Costantini A, De Bernardi T, Gotti A
Istituto di Chirurgia Vascolare e Angiologia, Università degli Studi, Milano.
Minerva Cardioangiol. 1999 Jan-Feb;47(1-2):39-46.
The pharmacological treatment of non-complicated chronic venous insufficiency is a current and well-debated topic. The introduction of new products with action on the venous system, improved knowledge on the physiopathology of venous insufficiency and the possibility provided by new analytical instruments, have given new impulse to the consolidation of the clinical value of phlebotonics in this indication.
In light of this, 24 patients with non-complicated chronic venous insufficiency were treated with oral administration of Oligomeric Proanthocyanidins (Pycnogenols-OPC) 100 mg/day. To evaluate the therapeutic efficacy of the treatment, an instrumental evaluation by optical probe capillaroscope was employed in addition to the traditional subjective clinical parameters: swelling, itching, heaviness and pain. The videocapillaroscope examination was performed at the lower third of the leg and the first toe. Edema in the capillaroscopic field, the number of observable capillaries and the capillary dilatation were the parameter chosen to evaluate the efficacy of treatment. All patients completed the study with no reports of adverse events during the period of observation.
The results obtained show a positive clinical response (improved or absent symptoms) in over 80% of patients, with significant improvement of symptoms already evident after the first 10 days of treatment. The mechanism of action of the OPCs explains the rapid reduction of the swelling of the lower limbs and correlated with this are the other evaluable symptoms: heaviness and itching. Particularly striking results were observed for itching and pain which completely disappeared during the course of therapy in 80% and 53% of the patients respectively. Noteworthy is the good correlation between the clinical and instrumental data, with improvement in a total of 70% of patients.
The results obtained in the course of this clinical experience, with evident improvement already during the first weeks of treatment, the absence of adverse events added to the benefit of a once-a-day administration, justify the use of OPC in the treatment of non-complicated chronic venous insufficiency.
非复杂性慢性静脉功能不全的药物治疗是当前一个备受争议的话题。作用于静脉系统的新产品的推出、对静脉功能不全病理生理学认识的提高以及新分析仪器提供的可能性,为巩固静脉活性药物在此适应症中的临床价值带来了新的推动力。
鉴于此,对24例非复杂性慢性静脉功能不全患者口服100毫克/天的低聚原花青素(碧萝芷-OPC)进行治疗。为评估治疗效果,除了传统的主观临床参数(肿胀、瘙痒、沉重感和疼痛)外,还采用光学探针毛细血管镜进行仪器评估。毛细血管镜检查在小腿下三分之一处和第一趾进行。毛细血管镜视野中的水肿、可观察到的毛细血管数量和毛细血管扩张是选择用来评估治疗效果的参数。所有患者均完成了研究,在观察期内未报告不良事件。
获得的结果显示,超过80%的患者有积极的临床反应(症状改善或消失),治疗开始10天后症状即有明显改善。OPC的作用机制解释了下肢肿胀的迅速减轻,与此相关的还有其他可评估的症状:沉重感和瘙痒。在瘙痒和疼痛方面观察到特别显著的结果,分别有80%和53%的患者在治疗过程中这些症状完全消失。值得注意的是临床数据和仪器数据之间有良好的相关性,共有70%的患者病情得到改善。
在本次临床经验过程中获得的结果,在治疗的最初几周就有明显改善,且无不良事件,加上每日一次给药的便利性,证明OPC可用于治疗非复杂性慢性静脉功能不全。