2018 年第 12 期 第 13 卷

自拟护心稳斑协定方对冠状动脉粥样硬化性心脏病心绞痛患者的治疗效果

Clinical effect of Huxinwenban decoction on coronary atherosclerotic heart disease with angina pectoris

作者：李静冯妍

英文作者：

单位：100029首都医科大学附属北京安贞医院中医理疗科（李静），全科医疗科（冯妍）

英文单位：

关键词：冠状动脉粥样硬化性心脏病；心绞痛；自拟护心稳斑协定方；颈动脉粥样硬化斑块

英文关键词：

• 摘要：

• 【摘要】目的    探究自拟护心稳斑协定方改善冠状动脉粥样硬化性心脏病（冠心病）心绞痛患者颈动脉粥样硬化斑块和心功能的效果及对血清中血管细胞黏附分子1（VCAM-1）、可溶性CD40配体（sCD40L）、转化生长因子β1（TGF-β1）水平的影响。方法    选取2017年3月至2018年3月首都医科大学附属北京安贞医院收治的110例冠心病心绞痛患者为研究对象，按照随机数字表法分为对照组和观察组，每组55例。对照组在常规治疗基础上口服辛伐他汀片和阿司匹林肠溶片治疗；观察组在对照组基础上采用自拟护心稳斑协定方内服治疗。治疗前后检测颈动脉内膜中层厚度(IMT)、颈动脉斑块面积、心功能指标和血清VCAM-1、sCD40L、TGF-β1及血脂水平，对比2组的临床治疗效果。结果    观察组的总有效率明显高于对照组［92.7%（51/55）比78.2%（43/55）］（P＜0.05）。治疗后，观察组颈动脉IMT和斑块面积明显小于对照组［（0.94±0.10）mm比（1.25±0.18）mm、（12.2±0.4）mm2比（12.8±0.8）mm2］，左心室射血分数明显高于对照组［（57±5）%比（50±4）%］，左心室收缩末期内径、左心室舒张末期内径、心肌耗氧量明显低于对照组［（4.12±0.10）cm比（5.35±0.24）cm、（4.65±0.23）cm比（5.10±0.46）cm、（28±4）ml/min比（75±4）ml/min］，血清VCAM-1、sCD40L、TGF-β1水平明显低于对照组［（418±94）ng/L比（479±121）ng/L、（152±13）ng/L比（178±22）ng/L、（5.9±1.5）μg/L比（11.5±3.2）μg/L］，差异均有统计学意义（均P＜0.05）。治疗后，观察组血脂指标改善优于对照组（P<0.05）。结论    自拟护心稳斑协定方利于稳定冠心病患者动脉粥样硬化斑块，改善患者的心肌功能，调节脂质代谢，治疗效果满意，其起效机制可能与干预血清中VCAM-1、sCD40L、TGF-β1因子表达而保护血管内皮作用有关。

• 【Abstract】Objective    To investigate the clinical effect of Huxinwenban decoction on carotid atherosclerotic plaque, heart function, serum vascular cell adhesion molecule-1（VCAM-1）, soluble CD40 ligand（sCD40L） and transforming growth factor-β1（TGF-β1） in patients with coronary atherosclerotic heart disease(CHD) complicated with angina pectoris. Methods    From March 2017 to March 2018, 110 CHD patients with angina pectoris were randomly divided into control group and observation group, with 55 cases in each group. The control group took simvastatin and aspirin. The observation group took Huxinwenban decoction plus simvastatin and aspirin. Carotid intima-media thickness（IMT）, carotid plaque area, heart function, VCAM-1, sCD40L, TGF-β1 and the clinical therapeutic effect were analyzed. Results    The total effective rate in the observation group was significantly higher than that in the control group［92.7%（51/55） vs 78.2%（43/55）］（P＜0.05）. After treatment, carotid IMT and plaque area in the observation group were significantly less than those in the control group［（0.94±0.10）mm vs （1.25±0.18）mm, （12.2±0.4）mm2 vs （12.8±0.8）mm2］; left ventricular ejection fraction in the observation group was significantly higher, left ventricular end-systolic dimension, left ventricular end-diastolic dimension and myocardial consumption of oxygen were significantly lower than those in the control group［（57±5）% vs （50±4）%, （4.12±0.10）cm vs （5.35±0.24）cm, （4.65±0.23）cm vs （5.10±0.46）cm, （28±4）ml/min vs （75±4）ml/min］; levels of serum VCAM-1, sCD40L and TGF-β1 in the observation group were significantly lower than those in the control group［（418±94）ng/L vs （479±121）ng/L, （152±13）ng/L vs （178±22）ng/L, （5.9±1.5）μg/L vs （11.5±3.2）μg/L］; the improvements of lipid indicators in the observation group were more significant than those in the control group（all P＜0.05）. Conclusion    Huxinwenban decoction can stabilize atherosclerotic plaque, improve heart function and regulate lipid metabolism in CHD patients; the mechanisms may be related with the protection on vascular endothelium by regulating expressions of VCAM-1, sCD40L and TGF-β1.