王淑兰 张彦虎 高波

　　(北京北亚骨科医院 北京 102445)

　　摘要目的 观察活血化瘀软坚散结法对颈动脉斑块患者的凝血因子活性(R值)、纤维蛋白原水平(K值、α角)、血小板功能聚集功能(MA值)的影响，以探讨其对颈动脉斑块的治疗作用。方法 将160例颈动脉斑块患者随机分为对照组和治疗组。对照组给予颈动脉斑块的常规治疗，治疗组在常规治疗基础上用活血化瘀，软坚散结中药(我院经验方动脉斑块汤)，观察两组患者的临床疗效及治疗前后血浆血栓弹力图(TEG)所测的R值、k值、α角、MA值、等指标变化。结果 治疗组有效率为93.3%(92/80),高于对照组73.3(72/80)(P﹤0.05);治疗前两组患者所测的R值、k值、α角、MA值、等指标比较，差异无统计学意义(P>0.05)，治疗后两组患者各项指标较治疗前有显著改善(均P﹤0.01),但治疗组R值、k值低于对照组，MA值、α角高于对照组，(均P﹤0.01)。结论 活血化瘀、软坚散结法可使颈动脉斑块患者血浆中凝血酶原活性减弱、纤维蛋白原水平降低、血小板的聚集功能减弱。对凝血酶原活性、纤维蛋白原水平、血小板功能的干预可以预防和治疗颈动脉斑块形成。

　　关键词 颈动脉斑块形成;活血化瘀软、坚散结法;凝血酶原活性、纤维蛋白原水平、血小板聚集功能

　　英文摘要

　　Effect of Huoxuehuayu and Ruanjian Sanjie on Plasma Prothrombin Activity, Fibrinogen Level and Platelet Aggregation in Patients with Carotid Plaque

　　WANG Shu-lan GAO Bo XU Xue-ying ZHANG Yan-hu FENG Wei-qiang YANG Xin-di

　　(Beijing Beiya Orthopedics Hospital Beijing 102445 China)

　　【Abstract】The purpose of this paper is to observe the effect of promoting blood circulation to remove blood stasis resolving hard lump on patients with carotid plaques of prothrombin activity (R), fibrinogen level (K), platelet function (MA), to explore the therapeutic effect of carotid plaques.This method of 200 patients with carotid plaques were randomly divided into control group and treatment group. The control group given conventional treatment of carotid plaques, the treatment group on the basis of conventional treatment with the traditional Chinese medicine for promoting blood circulation to remove blood stasis, resolving hard lump, in our experience (artery plaque soup), and to observe the clinical efficacy of two groups of patients before and after treatment plasma thrombus elastic graph (TEG) measured value of R, K value, MA index changes, etc. Results showed that the treatment group effective rate was 92%, higher than the control group 72% (P < 0.05); Two groups of patients were measured before treatment value of R, K value, MA, alpha Angle index comparison, there was no statistically significant difference (P > 0.05) in the two groups after treatment in patients with the indicators than before treatment significantly improved (both P < 0.01), but the treatment group R value, K value is higher than the control group, MA value is lower than the control group, (both P < 0.01). Conclusion, promoting blood circulation to remove blood stasis, resolving hard lump method can make the patients with carotid plaques in plasma prothrombin activity weakened, fibrinogen levels and platelet coagulation function. For the prothrombin activity, fibrinogen levels and platelet function intervention can prevention and treatment of carotid artery plaque formation.

　　【key words】Carotid Plaque prothrombin activity fibrinogen levels platelet coagulation function

　　研究表明颈动脉斑块形成患者的血液呈持续高凝状态，可导致颈动脉斑块形成。中医认为此病是气血运行不畅，使淤血、痰浊阻滞于经脉。与血瘀痰凝症有密切联系。因此，本研究观察了活血化瘀、软坚散结法对颈动脉斑块患者的治疗作用，并且从凝血酶原活性，纤维蛋白原水平、血小板功能等探讨颈动脉斑块形成的机制。

　　资料与方法

　　1 诊断标准 颈动脉超声检查，局限性内-中膜厚度>1.5mm[1]。血栓弹力图R值、K值低于正常水平，MA值、α角高于正常值。

　　2 纳入及排除标准 纳入标准：(1)符合诊断标准;(2)年龄50-80岁;(3)签署知情同意书。排除标准：血小板减少性紫癜、脑出血史的病人、严重消化道溃疡、血液病、宫血、近期大手术史、严重肝肾病等患者。

　　3 一般资料 选择2015年6月—2016年6月北京北亚骨科医院内科的160例颈动脉斑块形成患者，按随机数字表法分为治疗组(活血化瘀、软坚散结法加常规西药治疗)和对照组(常规西药治疗)，各80例。治疗组中男52例，女28例，年龄50-79岁，平均年龄(66±13)岁，病程1-5年，平均病程(2±1.2)年;对照组中男54例，女26例，年龄51-78岁，平均年龄(66±12)岁，病程(1-5)年，平均病程(2±1.2)年。两组患者性别、年龄、病程比较差异无统计学意义。(P﹥0.05)。