前列腺素E_1脂微球载体制剂治疗老年下肢动脉硬化闭塞症疗效观察
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摘要
目的：通过观察老年下肢动脉硬化闭塞症患者的临床症状、踝肱指数、足背激光多普勒血流成像、甲襞微循环及血液流变学的变化，来探讨老年下肢动脉硬化闭塞症的微循环状态和前列腺素E_1脂微球载体制剂(Lipo-PGE_1，北京泰德制药有限公司生产)对下肢动脉硬化闭塞症患者的疗效。
方法：选择自2001年3月至2002年1月在301医院住院的36例下肢动脉硬化闭塞症患者(诊断标准符合1995年中国中西医结合学会周围血管疾病专业委员会制定的诊疗标准)，均为男性，平均年龄68．5±4．5岁(60岁～93岁)。给予Lipo-PGE_1 10微克加入100毫升生理盐水，静脉滴注，每日一次，共14天。观察治疗前后临床症状改善情况、踝肱指数变化、足背激光多普勒血流成像的改变、血液流变学、甲襞微循环指标(应用田氏甲襞微循环综合定量评分方法进行观察、测量、记分)、肝肾功能、血脂、血、尿常规等。统计方法采用Stata4．0统计分析软件，方差分析，t检验；p≤0.05判断为有显著差异。
结果；治疗后临床症状显著改善，甲襞微循环的总积分值明显降低(p<0．01)，血粘度降低(p<0．05)。甘油三酯、胆固醇降低不明显(p>0．05)，踝肱指数增加，足背激光多普勒血流成像明显改善．用药前后肝、肾功能及血、尿常规检查结果无显著差异(p>0．05)。用药过程中未发现明显毒副作用。
解放军军医进修学院硕士研究生论文 凯时治疗动脉硬化闭塞症疗效观察
结论：L i P。－PGE；可显著改善老年下肢动脉硬化闭塞症患者
的临床症状，降低血粘度，改善甲缓微循环，安全有效，无明显
毒副作用。有着广阔的应用前景。
Objective: To investigate the effects of the Lipo-PGEi and the state of the microcirculation on the elderly patients with Low Extremity Atherosclerosis Disease (LEASD) by observing the alterations of clinical symptoms, ankle/ brachia index (ABI), Laser Doppler Perfusion Imagerofdorsum pedis ,nail fold microcirculation and hemorheology.
Methods: 36 Male LEASD patients with mean age 68.5?, 5 years(60~93) were selected from inpatient of 301 hospital during March 2001 and January 2002. The alterations of clinical symptoms, ankle/ bsrachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis, nail fold microcirculation and hemorheological markers , liver and renal function, TG,TC,blood routine and urine routine were observed in the 36 patients of LEASD before and after treatment with Lipo-PGE,10 micrograms per day for 14
days. Statistical analysis was performed using Stata 4.0 software.
Result : After treatment , clinical symptoms, ankle/ brachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis were improvement significantly .The nail fold microcirculation total scores was decreased prominently (p<0. 01).the blood viscosity was decreased as well (p<0.05), ankle/brachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis were obviously improved , There were no significant differences in triglyceride, Cholesterol, liver and renal functions, blood and urine routines before and after the treatment(p>0. 05).There was no significant side effect during drug therapy.
Conclusion: The Lipo-PGEi could improve the clinical symptoms , the nai fold microcirculation and decrease blood viscosity of the patients with LEASD . It is the medicine of safety, effect and prosperity to treat the patients with LEASD .
方法：选择自2001年3月至2002年1月在301医院住院的36例下肢动脉硬化闭塞症患者(诊断标准符合1995年中国中西医结合学会周围血管疾病专业委员会制定的诊疗标准)，均为男性，平均年龄68．5±4．5岁(60岁～93岁)。给予Lipo-PGE_1 10微克加入100毫升生理盐水，静脉滴注，每日一次，共14天。观察治疗前后临床症状改善情况、踝肱指数变化、足背激光多普勒血流成像的改变、血液流变学、甲襞微循环指标(应用田氏甲襞微循环综合定量评分方法进行观察、测量、记分)、肝肾功能、血脂、血、尿常规等。统计方法采用Stata4．0统计分析软件，方差分析，t检验；p≤0.05判断为有显著差异。
结果；治疗后临床症状显著改善，甲襞微循环的总积分值明显降低(p<0．01)，血粘度降低(p<0．05)。甘油三酯、胆固醇降低不明显(p>0．05)，踝肱指数增加，足背激光多普勒血流成像明显改善．用药前后肝、肾功能及血、尿常规检查结果无显著差异(p>0．05)。用药过程中未发现明显毒副作用。
解放军军医进修学院硕士研究生论文 凯时治疗动脉硬化闭塞症疗效观察
结论：L i P。－PGE；可显著改善老年下肢动脉硬化闭塞症患者
的临床症状，降低血粘度，改善甲缓微循环，安全有效，无明显
毒副作用。有着广阔的应用前景。
Objective: To investigate the effects of the Lipo-PGEi and the state of the microcirculation on the elderly patients with Low Extremity Atherosclerosis Disease (LEASD) by observing the alterations of clinical symptoms, ankle/ brachia index (ABI), Laser Doppler Perfusion Imagerofdorsum pedis ,nail fold microcirculation and hemorheology.
Methods: 36 Male LEASD patients with mean age 68.5?, 5 years(60~93) were selected from inpatient of 301 hospital during March 2001 and January 2002. The alterations of clinical symptoms, ankle/ bsrachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis, nail fold microcirculation and hemorheological markers , liver and renal function, TG,TC,blood routine and urine routine were observed in the 36 patients of LEASD before and after treatment with Lipo-PGE,10 micrograms per day for 14
days. Statistical analysis was performed using Stata 4.0 software.
Result : After treatment , clinical symptoms, ankle/ brachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis were improvement significantly .The nail fold microcirculation total scores was decreased prominently (p<0. 01).the blood viscosity was decreased as well (p<0.05), ankle/brachia index (ABI), Laser Doppler Perfusion Imager of dorsum pedis were obviously improved , There were no significant differences in triglyceride, Cholesterol, liver and renal functions, blood and urine routines before and after the treatment(p>0. 05).There was no significant side effect during drug therapy.
Conclusion: The Lipo-PGEi could improve the clinical symptoms , the nai fold microcirculation and decrease blood viscosity of the patients with LEASD . It is the medicine of safety, effect and prosperity to treat the patients with LEASD .
引文
1、尚德俊，赵徇德主编．中西医结合治疗动脉硬化闭塞症．第一版．北京：人民卫生出版社，1998：9～16。
2、崔公让，等．动脉硬化闭塞症．北京：人民军医出版社，2000；84．
3、Awas Ja Soteriou MC.Drougs G plasm a Prostaglandin E1 Concentrations and Hem odynamcs during intrayenous infusions of prostaglandin E1 in humans and Swine.T Ransplantaion.1996;61(11):1624.
4、田牛，等。微循环的临床与基础。北京：原子能出版社出版，1996。
5、王玉琦．血栓闭塞性脉管炎病人“高凝状态”的研究．山东医药，1983；8：41。
6. Clyne CA,Archer TJ,Atubaire LK,et al.Random control tral of a short course of aspirin and persantine for femoradistal grafts[J].Br J surg,1987;74:246-248.
7．叶任高，陆再英。周围血管疾病。实用内科学；第五版：364。
8. CAPRIE Steering Committee A randomized,blinded trial of clopidogred versns aspirin patients at risk of ischamic events[J]Lancet,1996;348:1329～1339.
9、董宗俊，管衍，等。西洛他唑和噻氯吡啶治疗四肢慢性动脉闭塞性疾病。中华新药杂志，1996；5(5)：348～351。
10、Becb,HG,Danson DL,Cutler BS,et al.A new pharmacology treatment for intermittent claudication:results of randomiced,multicenter trial[J],Arch Intern Med,1999;159:2041～2050.
11、张福先，边学志，金英姬，等。自体静脉移植物内皮细胞早期动态变化的研究。血管外科；1996(2)：48～49。
12、叶任高，陆再英。周围血管疾病。实用内科学，第五版：363。
13、德国临床用药，口服糖蛋白．Ⅱb和Ⅲa拮抗剂．德国医学(中文版)，1999；(1)：8～9。
14、Berridge DC,Gregson RHS,Hopinson BR,et al.Randomized trial of intra-arterial recombinant tissue plasminogen activator,intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis[J],BR J Surg,1991;78:988～995.
15、王春喜，梁发启，吴咸中等。内皮素、一氧化氮及其基因表达与动脉硬化闭塞症关系的研究。中华外科杂志，1999；37(7)：420。
16、Girerd XJ,Hirsch AT,Cooke JP,etal.L-arginine augmentsendothelium-depend vasodilation in cholesterolfed rabbits.Circ Res,1990;67(1):301.
17、Randall MD,UjjieH,Criffith TM.L-arginine reverses the impaiment of nitric oxidedependent collateral perfusion in dietary-induced hypercholesterolemia in the rabbit.Clin Sci Colch,1994;344:1653.
18、WU ZJ,Qian XX,Cai DH,et al.Long-term oral administration of L-arginine enhan endothelium-depedent vasorelaxation and inhibits neointimal thickening after endothelial denudation in rats.Clin Med J,1996;109(8):592.
19、中国中西医结合外科杂志 1999；6：130-135．
20、stiegler H,Diehm C,Grom E,et al.Placebokontrollierte doppelblinde studie zur wirksamkeit vor in prostaglanding El bei diabeyikernmit avkim stadium iv.VASA.1992;35(UPPL):164～166.
21、方祈，王钟林，宁田海，等。血脂异常防治建议。中华心血管病杂志，1997；25(3)：169-175。
22、王春喜，梁发启等。动脉硬化闭塞症480例临床治疗体会。中华综合医学杂志，2001；2(5)：396～397。
23、盛琴慧，朱国英，周爱儒，等．血管内皮生长因子基因治肢体动脉梗阻病的试验研究．中华医学杂志，1997；79(2)：129～132。
2、崔公让，等．动脉硬化闭塞症．北京：人民军医出版社，2000；84．
3、Awas Ja Soteriou MC.Drougs G plasm a Prostaglandin E1 Concentrations and Hem odynamcs during intrayenous infusions of prostaglandin E1 in humans and Swine.T Ransplantaion.1996;61(11):1624.
4、田牛，等。微循环的临床与基础。北京：原子能出版社出版，1996。
5、王玉琦．血栓闭塞性脉管炎病人“高凝状态”的研究．山东医药，1983；8：41。
6. Clyne CA,Archer TJ,Atubaire LK,et al.Random control tral of a short course of aspirin and persantine for femoradistal grafts[J].Br J surg,1987;74:246-248.
7．叶任高，陆再英。周围血管疾病。实用内科学；第五版：364。
8. CAPRIE Steering Committee A randomized,blinded trial of clopidogred versns aspirin patients at risk of ischamic events[J]Lancet,1996;348:1329～1339.
9、董宗俊，管衍，等。西洛他唑和噻氯吡啶治疗四肢慢性动脉闭塞性疾病。中华新药杂志，1996；5(5)：348～351。
10、Becb,HG,Danson DL,Cutler BS,et al.A new pharmacology treatment for intermittent claudication:results of randomiced,multicenter trial[J],Arch Intern Med,1999;159:2041～2050.
11、张福先，边学志，金英姬，等。自体静脉移植物内皮细胞早期动态变化的研究。血管外科；1996(2)：48～49。
12、叶任高，陆再英。周围血管疾病。实用内科学，第五版：363。
13、德国临床用药，口服糖蛋白．Ⅱb和Ⅲa拮抗剂．德国医学(中文版)，1999；(1)：8～9。
14、Berridge DC,Gregson RHS,Hopinson BR,et al.Randomized trial of intra-arterial recombinant tissue plasminogen activator,intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis[J],BR J Surg,1991;78:988～995.
15、王春喜，梁发启，吴咸中等。内皮素、一氧化氮及其基因表达与动脉硬化闭塞症关系的研究。中华外科杂志，1999；37(7)：420。
16、Girerd XJ,Hirsch AT,Cooke JP,etal.L-arginine augmentsendothelium-depend vasodilation in cholesterolfed rabbits.Circ Res,1990;67(1):301.
17、Randall MD,UjjieH,Criffith TM.L-arginine reverses the impaiment of nitric oxidedependent collateral perfusion in dietary-induced hypercholesterolemia in the rabbit.Clin Sci Colch,1994;344:1653.
18、WU ZJ,Qian XX,Cai DH,et al.Long-term oral administration of L-arginine enhan endothelium-depedent vasorelaxation and inhibits neointimal thickening after endothelial denudation in rats.Clin Med J,1996;109(8):592.
19、中国中西医结合外科杂志 1999；6：130-135．
20、stiegler H,Diehm C,Grom E,et al.Placebokontrollierte doppelblinde studie zur wirksamkeit vor in prostaglanding El bei diabeyikernmit avkim stadium iv.VASA.1992;35(UPPL):164～166.
21、方祈，王钟林，宁田海，等。血脂异常防治建议。中华心血管病杂志，1997；25(3)：169-175。
22、王春喜，梁发启等。动脉硬化闭塞症480例临床治疗体会。中华综合医学杂志，2001；2(5)：396～397。
23、盛琴慧，朱国英，周爱儒，等．血管内皮生长因子基因治肢体动脉梗阻病的试验研究．中华医学杂志，1997；79(2)：129～132。