血管活性因子在动脉硬化性闭塞症中的变化研究
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摘要
本研究旨在通过临床观察探讨血管活性因子：内皮素．1(ET-1) 、一氧化氮(NO)、
血栓素B2(TXB2) 和6-酮-前列腺素F1α(6-Keto-PGF1α)以及血脂、血液流变学指
标在动脉硬化性闭塞症中的变化规律。测定60例动脉硬化性闭塞症患者(其中血瘀
型和湿热下注型各30例)的ET-1、 NO、TXB2、 6-Keto-PGF1α、血脂、血液流变学
指标，并设立健康对照组。结果显示，在血脂方面，发现动脉硬化性闭塞症患者TC、
TG、LDL较健康查体者升高，而HDL水平降低；湿热下注型患者又较血瘀型患者TC、
TG、LDL水平升高，HDL水平降低；在血管活性因子方面，发现动脉硬化性闭塞症患
者ET-1、 FXB2较健康查体者升高，而6-Keto-PGF1α水平降低：湿热下注型患者又较
血瘀型患者ET-1、 FXB2水平升高，6-Keto-PGF1α水平降低：在血液流变学指标方面，
发现动脉硬化性闭塞症患者全血粘度、红细胞聚集指数和纤维蛋白原较健康查体者升
高，而红细胞变形指数水平降低；湿热下注型患者又较血瘀型患者全血粘度、红细胞
聚集指数和纤维蛋白原水平升高，红细胞变形指数水平降低。通过本研究，证明以上
各项指标的变化与中医辨证分型之间存在相应关系，揭示出不同的中医辨证分型的发
病规律，可以为临床诊断和辨证治疗方面提供客观依据，作到宏观辨证与微观辨证相
结合。
This research aims at discussing the rule of the changes of endotheliotoxin-1 (ET-1), nitrous oxide (NO), thromboxane B2(TXB2), 6-keto-prostaglandin F1a (6-keto-PGF1a), lipid and hemorheo logical factors through clinical observation. The author has measured the above factors in 60 patients with Arteriosclerosis Obliterans (ASO) among whom 30 were attributed to the syndrome of blood stasis, and 30 were attributed to pathogenic dampness-heat attacking the lower limb according to the syndrome differentiation of Traditional Chinese Medicine and the author also has set a control group consisting of checkup takers. As the result shows, the levels of TC, TG and LDL in lipid, the levels of ET-1 and TXB2 in active vascular factors and the whole blood viscosity, erythrocyte aggregation index, plasma fibrinogen of ASO patients are higher than those of checkup takers while the HDL level in lipid, 6-Keto-PGF1a in active vascular factors and the erythrocyte transforming index are comparatively lower. Compared with patient
s with blood stasis, the levels of TC, TG and LDL in lipid, the levels of ET-1 and TXB2 in active vascular factors and the whole blood viscosity, erythrocyte aggregation index, plasma fibrinogen are higher than those of patients with pathogenic dampness-heat attacking the lower limb and the level of HDL in lipid, the level of 6-Keto-PGF1a?in active vascular factors and the erythrocyte transforming indexes are comparatively lower. This research proves the changes of the indexes mentioned above corresponds to the dialectical type-classifications in Traditional Chinese Medicine, reveals the rule of incidence of different type-classifications of Traditional Chinese Medicine, provides objective basis for clinical diagnosis and dialectical treatment and helps to realize the combination of macro and micro dialectics.
血栓素B2(TXB2) 和6-酮-前列腺素F1α(6-Keto-PGF1α)以及血脂、血液流变学指
标在动脉硬化性闭塞症中的变化规律。测定60例动脉硬化性闭塞症患者(其中血瘀
型和湿热下注型各30例)的ET-1、 NO、TXB2、 6-Keto-PGF1α、血脂、血液流变学
指标，并设立健康对照组。结果显示，在血脂方面，发现动脉硬化性闭塞症患者TC、
TG、LDL较健康查体者升高，而HDL水平降低；湿热下注型患者又较血瘀型患者TC、
TG、LDL水平升高，HDL水平降低；在血管活性因子方面，发现动脉硬化性闭塞症患
者ET-1、 FXB2较健康查体者升高，而6-Keto-PGF1α水平降低：湿热下注型患者又较
血瘀型患者ET-1、 FXB2水平升高，6-Keto-PGF1α水平降低：在血液流变学指标方面，
发现动脉硬化性闭塞症患者全血粘度、红细胞聚集指数和纤维蛋白原较健康查体者升
高，而红细胞变形指数水平降低；湿热下注型患者又较血瘀型患者全血粘度、红细胞
聚集指数和纤维蛋白原水平升高，红细胞变形指数水平降低。通过本研究，证明以上
各项指标的变化与中医辨证分型之间存在相应关系，揭示出不同的中医辨证分型的发
病规律，可以为临床诊断和辨证治疗方面提供客观依据，作到宏观辨证与微观辨证相
结合。
This research aims at discussing the rule of the changes of endotheliotoxin-1 (ET-1), nitrous oxide (NO), thromboxane B2(TXB2), 6-keto-prostaglandin F1a (6-keto-PGF1a), lipid and hemorheo logical factors through clinical observation. The author has measured the above factors in 60 patients with Arteriosclerosis Obliterans (ASO) among whom 30 were attributed to the syndrome of blood stasis, and 30 were attributed to pathogenic dampness-heat attacking the lower limb according to the syndrome differentiation of Traditional Chinese Medicine and the author also has set a control group consisting of checkup takers. As the result shows, the levels of TC, TG and LDL in lipid, the levels of ET-1 and TXB2 in active vascular factors and the whole blood viscosity, erythrocyte aggregation index, plasma fibrinogen of ASO patients are higher than those of checkup takers while the HDL level in lipid, 6-Keto-PGF1a in active vascular factors and the erythrocyte transforming index are comparatively lower. Compared with patient
s with blood stasis, the levels of TC, TG and LDL in lipid, the levels of ET-1 and TXB2 in active vascular factors and the whole blood viscosity, erythrocyte aggregation index, plasma fibrinogen are higher than those of patients with pathogenic dampness-heat attacking the lower limb and the level of HDL in lipid, the level of 6-Keto-PGF1a?in active vascular factors and the erythrocyte transforming indexes are comparatively lower. This research proves the changes of the indexes mentioned above corresponds to the dialectical type-classifications in Traditional Chinese Medicine, reveals the rule of incidence of different type-classifications of Traditional Chinese Medicine, provides objective basis for clinical diagnosis and dialectical treatment and helps to realize the combination of macro and micro dialectics.
引文
[1] 陈柏楠，侯玉芬，周涛．周围血管疾病中西医诊疗学，北京：中国中医药出版社， 1999，1：263．
[2] 王嘉桔．肢体动脉硬化性闭塞症的研究现状和展望．辽宁医学杂志，1993，7(4) ： 170-172．
[3] 蔡海江．动脉粥样硬化基础与临床，南京：江苏科学技术出版社，1996，1：30
[4] Ross R．The pathogensis of atherosclerosis：a perspective for the 1990s． Nature，1993，362：801．
[5] Patrick EM．吸烟对动脉粥样硬化和心血管疾病的病理生理作用．国外医学老年 医学分册，1993，14(2) ：49．
[6] Bucala R，et al．Advanced glycosylation products quench nitric oxide and mediate defective endothelium-dependent vasodilation in experimental diabetes．J Clin Invest，1991，87：432．
[7] Daniel Steinberg，Joseph L，Witzum，et al．Lipoprotein and atherogenesiS． JAMA，1990，264(23) ：3047-3052．
[8] 武忠弼．病理学，北京：人民卫生出版社，1996，4：230．
[9] 杜俊宝．化瘀解毒法治疗晚期闭塞性动脉硬化21例．新中医，1992，24(1) ：39．
[10] 王景春，王志平，崔国伟．辨证治疗肢体动脉硬化闭塞症101例．辽宁中医杂志， 1993，(20) 11：21．
[11] 程婢，周玫，杨仁林．氧化修饰的低密度脂蛋白对培养的人脐静脉内皮细胞的影 响．第一军医大学学报，1991，11：296-298．
[12] Berliner JA，Territo MC，Sevanian A，et al．Minimally modified low lipoprotein is biologically active in vivo in mice[J]．J Clin Invest， 1991，87：2253．
[13] 汪浩川，刘秉文，傅明德．天然和氧化修饰脂蛋白对培养人动脉平滑肌细胞原癌 基因表达的影响[J]．生物化学与生物物理学报，1995，27(5) ：507 513
[14] 长野富，北撤．变性LDLとの生理意义[J]．日本临床，1990，48(11) ：59．
[15] Li M，Free man MW，Libby P．Regulation of smooth muscle cell scavenger
recepter express in vivo by.atherogenic diets and in vitro by cytokines[J]. J Clin Invest, 1995,95:122-123．
[16] Badimon JJ, Badimon L, Fuster V. Regression of arteriosclerotic lesions by high density lipoprotein plasma fraction in the cholesterol-fed rabbit. J Clin Invest 1990, 85:1234．
[17] Charles R. Harper, Terry A. Jacobson. New Perspectives on the Management of Low Levels of High-Density Lipoprotein Cholesterol. ARCH INTERNMED, 1999,159:1049．
[18] 徐亚平，肖嘉欣，吕心阳．血脂异常与动脉粥样硬化的关系．实用临床医 学，2000，1(1) ：31-37．
[19] Yanagisawa M, Kurihara H, Kimura S. et al.A noval potent vasoconstructor peptide by vascular endothelial cell .Nature, 1998,332:411．
[20] 汤健，唐朝枢，杨军，等编著．内皮素-基础、临床．北京医科大学、中国协和医科 大学联合出版社，1994：83-103．
[21] 张灵芝，潭国勇，周爱儒．组织一氧化氮含量测定的几种方法．生物化学与生物 物理进展，1993，26(6) ：412-414．
[22] White K A, Marlette M A. Nitric oxide synthase is a cytochrome P-450 type hemoprotein[J]. Biochemistry, 1992, 31: 627-31．
[23] Maris M,Morigi M, Donadell R,et al. Nitric oxide synthesis by curtured endothelial cell is modulatde by flow condition[J]. Circ-Res, 1995, 76(6) : 536-543．
[24] 赵铁军．血管内皮功能障碍及其治疗进展[J]．L国外医学心血管疾病分册， 1999，26(2) ：70-73。
[2] 王嘉桔．肢体动脉硬化性闭塞症的研究现状和展望．辽宁医学杂志，1993，7(4) ： 170-172．
[3] 蔡海江．动脉粥样硬化基础与临床，南京：江苏科学技术出版社，1996，1：30
[4] Ross R．The pathogensis of atherosclerosis：a perspective for the 1990s． Nature，1993，362：801．
[5] Patrick EM．吸烟对动脉粥样硬化和心血管疾病的病理生理作用．国外医学老年 医学分册，1993，14(2) ：49．
[6] Bucala R，et al．Advanced glycosylation products quench nitric oxide and mediate defective endothelium-dependent vasodilation in experimental diabetes．J Clin Invest，1991，87：432．
[7] Daniel Steinberg，Joseph L，Witzum，et al．Lipoprotein and atherogenesiS． JAMA，1990，264(23) ：3047-3052．
[8] 武忠弼．病理学，北京：人民卫生出版社，1996，4：230．
[9] 杜俊宝．化瘀解毒法治疗晚期闭塞性动脉硬化21例．新中医，1992，24(1) ：39．
[10] 王景春，王志平，崔国伟．辨证治疗肢体动脉硬化闭塞症101例．辽宁中医杂志， 1993，(20) 11：21．
[11] 程婢，周玫，杨仁林．氧化修饰的低密度脂蛋白对培养的人脐静脉内皮细胞的影 响．第一军医大学学报，1991，11：296-298．
[12] Berliner JA，Territo MC，Sevanian A，et al．Minimally modified low lipoprotein is biologically active in vivo in mice[J]．J Clin Invest， 1991，87：2253．
[13] 汪浩川，刘秉文，傅明德．天然和氧化修饰脂蛋白对培养人动脉平滑肌细胞原癌 基因表达的影响[J]．生物化学与生物物理学报，1995，27(5) ：507 513
[14] 长野富，北撤．变性LDLとの生理意义[J]．日本临床，1990，48(11) ：59．
[15] Li M，Free man MW，Libby P．Regulation of smooth muscle cell scavenger
recepter express in vivo by.atherogenic diets and in vitro by cytokines[J]. J Clin Invest, 1995,95:122-123．
[16] Badimon JJ, Badimon L, Fuster V. Regression of arteriosclerotic lesions by high density lipoprotein plasma fraction in the cholesterol-fed rabbit. J Clin Invest 1990, 85:1234．
[17] Charles R. Harper, Terry A. Jacobson. New Perspectives on the Management of Low Levels of High-Density Lipoprotein Cholesterol. ARCH INTERNMED, 1999,159:1049．
[18] 徐亚平，肖嘉欣，吕心阳．血脂异常与动脉粥样硬化的关系．实用临床医 学，2000，1(1) ：31-37．
[19] Yanagisawa M, Kurihara H, Kimura S. et al.A noval potent vasoconstructor peptide by vascular endothelial cell .Nature, 1998,332:411．
[20] 汤健，唐朝枢，杨军，等编著．内皮素-基础、临床．北京医科大学、中国协和医科 大学联合出版社，1994：83-103．
[21] 张灵芝，潭国勇，周爱儒．组织一氧化氮含量测定的几种方法．生物化学与生物 物理进展，1993，26(6) ：412-414．
[22] White K A, Marlette M A. Nitric oxide synthase is a cytochrome P-450 type hemoprotein[J]. Biochemistry, 1992, 31: 627-31．
[23] Maris M,Morigi M, Donadell R,et al. Nitric oxide synthesis by curtured endothelial cell is modulatde by flow condition[J]. Circ-Res, 1995, 76(6) : 536-543．
[24] 赵铁军．血管内皮功能障碍及其治疗进展[J]．L国外医学心血管疾病分册， 1999，26(2) ：70-73。