CAJ | 학술논문

目的：观察水蛭对脑动脉硬化症患者血小板活化程度及血液流变学的影响。方法将122例脑动脉硬化症患者按随机数字表法分为观察组（61例）和对照组（61例）。两组均采用降血压、降血糖加阿司匹林100 mg每天1次等常规治疗。观察组在常规治疗基础上加用水蛭胶囊0.75 g，每天3次；对照组仅采用常规治疗，疗程均为2个月。于治疗开始前和治疗结束次日检测两组中医临床表现积分、血小板膜糖蛋白半胱天冬酶原活化复合物-1（PAC-1）、P-选择素（CD62P）阳性率、血液流变学指标及不良反应发生情况。结果两组治疗前头痛、头晕、头胀、多寐善忘、唇甲紫暗、舌下脉络青紫等临床表现积分、PAC-1、CD62P阳性率、血液流变学指标比较差异均无统计学意义（均P＞0.05），两组治疗后各项临床表现积分、PAC-1阳性率、CD62P阳性率、低切黏度、高切黏度、血浆黏度、红细胞比容（HCT）均较治疗前明显降低，且以观察组治疗后降低更显著〔头痛（分）：0.75±0.69比1.23±0.92，头晕（分）：0.96±0.78比1.54±1.24，头胀（分）：0.65±0.59比1.48±1.17，多寐善忘（分）：0.77±0.72比1.69±1.14，唇甲紫暗（分）：0.83±0.81比1.32±0.79，舌下脉络青紫（分）：0.84±0.67比1.20±0.74，PAC-1：（10.31±4.57）%比（15.13±6.27）%，CD62P：（11.39±5.24）%比（16.40±7.91）%，低切黏度（mPa?s）：7.52±3.37比8.97±3.50，高切黏度（mPa?s）：4.35±1.12比5.58±1.19，血浆黏度（mPa?s）：1.54±0.35比1.88±0.42，HCT：0.43±0.09比0.49±0.10，均P＜0.05〕。随访治疗过程中未见水蛭有明显毒副作用。结论水蛭有助于降低脑动脉硬化症患者的血小板活化程度，改善其血液流变学指标，是一种治疗脑动脉硬化有效而安全的药物。
목적：관찰수질대뇌동맥경화증환자혈소판활화정도급혈액류변학적영향。방법장122례뇌동맥경화증환자안수궤수자표법분위관찰조（61례）화대조조（61례）。량조균채용강혈압、강혈당가아사필림100 mg매천1차등상규치료。관찰조재상규치료기출상가용수질효낭0.75 g，매천3차；대조조부채용상규치료，료정균위2개월。우치료개시전화치료결속차일검측량조중의림상표현적분、혈소판막당단백반광천동매원활화복합물-1（PAC-1）、P-선택소（CD62P）양성솔、혈액류변학지표급불량반응발생정황。결과량조치료전두통、두훈、두창、다매선망、진갑자암、설하맥락청자등림상표현적분、PAC-1、CD62P양성솔、혈액류변학지표비교차이균무통계학의의（균P＞0.05），량조치료후각항림상표현적분、PAC-1양성솔、CD62P양성솔、저절점도、고절점도、혈장점도、홍세포비용（HCT）균교치료전명현강저，차이관찰조치료후강저경현저〔두통（분）：0.75±0.69비1.23±0.92，두훈（분）：0.96±0.78비1.54±1.24，두창（분）：0.65±0.59비1.48±1.17，다매선망（분）：0.77±0.72비1.69±1.14，진갑자암（분）：0.83±0.81비1.32±0.79，설하맥락청자（분）：0.84±0.67비1.20±0.74，PAC-1：（10.31±4.57）%비（15.13±6.27）%，CD62P：（11.39±5.24）%비（16.40±7.91）%，저절점도（mPa?s）：7.52±3.37비8.97±3.50，고절점도（mPa?s）：4.35±1.12비5.58±1.19，혈장점도（mPa?s）：1.54±0.35비1.88±0.42，HCT：0.43±0.09비0.49±0.10，균P＜0.05〕。수방치료과정중미견수질유명현독부작용。결론수질유조우강저뇌동맥경화증환자적혈소판활화정도，개선기혈액류변학지표，시일충치료뇌동맥경화유효이안전적약물。
Objective To observe the effects of hirudo capsules on degree of platelet activation and blood rheology in patients with cerebral arteriosclerosis. Methods 122 patients with cerebral arteriosclerosis were randomly divided into two groups by the random number table:observation group(61 cases)and control group (61 cases). The two groups received conventional treatment such as antihypertensive and hypoglycemic drugs,and 100 mg of aspirin once a day. In the observation group,additionally hirudo capsules 0.75 g,3 times a day were given. The therapeutic course in both groups was 2 months. Prior to the start of treatment and on the next day after the end of treatment,traditional Chinese medicine(TCM)clinical syndrome integral,platelet membrane glycoproteins caspase 1 (PAC-1),platelet adhesion molecule P selection(CD62P)positive rate,and blood rheology indexes were detected,in addition to the adverse reactions . Results Before treatment,there were no statistical significant differences between the two groups in terms of TCM clinical syndrome integral such as headache,dizziness,head fullness,multiple somnolence amnesia,lip dark purple,sublingual veins purple in color,PAC-1,CD62P positive rate,hemorheology indexes(all P>0.05). After treatment,TCM clinical syndrome integral PAC-1,CD62P,low shear viscosity,high shear viscosity,plasma viscosity and the hematocrit of two groups were significantly lower than those before treatment, the improvement in observation group being more remarkable〔headache:0.75±0.69 vs. 1.23±0.92,dizziness:0.96±0.78 vs. 1.54±1.24,head fullness:0.65±0.59 vs. 1.48±1.17,multiple somnolence amnesia:0.77±0.72 vs. 1.69±1.14,lip dark purple:0.83±0.81 vs. 1.32±0.79,sublingual veins purple:0.84±0.67 vs. 1.20±0.74, PAC-1:(10.31±4.57)%vs.(15.13±6.27)%,CD62P:(11.39±5.24)%vs.(16.40±7.91)%,low shear viscosity (mPa?s):7.52±3.37 vs. 8.97±3.50,high shear viscosity(mPa?s):4.35±1.12 vs. 5.58±1.19,plasma viscosity (mPa?s):1.54±0.35 vs. 1.88±0.42,hematocrit(HCT):0.43±0.09 vs. 0.49±0.10〕. In the patients' follow-up, there were no obvious side effects of hirudo capsules. Conclusion Hirudo capsule is a safe and effective drug for treatment of patients with cerebral arteriosclerosis as it is helpful in reducing platelet activation degree and improving the blood rheology indexes.