降脂消斑片辅助西医常规治疗对冠心病心绞痛冠脉斑块和炎症因子的影响

摘要

Objective To observe the clinical efficacy of Jiangzhi Xiaoban Tables facilitating routine Western medicine therapy on coronary plaque and inflammatory factors in patients with coronary heart disease angina (CHDA) of blood stasis obstruction syndrome. Methods Totally 156 patients were divided into TCM group and control group with randomized parallel controlled method, with 78 cases in each group. The control group orally took aspirin enteric-coated tablets and trimetazidine hydrochloride tablets and received symptomatic treatment. On the basis of control group,TCM group received Jiangzhi Xiaoban Tablets,4 tablets per time,three times per day,for 12 weeks. Angina pectoris, TCM curative effect, electrocardiogram, TCM symptom scores, TPS, SSS, CADS and inflammatory factors before and after treatment in both groups were evaluated. Results 12 and 10 cases in TCM group and control group were lost, respectively. The total effective rate of angina pectoris was 89.39% (59/66) in the TCM group and 72.06% (49/68) in the control group. The total effective rate of TCM efficacy was 90.09% (60/66) in the TCM group and 67.65% (46/68) in the control group. TCM group better than the control group (P<0.05). Compared with before treatment, the numbers of ST segment down shift, T wave lowering and T wave inverting decreased in both groups (P<0.05). After treatment, the numbers of ST segment down shift, T wave lowering and T wave inverting in the TCM group were less than the control group (P<0.05). Compared with before treatment, SAQ scores in both groups increased, while TCM syndrome score decreased significantly. SAQ scores in the TCM group after treatment were higher than the control group, while TCM score were lower than the control group (P<0.05). Compared with before treatment, the TPS, SSS and CADS of the patients with blocking coronary lesions decreased in both groups (P<0.05). After treatment, the ratio of TPS, SSS and CADS of the patients with blocking coronary lesions in TCM group was lower than the control group (P<0.05). Compared with before treatment, the levels of hs-CRP, IL-6, TNF-α, TGF-β1 and MCP-1 decreased in both groups after treatment (P<0.05). The levels of hs-CRP, IL-6, TNF-α and TGF-β1 in the TCM group were better than the control group (P<0.05). Conclusion Jiangzhi Xiaoban Tables facilitating routine Western medicine therapy can stabilize coronary plaque of CHDA of blood stasis obstruction syndrome, which may realize cardiomyocyte protection by inhibiting inflammatory factors.%目的 观察降脂消斑片辅助西医常规治疗对冠心病心绞痛心血瘀阻证患者冠脉斑块和炎症因子的影响.方法 采用随机平行对照法将156例患者分为中药组和对照组各78例.对照组口服拜阿司匹林肠溶缓释片、盐酸曲美他嗪片并予对症治疗.中药组在对照组基础上予降脂消斑片,每次4片,每日3次,口服.连续治疗12周.评价2组患者治疗前后心绞痛疗效、中医疗效,观察心电图、中医证候积分、总斑块积分(TPS)、节段狭窄积分(SSS)、冠脉病变严重程度评分(CADS)及炎症因子情况.结果 中药组、对照组分别剔除和脱落12、10例.中药组心绞痛疗效总有效率为89.39%(59/66)、对照组为72.06%(49/68),中药组中医疗效总有效率为90.09%(60/66)、对照组为67.65%(46/68),中药组均优于对照组(P<0.05);与本组治疗前比较,2组治疗后ST段下移导联数、T波低平导联数、T波倒置导联数均减少(P<0.05);治疗后中药组ST段下移导联数、T波低平导联数和T波倒置导联数均少于对照组(P<0.05).与本组治疗前比较,治疗后2组西雅图心绞痛量表(SAQ)评分均升高,中医证候积分显著下降(P<0.05);中药组治疗后SAQ量表评分高于对照组,中医证候积分低于对照组(P<0.05).与本组治疗前比较,2组TPS、SSS及CADS中阻塞型冠脉病变人群比例下降(P<0.05);治疗后中药组TPS、SSS和CADS中阻塞型冠脉病变人群比例均低于对照组(P<0.05).与本组治疗前比较,2组血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1(TGF-β1)及尿液单核细胞趋化蛋白水平均降低(P<0.05);中药组治疗后血清hs-CRP、IL-6、TNF-α、TGF-β1改善明显优于对照组(P<0.05).结论 降脂消斑片辅助西医常规治疗可稳定冠心病心绞痛心血瘀阻证冠脉硬化斑块,其机制可能是通过抑制炎症因子发挥心肌细胞保护作用.