Rational therapy of chronic venous insufficiency – chances and limits of the therapeutic use of horse-chestnut seeds extract

BACKGROUND AND METHODS: We report two clinical studies, one already published, performed in patients with early and advanced chronic venous insufficiency (CVI). In both, compression therapy and oral therapy with horse-chestnut seeds extracts (HCSE) were compared to placebo. RESULTS: The published study in early CVI (Grade I) showed HCSE and compression to be superior to placebo and to be equivalent to each other in reducing lower leg volume, a measure for oedema. In the study, in advanced CVI (Grade II and IIIa), compression appeared to be superior to placebo, whereas HCSE was not. HCSE fared better in Grade II than in Grade IIIa patients. These results are discussed in the light of data from an in vitro model, where HCSE has been able to close the intercellular gaps in the venular endothelium. Not fully specified factors lead to an opening of these gaps, resulting in oedema as well as in local coagulation and thrombosis. The subsequent inflammation keeps these gaps open and initiates and maintains a chronic disease process, which may be the starting point of CVI. CONCLUSION: Due to its ability to close the venular endothelial gaps, HCSE seems to be a suitable and protecting therapy during the early stages of CVI. In later more severe stages compression therapy is indicated. Taking into account the observed negative impact of compression on quality of life, pharmacological CVI therapy should start early to avoid progress and to spare patients compression therapy.

背景与方法：本研究报告两项针对早、晚期慢性静脉功能不全（chronic venous insufficiency, CVI）患者的临床研究，其中一项已发表。两项研究均比较了加压治疗与七叶树种子提取物（horse-chestnut seeds extracts, HCSE）口服治疗与安慰剂的疗效差异。结果：针对早期CVI（I级）的已发表研究显示，七叶树种子提取物口服治疗与加压治疗均优于安慰剂，且二者在降低小腿体积（水肿评估指标）方面效果相当。针对晚期CVI（II级与IIIa级）的研究则显示，加压治疗优于安慰剂，而七叶树种子提取物口服治疗未表现出类似优势；且七叶树种子提取物在II级患者中的疗效优于IIIa级患者。本研究结合体外模型数据对上述结果进行讨论：该模型证实七叶树种子提取物可闭合静脉内皮细胞间的间隙。尚未完全明确的因素可导致此类间隙开放，进而引发水肿、局部凝血与血栓形成。后续的炎症反应会维持间隙开放状态，并启动并维持慢性病程，而这可能是慢性静脉功能不全的发病起始环节。结论：鉴于七叶树种子提取物可闭合静脉内皮间隙，其在慢性静脉功能不全早期阶段是一种合适且具有保护作用的治疗方案。而在病情更严重的晚期阶段，则应采用加压治疗。考虑到加压治疗对患者生活质量存在已知的负面影响，慢性静脉功能不全的药物治疗应尽早启动，以延缓病情进展并避免患者接受加压治疗。