【摘要】 目的 分析慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者应用宁肺活血利水方治疗后所产生的效果及影响。方法 60例COPD合并肺动脉高压患者,采用随机数字表法分为对照组及研究组,每组30例。对照组进行常规治疗,研究组采用常规治疗+宁肺活血利水方治疗。对比两组患者治疗前后中医证候积分、肺动脉压、外周血内皮祖细胞(EPCs)计数及功能、治疗效果。同时选取30只雄性SD大鼠,随机分为模型组、干预组及空白对照组,每组10只。模型组及干预组于项背部皮下注射1%的野百合碱以诱导形成肺动脉高压模型,空白对照组注射等量磷酸盐缓冲液(PBS)。干预组于第3天开始予以宁肺活血利水方水煎液灌胃,模型组以等量蒸馏水灌胃,空白对照组不进行灌胃治疗。对比三组大鼠右心室收缩压(RVSP)、静脉血EPCs计数及功能。结果 临床研究中,治疗后,两组中医证候积分、肺动脉压均较治疗前降低,且研究组中医证候积分(5.46±0.71)分、肺动脉压(37.11±8.07)mm Hg(1 mm Hg=0.133 kPa)显著低于对照组的(9.98±1.01)分、(41.83±8.46)mm Hg,差异有统计学意义(P<0.05)。治疗后,两组EPCs计数、EPCs增殖能力、EPCs迁移能力、EPCs粘附能力均较治疗前升高,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组的治疗总有效率为93.33%,明显高于对照组的73.33%,差异有统计学意义(P<0.05)。动物实验研究中,空白对照组RVSP低于模型组及干预组, EPCs计数、EPCs增殖数、EPCs粘附能力、EPCs迁移能力高于模型组及干预组,差异有统计学意义(P<0.05)；干预组RVSP低于模型组, EPCs计数、EPCs增殖数、EPCs粘附能力、EPCs迁移能力高于模型组,差异有统计学意义(P<0.05)。结论 将宁肺活血利水方应用在COPD合并肺动脉高压的临床治疗中,对于降低患者肺动脉压,改善心肺功能有显著效果,同时也有利于增加外周血EPCs计数,改善血EPCs各项功能,从而可缓解患者病情。更多还原

【Abstract】 Objective To analyze the effect and influence of Ningfei Huoxue Lishui Recipe on the count and function of peripheral blood endothelial progenitor cells in chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH). Methods A total of 60 patients with COPD and pulmonary hypertension were randomly divided into control group and research group, with 30 cases in each group. The control group received conventional treatment, while the research group received conventional treatment + Ningfei Huoxue Lishui Recipe. The traditional Chinese medicine syndrome score, pulmonary arterial pressure, peripheral blood endothelial progenitor cells(EPCs) count and function before and after treatment, and therapeutic effects were compared between the two groups. At the same time, 30 male SD rats were selected and randomly divided into model group, intervention group and blank control group, with 10 rats in each group. The model group and the intervention group were injected subcutaneously with 1% monocrotaline on the back of the neck to induce the formation of pulmonary hypertension model, and the blank control group was injected with the same amount of phosphate buffered saline(PBS). The intervention group was gavaged with Ningfei Huoxue Lishui Recipe from the 3rd day, the model group was gavaged with an equal amount of distilled water, and the blank control group was not treated with gavage. The right ventricular systolic pressure(RVSP), venous blood EPCs count and function were compared among the three groups. Results In the clinical study, after treatment, the traditional Chinese medicine syndrome score and pulmonary arterial pressure in both groups were lower than those before treatment in this group; the traditional Chinese medicine syndrome score(5.46±0.71) points and pulmonary artery pressure(37.11±8.07) mm Hg(1 mm Hg=0.133 kPa) in the research group were significantly lower than(9.98±1.01) points and(41.83±8.46) mm Hg in the control group; the differences were all statistically significant(P<0.05). After treatment, the EPCs count, EPCs proliferation ability, EPCs migration ability, and EPCs adhesion ability in the two groups were all increased compared with those before treatment in this group, and the research group was higher than the control group, and the differences were all statistically significant(P<0.05). The total effective rate of treatment in the research group was 93.33%, which was significantly higher than 73.33% in the control group, and the differences were all statistically significant(P<0.05). In the animal experimental study,the RVSP of the blank control group was lower than that of the model group and the intervention group; the EPCs count, number of EPCs proliferation, EPCs adhesion ability, EPCs migration ability of the blank control group were higher than those of the model group and intervention group; the differences were all statistically significant(P<0.05). The RVSP of the intervention group was lower than that of the model group; the EPCs count, number of EPCs proliferation, EPCs adhesion ability, and EPCs migration ability of the intervention group were higher than those of the model group; the differences were all statistically significant(P<0.05). Conclusion The application of Ningfei Huoxue Lishui Recipe in the clinical treatment of COPD complicated with pulmonary hypertension has a significant effect on reducing pulmonary artery pressure and improving cardiopulmonary function. At the same time, it is also conducive to increasing peripheral blood EPCs count and improving the functions of blood EPCs, so as to alleviate the condition of patients.更多还原