【摘要】 目的探讨内毒素(ETx)和内皮素-1(ET-1)在慢性阻塞性肺疾病(COPD)血瘀证发病机制中的作用。方法采用分层抽样、分段随机方法将150例符合血瘀证诊断标准的COPD急性发作期患者随机均分成常规治疗组、肝素治疗组、黄芪治疗组、川芎嗪治疗组、黄芪川芎嗪治疗组;同时设立健康对照组。分别测定各组治疗前及治疗后1、2和4周COPD患者的ETx和ET-1水平,并计算治疗前后两者的相关回归方程。结果治疗前COPD患者ETx和ET-1明显高于健康对照组,治疗后4周,COPD患者ETx和ET-1较治疗前均明显降低(P均<0.01),但ET-1水平仍明显高于健康对照组(P<0.05)。COPD患者治疗前血浆ET-1和ETx相关系数(r)=0.401,治疗后r=0.544,均呈明显的正相关关系(P均<0.01)。各治疗组治疗后随时间延长,ETx和ET-1均呈明显下降趋势(P<0.05或P<0.01);治疗后2周黄芪及黄芪川芎嗪治疗组的ETx较常规治疗组明显下降,治疗后2周和4周川芎嗪及黄芪川芎嗪治疗组ET-1较常规治疗组明显下降(P均<0.05)。结论ETx可激活血管内皮系统,致COPD患者ET-1分泌增加,直接影响COPD血瘀证的病理生理变化;益气、活血治疗能有效清除血浆ETx,降低血浆ET-1水平,保护血管内皮功能。更多还原

【Abstract】 To approach the action of endotoxin (ETx) and endothelin-1 (ET-1)in the pathogenesis of chronic obstructive pulmonary disease (COPD) and blood stasis syndrome (血瘀证, a syndrome in traditional Chinese medicine). Methods One hundred and fifty COPD patients with diagnostic criteria of blood stasis syndrome were randomly divided into 5 groups: Radix Astragali seu Hedysari (黄芪) group(MM group), ligustrazine (川芎嗪) group (Li group), Radix Astragali seu Hedysari plus ligustrazine group (MM plus Li group), negative control group or conventional treatment group and heparin control group, respectively. Simultaneously, a normal healthy control group was set up as control group. The plasma ETx and ET-1 were observed before and after 1, 2 and 4 weeks of treatment, and their correlative regression analyses were made before and after the treatment. Results Compared with the normal healthy control group, the ETx and ET-1 levels elevated obviously in COPD patients (all P<0.01). After 4 weeks of treatment, as compared to the initial stage before the treatment, the ETx and ET-1 had been declined obviously (all P<0.01), but the ET-1 level was still obviously higher than that in the conventional treatment group (P<0.05). Plasma ET-1 level in COPD patients was positively correlated with ETx, r=0.401 (before therapy) and 0.544 (after therapy), separately (both P<0.01). Along with the prolongation of therapeutic course, the levels of ETx and ET-1 in each treatment group tended to be decreased markedly (P<0.05 or P<0.01) ;after 2 weeks of treatment, the ETx was reduced more significantly in MM group and MM plus Li group than that in the conventional treatment group,so did ET-1 in Li group and MM plus Li group after 2 and 4 weeks of treatment (all P<0.05). Conclusion ETx may activate vascular endothelium system, leading to the increase of ET-1 secretion in COPD patients and directly effecting the patho-physiological changes in cases with COPD accompanied with blood stasis syndrome. The treatment of invigorating Qi (益气) and promoting blood (活血) circulation can effectively eliminate plasma ETx, lower plasma ET-1 level and protect the function of endothelium.更多还原