【作者】 杨增敏；

【导师】 许建安；

【作者基本信息】 南京中医药大学 ， 中医骨伤学， 2009， 博士

【摘要】 本文运用中医传统理论,根据导师许建安教授长期治疗下肢深静脉血栓形成丰富的临床经验,应用活血通络汤进行实验研究,探索其在血栓形成方面的预防作用及其作用机制。近年来,下肢深静脉血栓形成病理机制的理论进展认为:炎症与血栓形成密切相关以及内皮功能损害在血栓形成中占有重要地位。血流缓慢、血液成分异常和血管损伤是静脉血栓形成三大发病原因,我们将其作为相关因素进行研究,通过动物实验,设立空白对照组,以复方丹参片、阿司匹林作为对照,分成活血通络汤高、中、低剂量组,建立血瘀证大鼠模型、创伤性深静脉损伤模型、HUVECs缺氧-复氧(I/R)模型,系统地探讨了中药对血管内皮显微结构和内皮细胞功能的影响,研究了深静脉血栓形成与内皮细胞表达细胞粘附分子—CD54表达、中性粒细胞粘附关系,进行了中药对静脉血栓形成后血液流变学、凝血功能和血管壁炎性细胞干预的研究,论证了炎症与血栓形成的关系。实验结果表明:各剂量组对创伤性大鼠深静脉血管损伤均具有保护作用,含药血清中、高剂量组干预内皮细胞CD54分子表达数与缺氧组有明显区别,统计学处理有显著差异(P＜0.05),提示活血通络汤可以改善内皮细胞在缺氧条件下的细胞粘附性。活血通络汤高剂量组可见中性粒细胞与血管内皮细胞的粘附率显著降低,与缺氧组有明显区别,统计学处理有显著差异(P＜0.05),表明活血通络汤可能是通过影响两种细胞之间的粘附来发挥其抗血栓作用。活血通络汤具有显著抑制血栓形成、抑制血小板粘附、聚集,降低血液粘度的作用,降低足跖肿胀容积及肿胀率,抑制CD54表达,抑制炎性细胞的浸润,保护血管内皮细胞功能等作用。可以得出结论:活血通络汤防治深静脉血栓形成不是单一作用,而是具有多种综合调节作用,对血栓形成的每个因素都能发挥作用,从分子生物学角度分析,活血通络汤对深静脉血栓形成相关因素的干预机制主要表现在对血管内皮细胞的保护方面,对血栓形成复杂的发病机理特点具有良好的针对性和科学性,本研究对防治DVT会带来良好的社会效益和经济效益。更多还原

【Abstract】 By use of theory of traditional Chinese medicine(TCM) and combination with copious clinical experience of Prof. Xu Jian-an on treating deep venous thrombosis, we explored the prophylactic effect and mechanism of action of Huo Xue Tong Luo broth.It is believed that lower limbs deep venous thrombosis is stronger relation to inflammation and endothelium dysfunction which play roles in thrombosis by recently developed theory of mechanism of deep venous thrombosis. The correlation factor includes Three kind of main etiological factor: slow bloodstream,abnormal blood constituents, vascular injury.It is systematically discussed that Huo Xue Tong Luo broth was able to influence on endothelium structure and function. We have been initially discussed that expression of CD54 of endothelial cells and inflammatory cells of vascular wall those were association with venous thrombosis. We studied on effect of Huo Xue Tong Luo broth on interventional mechanism of hemorheology, thromboxane function inflammatory cells in rats with deep venous thrombosis. We demonstrated the relationship between inflammation and thrombosis.Huo Xue Tong Luo Broth can lighten traumatic occlusion deep vein injury of rats. Middle and/or high dose blood serum containing broth can lower neutrophil adhesion rate and platelet aggregation rate(P<0.05).It is showed that the mechanism of Huo Xue Tong Luo broth was association with inhibiting thrombosis, platelet adhesion reaction and aggregation, degrading blood viscidity, decreasing voix pedis voix pedis swelling volume and ratio, inhibiting expression of CD54 and inflammatory cell infiltrating, protecting vascular endothelial cell function.We conclude that Huo Xue Tong Luo broth has multiply synthetic adjusting therapeutic action on deep venous thrombosis. We think it possesses well direct and scientific siginificance to complicated pathogenesis about thrombosis.更多还原