【摘要】：目的:觀察活血生肌湯內(nèi)服和沐足早期糖尿病足(DF)氣陰兩虛、脈絡(luò)閉阻證的療效,并從血管內(nèi)皮功能、氧化應(yīng)激和炎癥反應(yīng)方面探討了其作用機制。方法:將110例DF患者采用住院先后順序,隨機按數(shù)字表法分為對照組和觀察組各55例。對照組除給予防護措施處,采用甲鈷胺注射液,0.5 mg/次,肌內(nèi)注射,3次/周;和阿司匹林腸溶片,100 mg/次,1次/d。觀察組西醫(yī)處理措施同對照組,并加用活血生肌湯內(nèi)服和沐足。兩組療程均為12周。檢測腓總神經(jīng)、腓淺神經(jīng)及脛神經(jīng)的運動傳導(dǎo)速度(MNCV)和感覺傳導(dǎo)速度(SNCV);測量治療前后踝肱指數(shù)(ABI);進行治療前后氣陰兩虛、脈絡(luò)閉阻證評分和多倫多臨床神經(jīng)病變評分(TCSS);檢測治療前后一氧化氮(NO),內(nèi)脂素和血管內(nèi)皮素-1(ET-1)水平,丙二醛(MDA),超氧化物歧化酶(SOD),細(xì)胞間黏附分子-1(ICAM-1),超敏C反應(yīng)蛋白(CRP)和白細(xì)胞介素-6(IL-6)水平。結(jié)果:觀察組臨床總有效率為84%,優(yōu)于對照組的66.67%(χ2=4.072,P0.05);觀察組腓總神經(jīng)、腓淺神經(jīng)及脛神經(jīng)的MNCV和SNCV均高于對照組(P0.01);觀察組TCSS量表各維度評分及總分均低于對照組;治療后觀察組ABI高于對照組,ABI升高幅度多于對照組(P0.01),觀察組氣陰兩虛、脈絡(luò)閉阻證低于對照組,氣陰兩虛、脈絡(luò)閉阻證下降幅度多于對照組(P0.01);觀察組內(nèi)脂素和ET-1水平均低于對照組(P0.01),NO水平高于對照組(P0.01);觀察組患者MDA,ICAM-1,CRP和IL-6水平均低于對照組,SOD水平高于對照組(P0.01)。結(jié)論:活血生肌湯內(nèi)服和沐足治療早期DF氣陰兩虛、脈絡(luò)閉阻證患者,能改善患者的周圍血管病變和神經(jīng)病變,減輕臨床癥狀和體征,療效優(yōu)于單純的西醫(yī)治療,并能調(diào)節(jié)血管內(nèi)皮功能,減輕氧化應(yīng)激反應(yīng)和炎癥反應(yīng),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.
【作者單位】： 河南省中醫(yī)藥研究院附屬醫(yī)院;黃河科技學(xué)院醫(yī)學(xué)院;
【基金】：河南省科技攻關(guān)重點項目(152102310170)
【分類號】：R259

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