【作者】 张燕；

【导师】 梅同华；

【作者基本信息】 重庆医科大学 ， 内科学， 2003， 硕士

【摘要】 目的：慢性肺源性心脏病严重威胁着人类的健康和生命，因此，肺心病的防治工作是我国医学界的重大课题。血液流变学的研究有助于阐明肺心病的病理生理学和制定有效的防治措施。本文首先从宏观上研究了慢性肺心病患者急性期的血液流变学变化，然后用微管吸吮技术研究了慢性肺心病患者红细胞（RBC）变形性降低的机制以及疏血通的干预作用,力图从宏观微观两方面提示改善肺心病急性加重期患者的微循环障碍可作为重要的治疗措施之一。 方法 采用全自动粘度快测仪FASCO-94A测定慢性肺心病急性期患者的宏观血液流变学变化，采用微管吸吮技术定量测定慢性肺心病急性期患者的弹性模量、粘性系数、表面积/体积以及体外疏血通对其的影响。结果 （1）慢性肺心病急性加重期患者血液呈高粘状态，全血和<WP=6>血浆粘度增加，RBC比积增大、聚集指数增加、血沉加快、RBC变形指数降低。（2）慢性肺心病急性加重期患者与正常对照相比，RBC的表面积/体积降低，球度指数增加；RBC膜的弹性模量、粘性系数增加。（3）在不同浓度的疏血通作用下，RBC的表面积/体积的比值（S/V）比患者的S/V显著增高，在2.5ug/ml时增高尤为明显（1.527±0.051 VS 1.340±0.045，P〈0.001〉；RBC的球度指数（Si）比患者的Si显著降低，在2.5ug/ml时降低尤为明显(0.787±0.018 VS 0.858±0.012 , P<0.001)。用疏血通2.5ug/ml处理后，RBC膜的弹性模量下降（3.122±0.481 VS 6.970±0.672, P<0.001），粘性系数上升(1.182±0.701 VS 0.936±0.242, P<0.05)；在5ug/ml以后浓度组RBC膜的弹性模量(5ug/ml:2.881±0.390 VS 6.970±0.672, P<0.001; 10ug/ml: 4.855±1.349 VS 6.970±0.672, P<0.001; 20ug/ml: 4.328±0.403 VS 6.970±0.672, P<0.001)、粘性系数(5ug/ml:0.450±0.194 VS 0.936±0.242, P<0.001; 10ug/ml: 0.628±0.128 VS 0.936±0.242, P<0.05; 20ug/ml: 0.288±0.061 VS 0.936±0.242, P<0.001)显著下降。结论：慢性肺心病急性加重期患者RBC的变形性下降与RBC的表面积/体积的比值下降、球度指数增加以及RBC膜的弹性模量、粘性系数增加有关；疏血通能通过降低RBC的球度指数、RBC膜的弹性模量、粘性系数改善RBC的流变特性，从而为临床上在肺心病的综合治疗中包括改善RBC变形性的药物或措施提供了实验依据更多还原

【Abstract】 Objectives:Chronic pulmonary heart disease seriously threaten human’s health. So it is important topic to prevent and treat pulmonary heart disease. The study on hemorheology is beneficial to clarify the pathophysiology of chronic pulmonary heart diseases and formulate effective prevention and treatment measure. The study firstly addresses the change of hemorheology of the acute phase patients suffering from chronic pulmonary heart disease in macroscopic, then the study focuses the mechanism that erythrocyte deformability decrease and intervention study of Shuxuetong using micropipette aspiration technique. The text will try hard to hint that it is one of important treatment measure to improve microcirculation disorder of the acute phase patients suffering from chronic pulmonary heart disease both macro- and microscopically.Methods: Using fully automatic viscometer(FASCO-94A), the authors investigated the macroscopic hemorheology of the acute phase patients<WP=8>suffering from chronic pulmonary heart disease, and using the micropipette aspiration technique, the authors then investigated the membrane elastic modulus, viscous coefficient, surface /volume ratio of the erythrocytes of the patients. And Finally, the effect of Shuxuetong was investigated microscopically. Results:The blood of acute phase patients suffering from chronic pulmonary heart disease was in hyperviscosity state. The blood viscosity, plasm viscosity, hematocrit, aggregation indexes, erythrocyte sedimentation were higher as compared to healthy controls, while erythrocyte deformability index decreased. The acute phase patients suffering from chronic pulmonary heart disease was in contrast to normal human, the erythrocyte surface/volume ratio decreased, while the spherical indexes, membrane elastic moduli and viscous coefficients of the erythrocytes increased. Upon treatment with Shuxuetong in a concentration range of 2.5ug/ml, 5ug/ml, 10ug/ml, 20ug/ml, the surface/volume ratio of erythrocytes were higher as compared to the surface/volume ratio of erythrocytes of the patients, this is most significant at 2.5ug/ml（1.527±0.051 VS 1.340±0.045，P〈0.001〉; The spherical indexes were lower than those of patients, this decrease is also most significant at an agent concentration of 2.5ug/ml(0.787±0.018 VS 0.858±0.012 , P<0.001). Treatment with Shuxuetong in a concentration of 2.5ug/ml, led to a decrease in the<WP=9>membrane elastic moduli （3.122±0.481 VS 6.970±0.672, P<0.001）and an increase in viscous coefficients of the erythrocytes(1.182±0.701 VS 0.936±0.242, P<0.05). The membrane elastic moduli(5ug/ml:2.881±0.390 VS 6.970±0.672, P<0.001; 10ug/ml: 4.855±1.349 VS 6.970±0.672, P<0.001; 20ug/ml: 4.328±0.403 VS 6.970±0.672, P<0.001) and viscous coefficients(5ug/ml:0.450±0.194 VS 0.936±0.242, P<0.001; 10ug/ml: 0.628±0.128 VS 0.936±0.242, P<0.05; 20ug/ml: 0.288±0.061 VS 0.936±0.242, P<0.001) decreased with Shuxuetong in concentrations of 5ug/ml or higher.Conclusion: The decrease of erythrocyte deformability relates to the decrease of the surface/volume ratio, the increase of spherical index, the increase of red cell membrane elastic modulus、viscous coefficient. Shuxuetong can improve erythrocyte rheological properties by decreasing spherical indexes, membrane elastic moduli and viscous coefficients. The study offers experimental evidences that the comprehensive treatment of pulmonary heart disease should involve the drug or measure to improve the erythrocyte deformability更多还原