脉络宁注射液在下肢动脉硬化闭塞症中对血液循环的改善及对血管内皮的影响

康海涵; 李飞; 吴成稳; 崔文军

doi:10.16766/j.cnki.issn.1674-4152.002672

脉络宁注射液在下肢动脉硬化闭塞症中对血液循环的改善及对血管内皮的影响

doi: 10.16766/j.cnki.issn.1674-4152.002672

1.
郑州大学第二附属医院血管外科，河南郑州 450000
2.
郑州大学第五附属医院血管外科

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20190420

详细信息

通讯作者:
康海涵, E-mail: lxh157385@163.com

中图分类号: R543.5
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-15
- 网络出版日期: 2022-11-30

Effect of Mailuoning injection on blood circulation and vascular endothelium in patients with lower extremity arteriosclerosis obliterans

1.
Department of Vascular Surgery, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China

摘要

摘要: 目的探讨脉络宁注射液在下肢动脉硬化闭塞症(ASO)中对血液循环的改善及对血管内皮的影响。方法纳入2018年1月—2020年1月在郑州大学第二附属医院就诊的下肢ASO患者104例，按照随机数字表法分为对照组(52例)和观察组(52例)。对照组采用前列地尔治疗，观察组采用前列地尔联合脉络宁治疗。比较治疗前后2组血液流变学指标、黏附因子、炎症因子水平，比较2组的近期临床疗效及治疗期间的不良反应。结果治疗前2组血浆黏度、红细胞刚性指数、红细胞聚集指数、全血黏度比较，差异无统计学意义(均P＞0.05)，治疗后2组以上指标水平均低于治疗前，且观察组低于对照组(均P＜0.05)。治疗前2组黏附因子血浆内皮素(ET-1)及血清细胞间黏附因子1(ICAM-1)水平比较，差异无统计学意义(均P＞0.05)，治疗后2组ET-1及ICAM-1水平均低于治疗前，且观察组低于对照组(均P＜0.05)。治疗前2组炎症因子IL-6、IL-8、TNF-α及hs-CRP比较，差异无统计学意义(均P＞0.05)，治疗后2组以上指标水平均低于治疗前，且观察组低于对照组(均P＜0.05)。观察组有效率高于对照组(92.31% vs. 76.91%，χ²=4.727，P=0.030)。2组总不良反应发生率(11.45% vs. 9.62%)比较，差异无统计学意义(χ²=0.102，P=0.749)。结论前列地尔联合脉络宁注射液治疗下肢ASO，可改善患者血液流变学指标，调节黏附因子与炎症因子水平，且未增加不良反应，安全性较高，疗效显著。
- 下肢动脉硬化闭塞症 /
- 前列地尔 /
- 脉络宁 /
- 血液循环 /
- 黏附因子
Abstract: Objective To investigate the effect of Mailuoning injection on blood circulation and vascular endothelium in lower extremity arteriosclerosis obliterans (ASO). Methods A total of 104 lower extremity ASO patients treated in the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were enrolled and were divided into control group (52 cases) and observation group (52 cases) according to the random number table method. The control group was treated with Alprostadil injection, and the observation group was treated with Alprostadil injection combined with Mailuoning. The blood rheology indexes, adhesion factors and inflammatory factor levels of the two groups were compared before and after treatment, and the short-term clinical efficacy and adverse reactions during the treatment of the two groups were compared. Results No significant difference in plasma viscosity, erythrocyte stiffness index, erythrocyte aggregation index and whole blood viscosity was found between the two groups before treatment (all P>0.05). After treatment, the levels of five indicators in the two groups were lower than before treatment, and the observation group was lower in the control group (all P < 0.05). No significant differences in the levels of adhesion factor ET-1 and ICAM-1 in the two groups before treatment (all P>0.05). After treatment, the levels of ET-1 and ICAM-1 in the two groups were lower than those before treatment, and the levels in the observation group were lower than those of control group (all P < 0.05). No significant difference in serum inflammatory factors IL-6, IL-8, TNF-α and hs-CRP was found between the two groups before treatment (all P>0.05). After treatment, the levels of four indicators in the two groups were lower than those before treatment, and the observation group had lower levels than the control group (all P < 0.05). The effective rate of the observation group was higher than that of the control group (92.31% vs. 76.91%, χ²=4.727, P=0.030). No serious adverse reactions were observed in the two groups, and the total adverse reaction rate (11.45% vs. 9.62%) was not statistically significant (χ²=0.102, P=0.749). Conclusion Alprostadil combined with Mailuoning injection in the treatment of lower extremity ASO can improve patient ' s hemorheological indexes, regulate the levels of adhesion factors and inflammatory factors without increasing adverse reactions and have high safety and significant efficacy.
- Lower extremity arteriosclerosis obliterans /
- Alprostadil /
- Mailuoning /
- Blood circulation /
- Adhesion factor

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表 1 2组下肢ASO患者血液流变学指标比较(x ±s)

Table 1. Comparison of hemorheology indexes between two groups of patients with ASO(x±s)

组别	例数	血浆黏度(mPa/s)		红细胞刚性指数		红细胞聚集指数		全血黏度高切(mPa/s)		全血黏度低切(mPa/s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	52	2.13±0.51	1.73±0.26^a	8.63±0.79	6.41±0.57^a	7.59±0.47	5.51±0.36^a	7.78±1.42	5.59±0.59^a	12.31±1.14	9.56±1.47^a
观察组	52	2.11±0.47	1.34±0.29^a	8.76±0.74	5.75±0.32^a	7.60±0.49	2.62±0.27^a	7.81±1.24	3.79±0.39^a	12.34±1.23	7.11±0.62^a
t值		0.208	7.221	0.866	7.281	0.106	46.311	0.115	18.353	0.129	11.074
P值		0.836	< 0.001	0.389	< 0.001	0.916	< 0.001	0.909	< 0.001	0.898	< 0.001
注：与同组治疗前比较，^aP＜0.05。

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表 2 2组下肢ASO患者黏附因子水平比较(x ±s，ng/L)

Table 2. Comparison of adhesion factor levels between two groups of patients with ASO(x ±s, ng/L)

组别	例数	ET-1		ICAM-1
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	52	89.39±8.17	65.53±6.26^a	434.92±43.41	379.41±30.57^a
观察组	52	88.94±8.66	55.34±5.29^a	434.96±43.35	302.75±30.32^a
t值		0.273	8.966	0.005	12.839
P值		0.786	< 0.001	0.996	< 0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 2组下肢ASO患者血清炎症因子比较(x±s)

Table 3. Comparison of serum inflammatory factors between two groups of patients with ASO(x±s)

组别	例数	IL-6(ng/mL)		IL-8(pg/mL)		TNF-α(pg/mL)		hs-CRP(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	52	269.25±25.48	196.74±19.51^a	150.75±14.95	62.44±6.56^a	147.59±11.47	105.51±8.36^a	15.33±1.45	6.77±0.69^a
观察组	52	269.88±24.93	159.82±16.38^a	149.69±14.23	48.57±4.79^a	147.60±11.49	82.62±7.27^a	15.21±1.48	4.59±0.41^a
t值		0.127	10.451	0.149	12.313	0.173	14.899	0.418	19.586
P值		0.899	＜0.001	0.574	＜0.001	0.879	＜0.001	0.677	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组下肢ASO患者近期临床总有效率比较

Table 4. Comparison of short-term total clinical effective rate between two groups of patients with ASO

组别	例数	临床治愈[例(%)]	显效[例(%)]	有效[例(%)]	无效[例(%)]	总有效率(%)
对照组	52	7(13.46)	5(9.62)	28(53.85)	12(23.08)	76.92(40/52)
观察组	52	16(30.77)	14(26.92)	18(34.62)	4(7.69)	92.31(48/52)
注：2组总有效率比较，χ²=4.727，P=0.030。

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表 5 2组下肢ASO患者治疗后总不良反应发生情况比较[例(%)]

Table 5. Comparison of total adverse reactions after treatment between two groups of patients with ASO[cases(%)]

组别	例数	轻度恶心	头晕头痛	心律失常	血压下降	总不良反应发生
对照组	52	2(3.85)	1(1.92)	1(1.92)	2(3.85)	6(11.54)
观察组	52	1(1.92)	1(1.92)	2(3.85)	1(1.92)	5(9.62)
注：2组总不良反应发生率比较，χ²=0.102，P=0.749。

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参考文献(19)

[1]	LI X X, XIAO H, LIN C W, et al. Synergistic effects of liposomes encapsulating atorvastatin calcium and curcumin and targeting dysfunctional endothelial cells in reducing atherosclerosis[J]. Int J Nanomedicine, 2019, 14(1): 649-665.
[2]	BOJANA J, MATTIAS C, MAJA B, et al. The effects of endurance exercise and diet on atherosclerosis in young and aged apoE-/- and wild-type mice[J]. Gerontology, 2018, 65(1): 1-12. doi: 10.3969/j.issn.1005-9202.2018.01.001
[3]	BAI J Q, WANG F L, WANG X G, et al. Expression and clinical significance of HSP27 and its phosphorylation in lower extremity arteriosclerosis obliterans[J]. Peer J, 2020, 8(3): e9305. DOI: 10.7717/peerj.9305.
[4]	杜桂芳, 樊文静. 前列地尔注射液联合丁苯酞软胶囊对重症缺血性脑卒中患者神经功能、炎症因子及凝血功能的影响[J]. 血栓与止血学, 2020, 26(5): 779-781. doi: 10.3969/j.issn.1009-6213.2020.05.021 DU G F, FAN W J. Effects of alprostadil injection combined with butylphthalide soft capsule on nervous function, inflammatory factors and coagulation function in patients with severe ischemic stroke[J]. Chinese Journal of Thrombosis and Hemostasis, 2020, 26(5): 779-781. doi: 10.3969/j.issn.1009-6213.2020.05.021
[5]	袁州. 脉络宁注射液联合脑苷肌肽治疗急性缺血性脑血管病的临床研究[J]. 现代药物与临床, 2017, 32(12): 2363-2367. https://www.cnki.com.cn/Article/CJFDTOTAL-GWZW201712016.htm YUAN Z. Clinical study on Mailuoning Injection combined with cattle encephalon glycoside and ignotin in treatment of acute ischemic cerebrovascular disease[J]. Drugs & Clinic, 2017, 32(12): 2363-2367. https://www.cnki.com.cn/Article/CJFDTOTAL-GWZW201712016.htm
[6]	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]. 中华普通外科学文献(电子版), 2016, 10(1): 1-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHPD201601003.htm Vascular Surgery Group of Chinese Society For General Surgery. Diagnosis and treatment guidelines for lower limb ar ter iosclerosis obliteran[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(1): 1-18. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHPD201601003.htm
[7]	田珂, 庞宏永, 朱岩. 四妙勇安汤加减治疗下肢动脉硬化闭塞症患者的疗效和其部分机制[J]. 世界中医药, 2019, 14(2): 454-458. doi: 10.3969/j.issn.1673-7202.2019.02.042 TIAN K, PANG H Y, ZHU Y, et al. Clinical observation and exploration of part mechanism of Simiao Yongan Decoction in treating arteriosclerosis obliterans[J]. World Chinese Medicine, 2019, 14(2): 454-458. doi: 10.3969/j.issn.1673-7202.2019.02.042
[8]	LIAN C, WANG Z C, QIU J C, et al. TIM-3 inhibits PDGF-BB-induced atherogenic responses in human artery vascular smooth muscle cells[J]. Mol Med Rep, 2020, 22(2): 1-9.
[9]	李文涛, 李志平, 王婵, 等. 丁苯酞注射液联合前列地尔注射液治疗急性大面积脑梗死并发脑心综合征的临床研究[J]. 中西医结合心脑血管病杂志, 2019, 17(21): 3395-3398. doi: 10.12102/j.issn.1672-1349.2019.21.035 LI W T, LI Z P, WANG C, et al. Clinical study of butylphthalide injection combined with alprostadil injection in the treatment of acute massive cerebral infarction complicated with cerebral heart syndrome[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2019, 17(21): 3395-3398. doi: 10.12102/j.issn.1672-1349.2019.21.035
[10]	唐文华, 姜秀云. 脉络宁注射液联合阿替普酶对急性缺血性脑卒中患者血液流变学的影响[J]. 国际医药卫生导报, 2020, 26(16): 2392-2394. doi: 10.3760/cma.j.issn.1007-1245.2020.16.019 TANG W H, JIANG X Y. Effect of Mailuoning injection combined with atexin on hemorheology in patients with acute ischemic stroke[J]. International Medicine and Health Guidance News, 2020, 26(16): 2392-2394. doi: 10.3760/cma.j.issn.1007-1245.2020.16.019
[11]	邱欣, 唐银霏, 陈新政, 等. 脉络宁注射液联合环磷酰胺对慢性肾小球肾炎患者血液流变学、肾功能、PAI-1及t-PA的影响[J]. 长春中医药大学学报, 2019, 35(2): 267-269. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201902019.htm QIU X, TANG Y F, CHEN X Z, et al. Effect of Mailuoning injection combined with cyclophosphamide on blood rheology, renal function, PAI-1 and t-PA in patients with chronic glomerulonephritis[J]. Journal of Changchun University of Chinese Medicine, 2019, 35(2): 267-269. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201902019.htm
[12]	LEE J, KANG H. Hypoxia promotes vascular smooth muscle cell proliferation through microRNA-mediated suppression of cyclin-dependent kinase inhibitors[J]. Cells, 2019, 8(8): 1-15.
[13]	肖永生, 杨柳, 刘一东. 下肢动脉硬化闭塞症介入后人内皮素-1和一氧化氮及动态变化及预测再狭窄的价值[J]. 中华实验外科杂志, 2019, 36(8): 1487-1487. doi: 10.3760/cma.j.issn.1001-9030.2019.08.046 XIAO Y S, YANG L, LIU Y D. The dynamic changes of endothelin-1 and NO and the value of predicting restenosis in lower extremity arteriosclerosis obliterans after interventional therapy[J]. Chinese Journal of Experimental Surgery, 2019, 36(8): 1487-1487 doi: 10.3760/cma.j.issn.1001-9030.2019.08.046
[14]	王祖辉, 朱国献, 杨红伟. 下肢动脉硬化闭塞症支架植入术患者血清DD、ET-1变化及其临床意义[J]. 陕西医学杂志, 2018, 47(8): 974-976. doi: 10.3969/j.issn.1000-7377.2018.08.007 WANG Z H, ZHU G X, YANG H W. Changes of serum DD and ET-1 levels and its clinical significance in patients with arteriosclerosis obliterans of lower extremity[J]. Shaanxi Medical Journal, 2018, 47(8): 974-976. doi: 10.3969/j.issn.1000-7377.2018.08.007
[15]	祁宁, 李黎, 庄舜玖, 等. 前列腺素E1联合硫酸氢氯吡格雷治疗老年下肢动脉硬化闭塞症的效果分析以及对IL-6, TNF-α, ICAM-1的表达水平影响[J]. 老年医学与保健, 2018, 24(3): 328-331. doi: 10.3969/j.issn.1008-8296.2018.03.032 QI N, LI L, ZHUANG S J, et al. Curative effect of prostaglandin E1 combined with clopidogrel bisulfate on arteriosclerosis obliterans in lower extremity of the elderly and the effect on the expression of IL-6, TNF-and ICAM-1[J]. Geriatrics & Health Care, 2018, 24(3): 328-331. doi: 10.3969/j.issn.1008-8296.2018.03.032
[16]	徐毅, 吕双燕, 汪海敏, 等. 中药内服外用联合法舒地尔治疗老年下肢动脉硬化闭塞症临床研究[J]. 中华全科医学, 2020, 18(4): 666-669. doi: 10.16766/j.cnki.issn.1674-4152.001325 XU Y, LYU S Y, WANG M M, et al. Clinical efficacy of oral and external use of traditional Chinese medicine combined with fasudil in treatment of lower extremity arteriosclerosis obliterans in elderly patients[J]. Chinese Journal of General Practice, 2020, 18(4): 666-669. doi: 10.16766/j.cnki.issn.1674-4152.001325
[17]	李语玲, 杨静. 脉络宁注射液对下肢动脉硬化闭塞症大鼠血管内皮功能及NF-κB介导炎症反应的影响[J]. 中南药学, 2020, 18(10): 1677-1680. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX202010012.htm LI Y L, YAGN J. Effect of Mailuoning injection on vascular endothelial function and inflammatory response mediated by NF-κB in rats with lower extremity arteriosclerosis obliterans[J]. Central South Pharmacy, 2020, 18(10): 1677-1680. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNYX202010012.htm
[18]	杨燕. 前列地尔对糖尿病下肢动脉硬化闭塞症病人下肢动脉内径和血流量的影响[J]. 安徽医药, 2017, 21(7): 1299-1302. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY201707035.htm YANG Y. The clinical curative effect of alprostadil for treating patients with diabetes lower limb arteriosclerosis obliterans[J]. Anhui Medical and Pharmaceutical Journal, 2017, 21(7): 1299-1302. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY201707035.htm
[19]	黄平, 张静, 刘婷婷. 脉络宁注射液治疗血栓闭塞性脉管炎30例临床观察[J]. 中医药导报, 2016, 22(1): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB201601029.htm HUANG P, ZHANG J, LIU T T. Clinical observation on 30 cases of thromboangiitis obliterans treated by Mailuoning injection[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2016, 22(1): 74-77. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB201601029.htm