加味通窍活血汤对瘀血阻络证椎基底动脉延长扩张症后循环血流量和管壁剪切力的影响

目的:观察加味通窍活血汤对瘀血阻络证椎基底动脉延长扩张症(VBD)患者后循环血流量和管壁剪切力的影响,并探讨其作用机制。方法:收集2017年10月至2019年8月在河南中医药大学第一附属医院住院治疗,中医证型符合瘀血阻络并通过磁共振血管成像(MRA)确诊为VBD的97例患者,分为治疗组(48例)和对照组(49例)。对照组给予基础治疗和中药安慰剂,治疗组给予基础治疗和加味通窍活血汤,疗程为30 d。观察两组眩晕症状的缓解程度、眩晕症状量表(VSS)和活动平衡信心(ABC)量表评分,以及经颅多普勒(TCD)双侧椎动脉和基底动脉血流速度平均血流速度(Vm),收缩期血流速度(Vs),舒张期血流速度(Vd)],平均血流量(MFV),搏动指数(PI),阻力指数(RI)及管壁剪切力(WSS)治疗前后的差异。结果:与本组治疗前比较,对照组ABC量表评分明显升高,VSS评分明显下降(P<0.05),而眩晕症状分级未见明显变化,差异无统计学意义。与本组治疗前比较,治疗组眩晕程度症状分级和VSS评分明显下降,ABC量表评分明显升高(P<0.05)。与对照组治疗后比较,治疗组眩晕程度症状分级和VSS评分明显下降,ABC量表评分明显升高(P<0.05)。与本组治疗前比较,对照组治疗后双侧椎动脉Vm,MFV和WSS明显升高,RI明显下降(P<0.05),而Vs,Vd和PI未见明显变化,差异无统计学意义;与本组治疗前比较,治疗组双侧椎动脉Vs,Vd,Vm,MFV和WSS明显升高,RI明显下降(P<0.05),PI未见明显变化,差异无统计学意义。与对照组治疗后比较,治疗组双侧椎动脉Vs,Vd,Vm,MFV和WSS明显升高(P<0.05),PI和RI未见明显变化,差异无统计学意义。治疗前后组间和组内比较,基底动脉血流参数也发现与双侧椎动脉类似的有统计学意义的改变。结论:加味通窍活血汤治疗瘀血阻络型VBD患者头晕或眩晕临床症状均有较好的改善,其作用机制可能与加味通窍活血汤对后循环血流动力学的改善有关。

Effect of Modified Tongqiao Huoxuetang on Circulating Blood Flow and Wall Shear Stress Due to Blood Stasis and Channel Blockage

Objective To observe the effect of modified Tongqiao Huoxuetang on circulating blood flow and wall shear stress of vertebrobasilar dolichoectasia (VBD) due to blood stasis and channel blockage. Method A total of 97 patients admitted in our department from October 2017 to August 2019 were collected. The traditional Chinese medicine (TCM) syndromes were consistent with blood stasis and channel blockage, and diagnosed as VBD by magnetic resonance angiography (MRA). The patients were divided into experimental group (48 cases) and control group (49 cases). Control group was given basic therapy and placebo of TCM, while treatment group was given basic therapy and modified Tongqiao Huoxuetang for 30 days. The degree of relief of vertigo symptoms, vertigo symptom scale (VSS), activity balance confidence (ABC), transcranial doppler (TCD) bilateral vertebral artery and basilar artery blood flow velocity systolic blood flow velocity (Vs), mean blood flow velocity (Vm), diastolic blood flow velocity (Vd)], mean blood flow differences between (MFV), pulsatility index, resistance index (RI), and wall shear force (WSS) were observed before and after treatment. Result Compared with control group before treatment, the score of ABC scale in control group after treatment was markedly higher, while the score of VSS was significantly lower (P<0.05). However, there was no statistical significance in the score of vertigo symptom. Compared with treatment group before treatment, the symptom grade of vertigo degree and the score of VSS in treatment group after treatment were substantially lower, while the score of ABC scale was significantly higher (P<0.05). Compared with control group, the score of vertigo degree symptoms and VSS in treatment group were markedly lower, while the score of ABC scale was significantly higher (P<0.05). Compared with control group before treatment, Vm, MFV and WSS of bilateral vertebral artery in control group after treatment were substantially higher, while RI was significantly lower (P<0.05). However, there were no statistical significances in Vs, Vd and PI in control group before and after treatment. Compared with treatment group, Vs, Vd, Vm, MFV and WSS of bilateral vertebral artery in treatment group after treatment were markedly higher, while RI was significantly lower (P<0.05). However, there was no statistical significance in PI of experimental group before and after treatment. Compared with control group after treatment, Vs, Vd, Vm, MFV and WSS of bilateral vertebral artery in treatment group after treatment were substantially higher, while there was no statistical significance in PI and RI. Before and after treatment, there were similar changes in blood flow parameters of the basilar artery and bilateral vertebral artery. Conclusion Modified Tongqiao Huoxuetang could improve the clinical symptoms of dizziness or vertigo in patients of VBD due to blood stasis and channel blockage, and the mechanism might be related to the improvement of post-circulation hemodynamics by Tongqiao Huoxuetang.