中医中药

探讨血府逐瘀汤对冠心病患者血脂、血清炎症因子及内皮功能的影响

王姣

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【摘要】  【摘要】目的 探讨血府逐瘀汤对冠心病患者血脂、血清炎症因子及内皮功能等相关指标水平的影响。方法 研究对象为2018年1月至2019年1月期间于本院心血管内科住院治疗的冠心病患者110例,随机分为实验组和对照组各55例。对照组患者予常规治疗,实验组患者在常规治疗的基础上予血府逐瘀汤治疗,共治疗24周。24周后对比两组患者血脂、血清炎症因子及内皮功能等指标水平。

【关键字】  冠心病,血府逐瘀汤,血脂,血清炎症因子,内皮功能

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[Abstract]Objective To study the effect of xuefu zhuyu decoction on blood lipid, serum inflammatory factors and endothelial function in patients with coronary heart disease. Methods 110 patients with coronary heart disease who were hospitalized in the department of cardiovascular medicine of our hospital from January 2018 to January 2019 were selected as subjects for this study,who were randomly divided into the experimental group and the control group.The control group received conventional treatment ang the experimental group was treated with xuefu zhuyu decoction on the basis of conventional treatment.Patients in both groups were treated for 24 weeks.serum lipids, inflammatory cytokines and endothelial functions of the two groups were compared after 24 weeks. Results after 24 weeks, the levels of serum lipid, inflammatory cytokines and endothelial function in the two groups were all improved compared with those before treatment, but the improvement degree of the experimental group was significantly better than that of the control group,the difference was significant and statistically significant (P<0.05). Conclusions Xuefu zhuyu decoction can significantly reduce the level of blood lipid in patients with coronary heart disease, inhibit inflammatory reaction, protect vascular endothelial function, so that it can reduce the cardiovascular and cerebrovascular accidents caused by atherosclerosis, and improve the treatment effect of coronary heart disease. It is worthy of wide clinical application.

作为临床常见疾病,冠心病又称为缺血性心脏病,是由于冠状动脉发生粥样硬化,动脉管壁增厚变硬,心肌供血不足而致坏死引起的胸闷、胸痛为主要表现的疾病[1]。随着经济社会的蓬勃发展,高血压、高血脂症及2型糖尿病等疾病的发病率激增,同时也作为冠心病的高危因素威胁我国人民的身心健康[2]。临床研究显示,动脉粥样硬化最重要的危险因素即为脂质代谢异常,同时血清炎症因子与内皮功能也参与了冠心病的发生与发展[3]。冠心病属于中医的胸痹病范畴,研究显示[4],血府逐瘀汤对心血瘀阻型胸痹效果显著,本文研究血府逐瘀汤对心血瘀阻型胸痹患者的血脂、血清炎症因子及内皮功能的影响取得良好效果。现报道如下。 1 资料与方法 1.1 一般资料:本文的研究对象为2018年1月至2019年1月于本院治疗的冠心病患者110例,随机分为实验组与对照组。对照组:男26例,女19例;年龄:49~78岁,平均(59.21±12.15)岁;病程1~8年,平均(4.65±2.41)年。实验组:男:25例,女20例;年龄:51~79岁,平均(60.72±11.05)岁;病程1~9年,平均(4.86±2.62)年。两组患者一般资料对比差异较小,具有可比性(P>0.05)。 1.2 纳入与排除标准:纳入标准:①符合《缺血性心脏病命名及诊断标准》中冠心病的诊断标准[5];②符合第三版中医内科学中胸痹病心血瘀阻证的诊断标准[6];③心电图检查提示心肌缺血;④生命体征平稳;⑤患者及其家属同意并签署知情同意书。排除标准:①合并急性心肌梗死、严重心律失常及心肌炎的患者;②合并其他严重疾病者;③研究进行前1周内服用活血化瘀药物史者;④精神疾病史者;⑤不能配合完成本研究内容者。 1.3 研究方法 1.3.1 对照组治疗方案:对照组患者予常规治疗方案:硫酸氢氯吡格雷片(Sanofi Winthrop Industrie,国药准字:J20130083)75 mg qn po,酒石酸美托洛尔片(阿斯利康制药有限公司,国药准字:H32025391) 12.5 mg bid po,单硝酸异山梨酯缓释片(齐鲁制药有限公司,国药准字:H20066717) 40 mg qd po,瑞舒伐他汀钙片(IPR PHARMACEUTICALS INCORPORATED,国药准字:J20190009) 5 mg qn po。 1.3.2 实验组治疗方案:实验组患者在对照组患者治疗的基础上予血府逐瘀汤,方药组成:桃仁15 g,红花、当归、生地、牛膝各10 g,川芎、桔梗、柴胡各5 g,赤芍、枳壳各10 g,甘草3 g。瘀血痹阻较重者可加乳香、没药各10 g,丹参15 g;乏力、气虚明显者加黄芪15 g,党参10 g。日1剂,水煎服,分2次温服。 1.4 评价指标:①血脂:总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C及低密度脂蛋白胆固醇(LDL-C)等。②血清炎症因子:白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)及超敏-C反应蛋白(hs-CRP)。③血管内皮功能:一氧化氮(NO)、内皮素1(ET-1)、血栓素B2(TXB2)及6-酮-前列腺素F-1α(6-Keto-PGF-1α)。 1.5 统计学处理:采用SPSS 23.0软件处理本研究数据,计量资料采用( )表示,采用t检验;P<0.05为差异具有统计学意义。

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