results: the total effective rate was 84% in the observation group, which was better than 66.67% in the control group (蠂 2 = 4.072, P0.05), and the MNCV and SNCV of the common peroneal nerve, superficial peroneal nerve and tibial nerve in the observation group were higher than those in the control group (P0.01). The scores of every dimension and total score of TCSS in the observation group were lower than those in the control group. After treatment, the ABI in the observation group was higher than that in the control group, and the increase of ABI in the observation group was more than that in the control group (P0.01). In the observation group, the qi-yin deficiency and choroidal obstruction syndrome were lower than those in the control group (P0.01). The levels of lipoprotein and ET-1 in the observation group were lower than those in the control group (P0.01), and the levels of MDA,ICAM-1,CRP and IL-6 in the observation group were lower than those in the control group (P0.01). Conclusion: the treatment of early DF deficiency of Qi and Yin and choroidal obstruction by Huoxue Shengji decoction can improve the peripheral vascular disease and neuropathy, relieve the clinical symptoms and signs, and the curative effect is better than that of western medicine alone. And can regulate vascular endothelial function, reduce oxidative stress and inflammatory response, and improve the disease.
【作者单位】：河南省中医药研究院附属医院;黄河科技学院医学院;
【基金】：河南省科技攻关重点项目(152102310170)
【分类号】：R259

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