| Objective and Significance:Arteriosclerosis obliterans of the lower extremities,ASOLE)is a chronic ischemic disease of the lower extremities characterized by stenosis or occlusion of the lumen,resulting in claudication,decreased skin temperature,pain and even necrosis of the lower extremities.With the change of lifestyle and aging of population,the incidence of arteriosclerosis obliterans has increased year by year,and the incidence rate incidence rate has increased with age.At present,the treatment of ASOLE in western medicine mainly includes medicine,intervention and operation,but there are some side effects,and the long-term effect is not sure.At present,Chinese medicine has its unique advantages in the treatment of ASOLE,and gradually accepted by the clinical,but the mechanism of its treatment of ASOLE needs to be further explored.The purpose of this paper is to scientifically verify the effectiveness of Xiaozheng Tongluo method in the treatment of asole through clinical observation and experimental research,and to preliminarily explore its mechanism of promoting angiogenesis.Method:Clinical Study:All cases were from the patients who came to the peripheral vascular department from June 2015 to December 2017.80 ASOLE patients who met the inclusion criteria were divided into treatment group and control group according to the random number table method,40 cases each.In addition to diet,blood pressure and lipid reduction,the treatment group was treated with Alprostadil Injection combined with Xiaozheng Tongluo Method,while the control group was treated with Alprostadil Injection combined with Cilostazol Tabltes,in which Alprostadil Injection was stopped for 2 weeks,Xiaozheng Tongluo Method and Cilostazol Tabltes for 3 months as a course of treatment,and stopped after 1 course of treatment,with a follow-up of 6months.The changes of ABI,TBI,Tc PO2,and other indexes of limb circulation were observed before,after and 6 months after treatment to evaluate the clinical effect of ASOLE.Experimental study:58 male SD rats were fed for one week,10 rats were randomly selected as the blank group;48 rats were fed with high-fat diet combined with intimal injury of saphenous artery,and randomly divided into model group,Xiaozheng Tongluo Method group（high,medium and low concentration）.The administration method is as follows:Blank group:General diet feeding,drinking water freely.Model group:One week after the model was established successfully,the rats were fed with high-fat diet,and were given Stroke-physiological saline solution（1ml/100g）by gavage,once a day for 12 weeks,free drinking water.Xiaozheng Tongluo Method group（high,medium and low concentration）:One week after the model was established successfully,the rats were fed with high-fat diet,the corresponding concentration of Xiaozheng Tongluo Method is infused into the stomach once a day for 12 weeks,free drinking water.The expression of VEGF in serum,ERK,p38 phosphorylation signal pathway and VEGF protein in diseased muscle of ASOLE rats were detected by ELISA and Western blot.Result:Clinical observation:After treatment:The two groups of patients were more effective than before treatment,ABI,TBI,Tc PO2 and other indexes of limb circulation were improved（P<0.05）;at the same time,there was no significant difference between the treatment group and the control group,indicating that the therapeutic effect of Xiaozheng Tongluo Method of traditional Chinese medicine was equivalent to that of Cilostazol Tabltes.Six months after the treatment:The indexes of the two groups were improved before and after treatment（P<0.05）,and the curative effect of the treatment group was better than that of the control group（P<0.05）.Experimental study:（1）The expression of VEGF protein in serum:the level of VEGF in model group and Chinese medicine treatment group was significantly lower than that in blank group（P<0.05）.VEGF in serum of Chinese medicine treatment group was significantly higher than that of model group（P<0.05）;there was a certain correlation between the effect of Chinese medicine treatment and the concentration,the effect of middle concentration group and high concentration group was significantly higher than that of low concentration group（P<0.05）,but there was no significant difference between middle concentration group and high concentration group（P>0.05）.（2）The expression of VEGF protein in muscle tissue:compared with the blank group,the expression of VEGF protein in the model group and the traditional Chinese medicine treatment group decreased significantly（P<0.05）;compared with the model group,the expression of VEGF protein in the traditional Chinese medicine treatment group increased significantly（P<0.05）,which had a certain correlation with the concentration of traditional Chinese medicine.（3）Expression of p38 and p-p38 in muscle tissue:the change of protein expression level was consistent with VEGF protein expression.Compared with the blank group,p38 and p-p38 of the model group and the Chinese medicine treatment group were significantly lower（P<0.05）;compared with the model group,the Chinese medicine treatment group increased the expression of p38 and p-p38 protein（P<0.05）;there was a certain correlation with the concentration of Chinese medicine.（4）The expression of ERK and p-ERK in muscle tissue:compared with the blank group,ERK and p-ERK in model group and traditional Chinese medicine treatment group decreased significantly（P<0.05）;compared with model group,ERK and p-ERK in traditional Chinese medicine treatment group increased significantly（P<0.05）;there was a definite correlation with the concentration of traditional Chinese medicine.Conclusion:1.Xiaozheng Tongluo Method is effective in the treatment of ASOLE.Its short-term effect is similar to that of Cilostazol Tabltes,and its long-term effect is better than that of Cilostazol Tabltes;2.Xiaozheng Tongluo Method can promote the expression of VEGF in serum,ERK,p38 phosphorylation signal pathway and VEGF protein in muscle tissue,promote angiogenesis,and achieve the purpose of treating ASOLE.3.The treatment of ASOLE by Xiaozheng Tongluo Method is related to the mechanism of promoting angiogenesis. |
