| ObjectiveClinical Observations:This study aimed to observe the clinical symptoms of pain,itching,varicose veins,venous edema and skin pigmentation by using the modified clinical severity score of venous disease(VCSS)in C4 patients with chronic venous insufficiency of the lower extremities.The modified VCSS scores before and after treatment in the groups and the control group were evaluated to evaluate the clinical efficacy of Chaihu Shugan Powder in the treatment of chronic venous insufficiency in the C4 lower extremities.Experimental study: Through the varicose veins and normal saphenous vein surgical specimens collected during the operation,the normal veins and varicose veins were examined by HE staining.Observe and compare the pathological and structural differences between normal saphenous veins and varicose veins;by immunohistochemistry To observe the differences in the expression of monocyte chemoattractant protein-1 and matrix metalloproteinase-2 in the varicose veins of the normal control group,the varicose vein group,and the Chaihu Shugan San group,and to explore the effects of Chaihu Shugan Powder on chronic lower extremities The mechanism of inflammation and vascular remodeling in venous insufficiency.MethodsClinical observation: From the Department of Vascular Disease Outpatient Clinic and Inpatient Department of Guangzhou Traditional Chinese Medicine Hospital,60 cases of chronic venous insufficiency in the lower extremities of C4 who met the inclusion criteria were randomly divided into traditional Chinese medicine group and control group according to the randomized controlled trial study method,30 cases in each group.The Chinese medicine group was given oral decoction of Bupleurum Shugan San and the control group was given Diosmin tablets and Maixuekang capsules.The treatment duration was21 days in each group.The revised VCSS score table was used to observe the changes of symptom scores before and after treatment in the two groups of patients.Statistical analysis was performed on relevant data to evaluate the clinical efficacy of Chaihu Shugan Powder in the treatment of chronic venous insufficiency in the C4 lower extremities.Experimental study: Six patients with chronic venous insufficiency in the lower extremity who agreed with the inclusion criteria were agreed to undergo surgical treatment.During the operation,the varicose veins of the lesions were taken from the no-injury principle;4 patients who underwent amputation were selected from the hospitalized patients in our department.The normal saphenous vein trunk was used as a normal control group.The saline was washed and segmented and fixed directly with 10% paraformaldehyde.The varicose veins were removed and washed with saline.They were divided into varicose vein group and Chaihu Shugan San group randomly.The varicose vein group specimens were fixed directly with 10% paraformaldehyde and routinely pathologically sectioned.The samples of Bupleurum Shugan San group were incubated in Bupleurum Shugan Powder solution for 20 minutes at room temperature,fixed with 10% paraformaldehyde,and routinely pathologically sectioned.HE staining was performed in each group.Immunocytochemistry was used to detect Monocyte Chemoattractant protein-1 and Matrix Metalloproteinase-2 in venous tissue of vein.The expression of chemokine-1 and matrix metalloproteinase-2 in mononuclear cells was evaluated.The effects of Chaihu Shugan Powder on the expression of chemokine-1 and matrix metalloproteinase-2in monocytes were studied.Study Results1.From the revised VCSS score analysis,the total scores of revised VCSS after treatment in both groups were lower than before treatment(P<0.05),and the difference was statistically significant,indicating that both treatment methods have therapeutic effects on C4 CVI patients.It is worth mentioning that compared with the control group,the Chinese medicine group can significantly improve the clinical symptoms of pruritus,skin pigmentation,inflammation and induration in patients with chronic venous insufficiency of the C4 level(P<0.05),and the difference is statistically significant.There was no statistically significant difference in pain,varicose veins,venous edema,and compression(P>0.05),suggesting that the two treatments have comparable clinical efficacy.2.Efficacy evaluation: The total effective rate of the Chinese medicine group was 96.7%,and the total effective rate of the control group was 86.7%.After non-parametric tests,the difference in clinical efficacy between the two groups was statistically significant(P<0.05).It can be considered that the clinical efficacy of the Chinese medicine group is better than that of the control group.3.The results of microscopic examination of HE staining showed that the normal venous lumen was regular and the wall thickness was thin;the irregular varicosity of the varicose venous lumen was uneven,the thickness of the intima was thickened,and the fibroplasia between the subendocardial and muscular walls was observed.Pericranial lymphocyte infiltration can be seen in the cases.4.The expression of monocyte chemoattractant factor-1 and matrix metalloproteinase-2 were detected in the normal vein,varicose veins,and Chaihu Shugansan group,and monocyte chemotactic factor-1 and matrix metalloproteinase-2 were detected.The intensity of expression in the varicose vein group was significantly stronger than that of the Chaihu Shugan San group and the normal control group.Conclusion1.Chaihu Shugan Powder can effectively improve the clinical symptoms of patients,especially in the improvement of itching,skin pigmentation,inflammation and induration,the clinical efficacy is significant.2.The varicose veins and normal veins were significantly different in morphological structure,showing pathological structural features,indicating that the vascular remodeling properties of varicose veins were altered.The mechanism of action of Chaihu Shugan Powder in treating CVI may be through downregulating monocyte chemotactic factor 1,intervening in inflammatory response,and then reducing the expression of MMP-2,thereby inhibiting vascular remodeling. |
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