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1.中南大学 湘雅医学院 附属海口医院,海口 570208
2.海南省中医院,海口 570203
王景科,主治医师,从事中医心血管内科临床工作,E-mail:53582590@qq.com
收稿日期:2020-06-19,
网络出版日期:2020-08-12,
纸质出版日期:2021-03-20
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王景科,钟江华,黄康等.丹参饮合温胆汤加减对稳定型心绞痛患者心肌缺血的保护机制[J].中国实验方剂学杂志,2021,27(06):82-87.
WANG Jing-ke,ZHONG Jiang-hua,HUANG Kang,et al.Protection Mechanism of Addition and Subtraction Therapy of Danshenyin Combined with Wendantang for Myocardial Ischemia in Patients with Stable Angina[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(06):82-87.
王景科,钟江华,黄康等.丹参饮合温胆汤加减对稳定型心绞痛患者心肌缺血的保护机制[J].中国实验方剂学杂志,2021,27(06):82-87. DOI: 10.13422/j.cnki.syfjx.20201132.
WANG Jing-ke,ZHONG Jiang-hua,HUANG Kang,et al.Protection Mechanism of Addition and Subtraction Therapy of Danshenyin Combined with Wendantang for Myocardial Ischemia in Patients with Stable Angina[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(06):82-87. DOI: 10.13422/j.cnki.syfjx.20201132.
目的
2
观察丹参饮合温胆汤加减治疗痰瘀阻滞型稳定型心绞痛(SAP)的疗效及对心肌缺血的保护机制研究。
方法
2
将132例患者随机按数字表法分为对照组和观察组各66例。除去脱落、失访和剔除病例,两组最后分别完成63例。所有患者进行抗心绞痛药物和控制风险因素药物治疗。对照组口服丹蒌片,5片/次,3次/d;观察组给予丹参饮合温胆汤加减,1剂/d;两组疗程均为治疗3个月。每周进行心绞痛发作情况评分;冠心病心肌缺血情况采用心电图平板运动试验评价,中医症状和生活质量分别进行痰瘀阻滞证、西雅图心绞痛量表(SAQ)评分,血液流变学指标、白细胞介素-6(IL-6),肿瘤坏死因子-
α
(TNF-
α
),细胞间黏附分子-1(ICAM-1),胱抑素C(CysC),同型半胱氨酸(Hcy),缺血修饰白蛋白(IMA)和巨噬细胞移动抑制因子(MIF)水平,均治疗前后各评价1次;并进行安全性评价。
结果
2
观察组心绞痛发作次数、持续时间、疼痛程度和硝酸甘油用量评分均低于对照组(
P
<
0.01);观察组Duke评分、总运动时间、出现ST段压低1.0 mm的时间、心绞痛出现时间和代谢当量均多于对照组(
P
<
0.01);观察组SAQ评分高于对照组(
P
<
0.01),痰瘀阻滞证积分低于对照组(
P
<
0.01);观察组心绞痛疗效优于对照组(
Z
=2.091,
P
<
0.05);观察组ICAM-1,CysC,IL-6,TNF-
α
水平均低于对照组(
P
<
0.01);观察组全血黏度(低切、高切)、全血还原黏度、血浆黏度、血小板聚集率、纤维蛋白原(FIB)均低于对照组(
P
<
0.01);观察组IMA,Hcy和MIF水平均低于对照组(
P
<
0.01)。没有发现服用丹参饮合温胆汤相关不良反应。
结论
2
在西医常规治疗的基础上,丹参饮合温胆汤加减治疗SAP,可控制心绞痛发作,减轻痰瘀阻滞证症状,提高生活质量,有着较好临床疗效,且安全,并能改善患者血液流变性,抑制炎症反应,减轻管腔狭窄或阻塞,从而改善心肌缺血程度。
Objective
2
To observe the efficacy of addition and subtraction therapy of Danshenyin combined with Wendantang in the treatment to stable angina pectoris (SAP) with stagnation of phlegm and blood stasis, and to explore its protection mechanism for myocardial ischemia.
Method
2
One hundred and thirty-two patients were randomly divided into control group and observation group equally. Finished the 63 cases study both in control group and observation group after dropout, loss of follow-up and withdrawal. Patients in control group and observation group got antianginal drugs and the treatment of drug therapy to control the risk factors. All patients were treated with anti-angina drugs and risk factors control drugs. Patients in control group got Danlou Tablets by oral administration, 5 tablets/time, 3 times/day. Patients in observation group got dispensing decoction pieces of Danshenyin and Wendantang 1 dose/day. The treatment continued for 3 months in both groups. Scores of angina attack were graded every week. Before and after treatment, electrocardiogram treadmill exercise test was made to evaluate myocardial ischemia of coronary heart disease, and scores of phlegm stasis block syndrome and Seattle Angina questionnaire (SAQ) were graded for TCM symptoms and quality of life. Levels of hemorheology index, interleukin-6 (IL-6), tumor necrosis factor-
α
(TNF-
α
), intercellular adhesion molecule-1 (ICAM-1), Cystatin C (CysC), homocysteine (Hcy), ischemic modified albumin (IMA) and macrophage migration inhibitory factor were detected. In addition, safety was evaluated.
Result
2
After treatment, scores of times, duration, degree of angina pectoris, nitroglycerin dosage of angina pectoris and nitroglycerin dosage in the observation group were lower than those in the control group (
P
<
0.01). Total exercise time, duration of ST depression for 1.0 mm, occurrence time of stable angina pectoris, metabolic equivalent and scores of Duke in the observation group were more than those in the control group (
P
<
0.01). Score of stagnation of phlegm and blood stasis in the observation group was lower than that in the control group (
P
<
0.01), while score of SAQ was higher than that in the control group (
P
<
0.01). Levels of IL-6, TNF-
α
, ICAM-1, CysC, IMA, Hcy, MIF, whole blood viscosity (low cut, high cut), whole blood reducing viscosity, plasma viscosity, platelet aggregation rate and fibrinogen (FIB) in the observation group were lower than those in the control group (
P
<
0.01). Effect of angina pectoris in observation group was superior to that in control group (
Z
=2.091,
P
<
0.01). No adverse reactions related to Danshenyin combined with Wendantang were found.
Conclusion
2
Addition and subtraction therapy of Danshenyin combined with Wendantang based on the routine western medicine treatment can control the attack of angina pectoris, relieve the symptoms of phlegm and stasis block syndrome, and improve the quality of life for patients with SAP, showing superior clinical efficacy and safety. In addition, it can improve the hemorheology of patients, inhibit the inflammatory reaction, reduce the stenosis or obstruction of lumen in order to improve the degree of myocardial ischemia.
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