摘要
目的：研究中药蛇伤胶囊治疗竹叶青蛇伤患者凝血功能障碍的机制。方法采用前瞻性研究方法，将70例竹叶青蛇伤且符合火毒证诊断标准的患者按随机数字表法分为治疗组和对照组，每组35例。对照组在基础治疗（包括伤口消毒，肌注破伤风抗毒素1500 U，使用常规剂量抗菌药物、地塞米松10 mg、奥美拉唑40 mg）的同时口服季德胜蛇药片10片，每天3次；治疗组在基础治疗的同时口服蛇伤胶囊（院内制剂，由大黄、黄连、山慈菇、土木香、杨梅皮、冰片等组成）5粒，每天3次；两组疗程均为1周。用酶联免疫吸附试验（ELISA）测定两组患者治疗前后血清血小板α-颗粒膜糖蛋白（CD62p）、血栓素B2（TXB2）、血小板第3因子（PF3）和血管性血友病因子（vWF）的含量。结果治疗组和对照组治疗前CD62p、TXB2、PF3、vWF含量比较差异均无统计学意义〔CD62p（μg/L）：3.81±1.64比3.52±1.43，TXB2（μg/L）：13.04±1.67比13.31±1.14，PF3（μg/L）：2.84±1.08比2.88±1.23，vWF（μg/L）：12.36±2.42比11.89±2.08，均P＞0.05〕；两组治疗后CD62p、TXB2、PF3含量均较治疗前升高，vWF较治疗前降低，且以治疗组的变化更显著〔CD62p（μg/L）：6.73±1.77比5.81±1.62，TXB2（μg/L）：18.65±1.77比17.90±1.68，PF3（μg/L）：5.61±1.48比4.77±1.24，vWF（μg/L）：3.87±1.01比4.58±1.09，P＜0.05或P＜0.01〕。结论蛇伤胶囊治疗竹叶青蛇伤后的凝血功能障碍可能是通过改善血小板活化功能、减轻血管内皮细胞损伤来实现的。
Objective To investigate the mechanism of traditional Chinese medicine （TCM） Sheshang capsule for treatment of blood coagulation dysfunction in patients bitten by Trimeresurus stejnegeri snake. Methods A prospective study was conducted. Seventy Trimeresurus stejnegeri snake envenoming patients whose manifestations conformed to the diagnostic criteria of the fire toxin syndrome in TCM were assigned into therapy group and control group by random number table （each, 35 cases）. The basic treatments （including wound disinfection, intramuscular injection of 1500 U tetanus antitoxin, conventional dose of antibiotics, 10 mg dexamethasone, 40 mg omeprazole） and 10 Jidesheng Sheyao tablets three times a day were applied in the control group. In the therapy group, the basic treatments the same as those of the control group were given, and in the mean time 5 Sheshang capsules （the drug was prepared in our hospital including ingredients：rhubarb, coptidis rhizoma, pleione bulbocodioides, elecampane inula root, bayberry bark, borneol and so on） were administered three times a day. The therapeutic course in the two groups was 1 week. The levels of platelet α-granule membrane protein （CD62p）, thromboxane B2 （TXB2）, platelet factor 3 （PF3） and von Willebrand factor （vWF） in serum were measured by enzyme linked immunosorbent assay （ELISA） before and after treatment. Results Before treatment, there were no significant differences in CD62p, TXB2, PF3 and vWF between therapy group and control group [CD62p （μg/L）：3.81±1.64 vs. 3.52±1.43, TXB2 （μg/L）：13.04±1.67 vs. 13.31±1.14, PF3 （μg/L）： 2.84±1.08 vs. 2.88±1.23, vWF （μg/L）：12.36±2.42 vs. 11.89±2.08, all P〉0.05]. After treatment, the levels of CD62p, TXB2 and PF3 were increased, while vWF decreased compared with those before treatment in both groups, the level changes in therapy group being more remarkable [CD62p （μg/L）： 6.73±1.77 vs. 5.81±1.62, TXB2 （μg/L）：18.65±1.77 vs. 17.90±1.68, PF3 （μg/L）：5.61±1.48 vs. 4.77±1.24, vWF （μg/L）：3.87±1.01 vs. 4.58±1.09, P 〈 0.05 or P 〈 0.01]. Conclusion The Sheshang capsule is capable of treating patients with blood coagulative disorder after Trimeresurus stejnegeri snake bite, and its mechanism is possibly related to the improvement of platelet activation function and amelioration of the damage of vascular endothelial cells.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2015年第2期151-153,共3页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
福建省科技计划重点项目（2012Y0036）
福建省中西医结合急诊重点研究室建设项目（闽卫中2013-445）
福建中医药大学重点学科专项校管课题（X2014033-学科,X2014034-学科,X2014035学科）
关键词
蛇伤胶囊
竹叶青蛇
凝血功能障碍
血小板活化
血管内皮细胞
Sheshang capsule
Trimeresurus stejnegeri snake
Blood coagulation disorder
Platelet activation
Vascular endothelial cell
