| Objective: the purpose of this study to context theory as a guide,hypertension, hyperlipidemia, hyperglycemia and other risk factors inpopulation of nailfold microcirculation, morphology, flow around the loopstate changes,"characteristics of collaterals and microvascular disease," studyon intervention effect of Nailfold Microcirculation and carotid atherosclerosiscorrelation and Tongluo drugs, and provide clinical evidence in support of thedegree of carotid artery atherosclerosis lesions as the change of NailfoldMicrocirculation judgment from.Methods:This study is divided into the following three parts.The first part:hypertension, hyperlipidemia, hyperglycemia group “collaterals-microvascular” lesion characteristics research1research subjects: from September to2013in August2012in YilingHospital Affiliated to Hebei Medical University treatment or examination ofhypertension, high cholesterol or diabetes in120cases.2the inclusion and exclusion criteria: in accordance with hypertension,hyperlipidemia, hyperglycemia diagnosis standard; at the age of40-70yearsold, sex is not limited; received primary school and higher education,understanding and consent. At the same time rule out acute complications,patients with acute infection; malignant tumor patients and connective tissuediseases; detection of skin disease affecting the microcirculation detection; theresearchers considered other factors impact test. 3Method: groups according to different risk factors of the patients weredivided into hypertension group, hyperlipemia group, diabetes group, thecombined incidence of first onset as the grouping criterion.4the Nailfold Microcirculation examination method: using ZL-104microcirculation detector, temperature22℃-25℃, the subjects take seat,quiet for30minutes, the hand heart the same level, nailfold incense tarprevent light scattering, to improve transparency, enjoin patient the left ringfinger in the operating area, according to the view definition focus and lightsource, the first observation of vascular loop clarity, alignment at lowmagnification, then at high magnification loop shape, flow pattern, the statesaround the loop. To observe the changes of nail fold microcirculation of leftring pathology.5observation of Nailfold Microcirculation indexes: morphological index:definition, loop number, branch diameter, branch diameter input output, input/output branch of ansa top diameter, diameter, pipe loop length, cross loopnumber, deformed loop number; flow index: velocity, vasomotor, aggregationof red cells, white blood cell count Weishuan, red, white. States around theloop index: exudation, hemorrhage, venous plexus under papilla, papilla,sweat gland duct.6statistical analysis: the SPSS18.0statistical software, the measurementdata are used（x s）said, between the two groups were compared using t test,chi square test with count data, P<0.05as the difference was significant.The second part:Study of the correlation between the degree of risk factors inducedcarotid atherosclerosis and “collaterals-microvascular” lesions1research subjects: from September to2013in August2012in YilingHospital Affiliated to Hebei Medical University treatment or examination.2the inclusion and exclusion criteria: three patients with the first part, increase the health group (40cases), sub healthy group (60cases).3grouping method: according to the risk factors of carotid ultrasonogra-phy in the subjects were divided into five groups: three normal carotid group,three carotid artery intima thickening group (0.9mm≤IMT≤1.2mm), threehigh plaque group (IMT>1.2mm), with the healthy group (40cases), subhealthy group (60cases as control).4the Nailfold Microcirculation examination method: same as the firstpart.5observation of Nailfold Microcirculation indexes: the first part.6statistical methods: statistical analysis was performed using SPSS18.0statistical software, the measurement data are used (±s) said, many groupswere compared with analysis of variance (F test), count data using chi squaretest, Spearman correlation analysis using P<0.05correlation, the differencehas statistical significance.The third part:through the intervention of Tongxinluo on Nailfold Microcirculation inpatients with different severity of carotid atherosclerosis1subjects: the same as the first part.2the inclusion and exclusion criteria: same as the first part.3Inspection method: same as part3.4observation index: the first part of the same.5groups: according to the severity of AS, will meet the inclusion criteriaof hypertension, hyperlipidemia, diabetes, according to the results of carotidartery ultrasound were randomly divided into normal IMT group, IMT group,thickening of carotid artery plaque formation group.6methods of administration: the group of patients after the first2weeksto observe the blood pressure, blood lipid, adjust medication, blood glucosecontrol in the standard range, and then randomly divided into the control group and the experimental group, the control group with routine westernmedicine control three indicators, test group of routine Western Medicinecombined with Tongxinluo capsule (4capsules each time, daily3) treatment,applied for8weeks in a row,"observed before and after treatment in differentgroups collaterals, microvascular lesion improvement".7statistical methods: statistical analysis was performed using SPSS18.0statistical software, all the data are expressed with±s, comparison betweenthe two groups using t test, P<0.05had significant difference.Result：1hypertension, hyperlipidemia, hyperglycemia group “collaterals-microvasc-ular” lesion characteristics researchAnalysis of Nailfold Microcirculation in integral: hypertension groupcompared with the hyperlipidemia group and diabetes group, the number ofinput/output pipe loop, there were statistically significant differences in shootproportion, venous plexus under papilla three indexes (P <0.05), the numberand duration and pipe loop integral correlation coefficient is0.87(P <0.01),course of disease and the output/input ratio of branch correlation coefficient-0.71(P <0.01); high lipid group and hypertension group and diabetes group,the difference of ansa top diameter, three indexes of velocity, white Weishuanwas statistically significant (P <0.05); diabetic group and hypertension groupand high lipid group had statistical significance, pipe loop cross, deformity,erythrocyte aggregation, exudation, hemorrhage and five indexes difference (P<0.05).Observation of Nailfold Microcirculation of results: Observation ofNailfold Microcirculation in patients with hypertension microvascular diseasemainly as follows: the input/output branch ratio increased, venous plexusunder papilla dilatation, decrease in the number of capillary loops, in line withthe "disease collaterals and characteristics of anxious"; with the extension ofmicrovascular disease gradually from the output/input ratio increased to pipeloop branch number the decrease of transition, in line with the "diseasecollaterals which features". Hyperlipidemia group of Nailfold Microcircu- lation morphological changes: Yu Zhang ansa top, blood flow, white Weishuanformation “with characteristics of pathological changes of sun Luoyuresistance”. The diabetic group of Nailfold Microcirculation morphologicalchanges: cross, deformity, erythrocyte aggregation, exudation, hemorrhage, inline with the “disease collaterals which features”.2Study of the correlation between the degree of risk factors inducedcarotid atherosclerosis and “collaterals-microvascular” lesionsMorphological integral: compared with normal group, the sub healthygroup, IMT normal group, IMT thickness group, group differences in plaqueformation was statistically significant (P <0.05, P <0.01); compared withhealthy group, IMT normal group, IMT thickness group, group differences inplaque formation was statistically significant (P <0.05, P <0.01); comparedwith normal IMT IMT thickness group, group differences in plaque formationwas statistically significant (P <0.05, P <0.01); compared with IMTthickness group, group differences in plaque formation was statisticallysignificant (P <0.05).Flow integral: compared with normal group, the sub healthy group, IMTnormal group, IMT thickness group, group differences in plaque formationwas statistically significant (P <0.01); compared with healthy group, IMTnormal group, IMT thickness group, group differences in plaque formationwas statistically significant (P <0.01); compared with the normal IMT groupof IMT thickness group, group differences in plaque formation wasstatistically significant (P <0.01); compared with IMT thickness group, groupdifferences in plaque formation was statistically significant (P <0.01).States around the loop integral: compared with normal group, IMT group,IMT group formation group thickening, plaque was statistically significant (P<0.05, P <0.01); compared with healthy group, IMT normal group, IMTthickness group, group differences in plaque formation was statisticallysignificant (P <0.05, P <0.01compared with the normal group); IMT groupdifferences in plaque formation was statistically significant (P <0.01);compared with IMT thickness group, group differences in plaque formation was statistically significant (P <0.01).Total: compared with normal group, the sub healthy group, IMT normalgroup, IMT thickness group, group differences in plaque formation wasstatistically significant (P <0.01); compared with healthy group, IMT normalgroup, IMT thickness group, group differences in plaque formation wasstatistically significant (P <0.01); compared with normal IMT thickening ofIMT group, group differences in plaque formation was statistically significant(P <0.01); compared with IMT thickness group, group differences in plaqueformation was statistically significant (P <0.01).Nailfold microcirculation and carotid correlation analysis: the NailfoldMicrocirculation in the total score and the degree of carotid artery stenosis hadsignificantly linear correlation (r=0.96, P <0.01); nailfold microcirculationmorphological integral and the degree of carotid artery stenosis hadsignificantly linear correlation (r=0.84, P <0.01); nailfold microcirculationintegral has a significant linear correlation between and the degree of carotidartery stenosis (r=0.92, P <0.01); nailfold microcirculation states around theloop integral has the remarkable linear relationship with the degree of carotidartery stenosis (r=0.77, P <0.01).3through the intervention of Tongxinluo on Nailfold Microcirculation inpatients with different severity of carotid atherosclerosisThe Result of fuii cross-reference:Tongxinluo combined with conventional western medicine treatment:three normal carotid group, compared with before treatment of NailfoldMicrocirculation in patients with morphology score decreased significantly (P<0.05); flow integral decreased significantly (P <0.01); the states around theloop integral decreased significantly (P <0.05); score decreased significantly(P <0.01). Three carotid artery intima thickening group, compared withbefore treatment of Nailfold Microcirculation in patients with morphologyscore decreased significantly (P <0.01); flow integral decreased significantly(P <0.01); the states around the loop integral decreased significantly (P <0.01); score decreased significantly (P <0.01). Group three carotid artery plaque formation, compared with before treatment of NailfoldMicrocirculation in patients with morphology score decreased significantly (P<0.01); flow integral decreased significantly (P <0.01); the states around theloop integral decreased significantly (P <0.01); score decreased significantly(P <0.01).The conventional western medicine treatment: three normal carotid groupbefore and after, the nail fold microcirculation in patients with decreased flowintegral (P <0.05); no significant morphological integral, the integral aroundthe loop, the score difference. Three carotid artery intima thickening groupbefore and after, the nail fold microcirculation in patients with flow integraldecreased significantly (P <0.05); score decreased significantly (P <0.05); nosignificant morphological integral, the states around the loop integraldifference. Three carotid artery intima thickening group before and after, thenail fold microcirculation in patients with decreased flow integral (P <0.05);the states around the loop integral decreased significantly (P <0.05); scoredecreased significantly (P <0.05); no significant differences in morphologicalintegral.The Result of parallel control:Compared the difference of Tongxinluo capsule combined with routinewestern medicine and simple routine western medicine therapy, shape, pattern,the states around the loop, the score differences were statistically significant(P <0.01).Conclusion:1In three high (high blood pressure, high cholesterol, high blood sugar)and AS risk factors, there are four kinds of lesion types in “collaterals-microvascular”, respectively is:“collaterals resistance”,“collaterals spasm “,“collaterals hyperplasia “,“collaterals lapses “. Patients with hypertension“collaterals-microvascular” lesions characterized by” collaterals spasm “,“collaterals lapses “, as early as “collaterals spasm “, with the extension ofcourse “collaterals lapses “is gradually obvious; characteristics of patientswith hyperlipidemia “collaterals-microvascular “lesions in “collaterals resistance”;“features in patients with type Ⅱ diabetes” collaterals-microvascular” is “collaterals hyperplasia”2There was a significant correlation between the degree of nailmicrocirculation lesion and carotid atherosclerosis, nail fold microcirculationdetection has a good reference value for the clinical evaluation ofatherosclerosis.3Tongxinluo capsule combined with routine western medicine not onlyin the improvement of microcirculation flow and the states around the loop isbetter than pure western medicine treatment, and can significantly improvemicrocirculation morphology. |
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