【作者】 王彬；

【导师】 侯玉芬；

【作者基本信息】 山东中医药大学 ， 中医外科学， 2008， 博士

【摘要】 目的:从细胞黏附因子的角度,深入探讨深静脉血栓形成(DVT)的本质,并探讨中药干预DVT中细胞黏附因子的作用机制,为临床诊治提供客观依据。方法:临床筛选急性期DVT患者60例,按中医证型分为湿热下注型、血瘀湿重型,观察血清ICAM-1,VCAM-1,PSGL-1的水平,探讨性别及临床分型间是否存在差异,并统计三个指标间的相关性。实验研究以下腔静脉结扎法大鼠为模型,采用中药消栓通脉颗粒为治疗组,血府逐瘀胶囊、穿王消炎片、肝素钠、生理盐水为对照组。观察各组大鼠血清ICAM-1水平以及下腔静脉病理形态学改变,及静脉壁中炎性细胞、VCAM-1、PSGL-1的表达。结果:临床研究显示DVT患者的血清ICAM-1、VCAM-1、PSGL-1均升高(P<0.01),湿热下注型较血瘀湿重型患者明显升高(P<0.01),性别间比较差异无显著性(P>0.05)。同组间混合型患者血清细胞黏附因子明显高于中央型、周围型,有显著性差异(P<0.05,P<0.01);中央型患者平均水平高于周围型,比较差异无显著性(P>0.05)。实验研究显示血栓模型组大鼠下腔静脉病理形态学改变较假手术组严重,血清ICAM-1水平以术后第1天最高,随天数增加逐渐下降;静脉壁中VCAM-1、PSGL-1表达以术后第3天最明显;在术后第1天炎性细胞以中性粒细胞为主,术后第3、6天以淋巴细胞、单核细胞为主;结果显示消栓通脉颗粒能明显改善大鼠下腔深静脉血栓形成的病理改变程度,降低血清ICAM-1水平,减少静脉壁中炎性细胞、VCAM-1、PSGL-1的表达(P<0.05,P<0.01)。结论:细胞黏附因子参与了DVT的发生、发展及机化、消退整个过程,并可做为中医临床辨证的客观指标之一,而中药可以通过干预细胞黏附因子的角度来达到治疗DVT的目的。更多还原

【Abstract】 Objective:To investigate the pathogenesis of deep vein thrombosis(DVT) from the view of cell adhesion molecules(CAMs) and interventional mechanism of Chinese Herbs on DVT,in order to provide objective basis for clinical diagnosis and treatment.Methods:60 patients of DVT were divided into groups according to the syndrome differentiation type of traditional Chinese medicine(TCM) respectively.Based on the type of TCM,it was divided into the syndrome of pathogenic dampness-heat(A), the syndrome of blood stasis and dampness(B), 20 health people as control(C). All patients and healths were determined blood serum levels of ICAM-1, VCAM-1,PSGL-1,and discuss whether there is difference in the point of gender and traditional medical syndrome.In the experiment, 180 Wistar rats were divided into six groups which included Xiao Shuan Tong Mai group, Xue Fu Zhu Yu capsule group, Chuan Wang Xiao Yan tablets group, Haperin group,model group, sham group.Then to observe the pathological character, the serum level of ICAM-1 and the expression of the inflammation cells,VCAM-1,PSGL-1 in the vein walls.Results:The serum levels of ICAM-1,VCAM-1,PSGL-1 of patients were higher than those of the control(P<0.01).The serum levels of ICAM-1,VCAM-1,PSGL-1 in group A were higher than group B and C(P<0.01),there is no distinct difference in the point of gender(P>0.05).The level of blood serum of CAMs of mixed type is higher than that of center type and around type(P<0.05,P<0.01).The level of CAMs of center type is higher than around type,but there is no obviously difference(P>0.05).Experiment shows that pathological changes in models were more severe than sham, higher levels of VCAM-1,PSGL-1 and higher expressions of the inflammation cells in the vein wall(P<0.05,P<0.01).The level of blood serum CAMs is maximal on the first day after operation,and then declined gradually.Xiao Shuan Tong Mai can effectively improved the pathological changes, reduced the expressions of these CAMs and inflammatory cytokines(P<0.05,P<0.01 ).Conclutions:CAMs may participate in all pathological courses of DVT which involved in genesis,development,organization and recanalization. It can be as one of the objective index in the syndrome type of TCM.The mechanism of the treatment of DVT by Chinese herbs may be the intervention and modulation of the CAMs.更多还原