【作者】 王伟；

【导师】 张伟；

【作者基本信息】 山东中医药大学 ， 中西医结合内科学， 2003， 硕士

【摘要】 目的 探讨肺心病患者氧化-抗氧化系统、血小板及肺血管内皮细胞功能变化及相互关系，通过观察益气活血组方对肺心病氧化—抗氧化系统、血小板、血管内皮细胞及动脉血氧分压的影响，探讨益气活血组方治疗肺心病的疗效和作用机制。方法 随机将所有肺心病观察病例分为治疗组（30例）及常规对照组（27例），对照组主要给予西医常规治疗：吸氧、抗生素、祛痰平喘等；治疗组除常规治疗外加用益气活血制剂150毫升／次，每日2次，连用10-14d。另选取13例为健康对照组。记录所有患者的临床疗效，检测治疗前后血LPO、SOD、GMP140、CEC的变化，进行血气分析以观察氧分压（PaO₂）和二氧化碳分压（PaCO₂）的变化，并进行上述各指标间的相关分析。结果 1．治疗组显效26例，好转3例，无效1例；对照组显效18例，好转8例，无效2例。益气活血治疗组显效率较西医常规对照组明显增高。2．与健康对照组LPO、SOD比较，两组肺心病治疗前LPO明显升高，SOD明显降低（P均＜0.01）；经治疗后，与常规西医治疗组比较，益气活血组LPO降低、SOD升高更明显（P均＜0.01）。3．与健康组比较，两组治疗前GMP140、CEC均明显升高，治疗后均明显下降，治疗组下降更明显（P均＜0.01）。4．治疗后益气活血组低氧血症明显改善（P＜0.01）。5．经相关分析发现，CEC数量与PaO₂呈负相关（r=-0.9234，P＜0.01），与LPO呈正相关（r=0.8564，P＜0.01），与SOD呈负相关（r=-0.8634，P＜0.01），与血小板膜GMP140呈正相关（r=0.7591，P＜0.05）。血小板膜GMP140与LPO呈正相关（r=0.7643，P＜0.05），与SOD呈负相关（r=-0.8167，P＜0.01），与PaO₂呈负相关（r=-0.7813，P＜0.05）。 结论 肺心病患者由于缺氧引起氧自由基生成增加，体内抗氧化能力降低，肺血管内皮细胞受损，内皮功能失调，由此引发血小板活化，导致肺血管收缩和肺血管重建及肺微血栓形成。益气活血治疗通过恢复氧化—抗氧化系统的平衡，保护肺血管内皮细胞和血小板功能，达到改善呼吸衰竭和降低肺动脉高压的目的。更多还原

【Abstract】 Objective To observe the clinical effect of Yi Qi Huo Xie herbs in treating the patients with chronic cor pulmonale and to explore its partial mechanism by determining the change and relationship of oxidative and antioxidant system, endothelial cells and platelets.Methods 57 patients were devided into two groups: regular therapy group (control group) and convention plus Yi Qi Huo Xie herbs group(treat group).The 27 patients in the control group received regular management such as oxygen therapy, antibiotics, bronchodilator drugs,and so on , the other 30 patients were treated with Yi Qi Huo Xie herbs 150ml 3 times a day besides the regular treatment. The lipid peroxides(LPO), superoxide dismutase (SOD), a -granule membrane protein(GMP140) and circulating endothelial cells(CEC) were measured respectively before and after treatment. The results were compared with those of 13 cases of healthy persons in the same period. All the patients examined the arterial blood gas and analyse the relations among the oxidative and antioxidant system, endothelial cells and platelets functions.Results: 1.In the treatment group, the.markedly effective rate(86.6%) was significant higher than that(64.2%) of the control group(’P<0. 05). 2. The levels of LPO,GMP140, CEC in all the patientsbefore therapy were significantly higher than those of the healthy(all P<0.01), and there were marked decreasement of levels of those after treatment (all P<0. 01).On the contrary, the levels of SOD in all the patients before therapy were remarkablely lower than that in the healthy and increased after treatment. 3. The increasement of SOD in the treatment from 443±137μg·g-1Hb-1 to 719±138μg·g-1Hb-1 were significantly obviously than that of the controlled group from 467±149μg·g-1Hb-1 to 584±97μ g·g-1Hb-1 (P<0. 01) . In the treatment group, the decreasement of LPO, GMP140, CEC from 12.3±3.1μmmol/L, 2340±1476 molecule/platelet, 13. 48±2. 61个/0.9μL to 6. 3±1. 7μ mmol/L, 1348 ±310 molecule/platelet, 6.91±1.01个/0.9μL respectively were remarkablely obvious than those in the control group from 11.9± 2.3μmmol/L, 2187±1546 molecule/platelet, 12. 54±2.58个/0.9μ L to 9. 1±1.6μ mmol/L , 1513±337 molecule/platelet, 9.74±0.98个/0.9 μL respectively (all P<0. 01). 4. The PaO2 were improved in both patient groups and there were more significantly improvement in the treated group(P<0.01). 5.The number of CEC, as well as GMP140.was adversely correlated to PaO, (r=-0.9234, P<0.01) and SOD(r=-0.8634, P<0. 01) , and it was positively correlated to LPO ( r=0.8564, P<0. 01) .There were positively correlation between CEC and GMP140 (r=0.7591, P<0.05).Conclusions: Yi Qi Huo Xie herbs in treating chronic cor pulmonale displays extraordinary effect by balancing the oxidation and antioxidation and curing the damane of pulmonary endothelial cells and activated platelets.更多还原