田琳+贾莉+牟秀霞+王瑶+吴巍+朱建贵

摘要：目的 观察补肾活血方治疗颈动脉粥样硬化斑块的有效性及安全性。方法 纳入颈动脉粥样硬化斑块患者50例，进行健康宣教。同时予补肾活血方颗粒剂，每日1剂，每日2次，冲服。连续治疗12周。观察治疗前后颈动脉超声相关指标，观察治疗前及治疗4、8、12周中医症状评分。观察治疗前后空腹血糖（FBG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、血清C反应蛋白（CRP）、同型半胱氨酸（HCY）、白细胞介素-6（IL-6）、胰岛素样生长因子-1（IGF-1）、骨保护素（OPG）水平，监测血、尿常规及肝、肾功能。结果 治疗后斑块Crouse积分、斑块等级积分较治疗前呈降低趋势，差異无统计学意义（P=0.060，P=0.336）；改良斑块总积分、最大斑块面积较治疗前降低（P<0.05）。治疗第4、8、12周，中医症状积分降低（P<0.01），且随着治疗时间增加，中医症状积分显著下降（F=160.352，P<0.001）。中医疗效总有效率为85.11%（40/47）。治疗后血清FBG、TC含量较治疗前降低，差异有统计学意义（P<0.05）；血清LDL-C、HCY、CRP、IL-6、IGF-1、OPG较治疗前有降低趋势，差异无统计学意义（P>0.05）。血、尿常规及肝、肾功能未见异常。结论 补肾活血方治疗颈动脉粥样硬化斑块临床疗效较好，可改善患者临床症状，缩小并稳定斑块，安全性较高。

关键词：补肾活血方；肾虚血瘀证；颈动脉粥样硬化斑块

DOI：10.3969/j.issn.1005-5304.2017.12.005

中图分类号：R255.6 文献标识码：A 文章编号：1005-5304（2017）12-0017-04

Clinical Research on Bushen Huoxue Decoction in Treating Carotid Atherosclerotic Plaque TIAN Lin， JIA Li， MU Xiu-xia， WANG Yao， WU Wei， ZHU Jian-gui （Guanganmen Hospital， China Academy of Chinese Medical Sciences， Beijing 100053， China）

Abstract： Objective To investigate the efficacy and safety of Bushen Huoxue Decoction in the treatment of carotid atherosclerotic plaque. Methods Totally 50 patients of carotid atherosclerotic plaque were collected to conduct health education. At the same time， they were given Bushen Huoxue Decoction， one dosage a day， twice a day， decoction， for 12 weeks. The correlation indexes of carotid artery before and after treatment were observed， and TCM syndrome integrals were evaluated before and after 4， 8 and 12 weeks treatment. FBG， TC， LDL-C， CRP HCY， IL-6， IGF-1， and OPG were detected before and after treatment. Hematuria routine， liver and renal function were monitored. Results After treatment， the Crouse score and the plaque grade score of carotid atherosclerotic plaque showed a tendency to decrease， without statistical significance （P=0.060， P=0.336）. Carotid maximal plaque area and modified total score of carotid atherosclerotic plaque were significantly reduced compared with that before treatment （P<0.05）. TCM syndrome integrals were significantly reduced compared with that before treatment （P<0.05）， and the scores decreased significantly with the prolongation of treatment time. TCM syndrome integrals after 4， 8， and 12 weeks were significantly reduced compared with that before treatment （F=160.352， P<0.001）. Total effective rate of treatment in the efficacy of TCM syndrome was 85.11% （40/47）. Serum levels of FBG and TC decreased significantly after the treatment compared with that before the treatment， with statistical significance （P<0.05）. Serum levels of LDL-C， HCY， CRP， IL-6， IGF-1， and OPG all showed a tendency to decrease， without statistical significance （P>0.05）. No abnormality in hematuria routine， liver and renal function examinations were found during the research. Conclusion Bushen Huoxue Decoction has obvious clinical efficacy for carotid atherosclerotic plaque， which can improve clinical symptoms of patients， it also could stabilize and reduce plaque with high safety.endprint

Key words： Bushen Huoxue Decoction； kidney deficiency and blood stasis syndrome； carotid atherosclerotic plaque

基金项目：国家自然科学基金（81303015）；人事部留学人员科技活动择优资助项目（2013年）

动脉粥样硬化（atherosclerosis，AS）不仅是一种独立的疾病，更是心、脑、肾等重要器官疾病的病理基础。血管壁內膜增厚是AS的早期标志，斑块形成是AS的明显特征。颈动脉粥样硬化（carotid atherosclerosis，CAS）作为全身AS的局部表现，与冠状动脉、脑动脉的粥样硬化间有着相似的病理学基础，与心脑血管疾病的发生有着密切关系[1]。笔者认为，肾虚血瘀为AS的主要病机，根据补益肾精、活血通脉法自拟补肾活血方[2-3]。……