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河南省中医院,河南中医药大学 第二附属医院,郑州 450002
曹程浩,硕士,主治中医师,从事心血管内科疾病的临床工作,E-mail:cch7711@163.com
* 黄斌,硕士,主任医师,从事心血管内科疾病的临床工作,E-mail:hbfred@sina.com
收稿日期:2020-08-07,
网络出版日期:2020-10-22,
纸质出版日期:2021-04-05
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曹程浩,董晓瑞,黄斌.丹参饮合二陈汤加减对颈动脉粥样硬化血管内膜损伤的保护作用[J].中国实验方剂学杂志,2021,27(07):86-91.
CAO Cheng-hao,DONG Xiao-rui,HUANG Bin.Protective Effect of Modified Danshenyin and Erchentang on Intimal Injury Caused by Carotid Atherosclerosis[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(07):86-91.
曹程浩,董晓瑞,黄斌.丹参饮合二陈汤加减对颈动脉粥样硬化血管内膜损伤的保护作用[J].中国实验方剂学杂志,2021,27(07):86-91. DOI: 10.13422/j.cnki.syfjx.20210132.
CAO Cheng-hao,DONG Xiao-rui,HUANG Bin.Protective Effect of Modified Danshenyin and Erchentang on Intimal Injury Caused by Carotid Atherosclerosis[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(07):86-91. DOI: 10.13422/j.cnki.syfjx.20210132.
目的
2
探讨丹参饮合二陈汤加减治疗颈动脉粥样硬化(CAS)痰瘀互结证的临床疗效及对血管内膜损伤的影响效果。
方法
2
将151例患者随机按数字表法分为对照组75例(脱失4例,剔除2例,完成69例)和观察组76例(脱失3例,剔除4例,完成69例)。两组患者均口服阿托伐他汀钙片,10 mg/次,1次/d,阿司匹林肠溶片,100 mg/次,1次/d。对照组口服荷丹片,2片/次,3次/d;观察组口服丹参饮合二陈汤加减,1剂/d。两组均为连续治疗4个月。进行治疗前后颈动脉彩色超声检测,记录颈动脉内-中膜厚度(IMT),斑块数量、斑块面积、斑块厚度和血流动力学;检测治疗前后一氧化氮(NO),内皮素-1(ET-1),血管性血友病因子(vWF),可溶性细胞间黏附分子-1(s ICAMs-1),血管内皮生长因子(VEGF),基质金属蛋白酶-9(MMP-9)水平;检测治疗前后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),全血低切黏度(LBV),全血高切黏度(HBV),血浆黏度(PV),血小板聚集率(PAR),纤维蛋白原(FIB),同型半胱氨酸(Hcy),白细胞介素-6(IL-6),IL-10,肿瘤坏死因子-
α
(TNF-
α
),血清超氧化物歧化酶(SOD),丙二醛(MDA),氧化低密度脂蛋白(ox-LDL)和循环谷胱甘肽过氧化物酶(GSH-Px)水平;进行安全性评价。
结果
2
治疗后观察组IMT,斑块数量、斑块面积和斑块厚度均低于对照组(
P
<
0.01);观察组收缩期峰值血流速度和舒张期末血流速度均高于对照组(
P
<
0.01),搏动指数和阻力指数均低于对照组(
P
<
0.01);观察组ET-1,vWF,sICAM-1,VEGF,MMP-9均低于对照组(
P
<
0.01),NO水平高于对照组(
P
<
0.01);观察组TG,TC,和LDL-C水平均低于对照组,HDL-C水平高于对照组(
P
<
0.01);观察组LBV,HBV,PV,PAR和FIB均低于对照组(
P
<
0.01);观察组Hcy,IL-6和TNF-
α
水平均低于对照组(
P
<
0.01);观察组IL-10,SOD和GSH-Px均高于对照组(
P
<
0.01),MDA和ox-LDL均低于对照组(
P
<
0.01)。未观察到与服用中药相关不良反应。
结论
2
丹参饮合二陈汤加减治疗CAS痰瘀互结患者能缩小斑块,改善血流动力学和血液流变学,调节血脂代谢和血管内皮因子,并具有抗炎和抗氧化损伤,保护血管内膜,抑制CAS发生、发展的效果,且临床使用安全。
Objective
2
To discuss the clinical efficacy of modified Danshenyin and Erchentang in treating carotid atherosclerosis (CAS), and the effect on intimal injury.
Method
2
Patients (151 cases) were divided into control group (75 cases) and observation group (76 cases). Specifically, 69 cases in control finished the treatment (4 cases fell off in follow-up, and 2 cases were eliminated), and 69 cases in observation group finished the treatment (3 cases fell off in follow-up, and 4 cases were eliminated). Patients in both group got atorvastatin calcium tablets, 10 mg/time, 1 time/day, and aspirin enteric-coated tablets, 100 mg/time, 1 time/day. Patients in control group got Hedan tablets, 2 tablets/time, 3 times/day. Patients in observation group got modified Danshenyin and Erchentang, 1 dose/day. The treatment lasted for 4 months. Before and after treatment, color Doppler ultrasound of carotid artery was detected, and carotid intima-media thickness (IMT), plaque number, plaque area, plaque thickness and hemodynamics were recorded. Levels of nitric oxide (NO), endothelin-1 (ET-1), von Willebrand factor (vWF), soluble intercellular adhesion molecule-1 (sICAM-1), vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), whole-blood low-shear viscosity (LBV), whole-blood high-shear viscosity (HBV), plasma viscosity (PV), platelet aggregation rate (PAR), fibrinogen (FIB), homocysteine (Hcy), interleukin-6 (IL-6), IL-10, tumor necrosis factor-
α
(TNF-
α
), serum superoxide dismutase (SOD), malondialdehyde (MDA), oxidized low density lipoprotein (ox LDL) and circulating glutathione peroxidase (GSH-Px) were detected before and after treatment. And the safety was evaluated.
Result
2
After treatment, IMT, number, area and thickness of plaque in observation group were less than those in control group (
P
<
0.01). Peak systolic velocity and end diastolic velocity in observation group were higher than those in control group (
P
<
0.01), while pulsatility index and resistance index were lower than those in control group (
P
<
0.01). And levels of ET-1, vWF, sICAM-1, VEGF, MMP-9, TG, TC, LDL-C, LBV, HBV, PV, PAR, FIB, Hcy, IL-6, TNF-
α
, MDA and ox-LDL were lower than those in control group (
P
<
0.01), whereas levels of NO, HDL-C, IL-10, SOD and GSH-Px were higher than those in control group (
P
<
0.01). And there was no adverse reaction caused by traditional Chinese medicine.
Conclusion
2
Modified Danshenyin and Erchentang can reduce plaque, improve hemodynamics and hemorheology, and regulate blood lipid metabolism and vascular endothelial factor, with anti-inflammatory and anti-oxidation damages. It can protect vascular intima, and inhibit the occurrence and development of CAS, with a safety in clinical use.
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