针刺治疗冠心病的疗效观察及其对冠状动脉斑块的影响
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摘要
目的观察针刺治疗冠心病的临床疗效及其对冠状动脉斑块的影响。方法将80例冠心病患者随机分为治疗组和对照组,每组40例。对照组采用常规药物治疗,治疗组在对照组基础上采用针刺治疗。观察两组治疗前后各项血脂指标[胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)]、平均动脉压(MAP)、心率(HR)、心电图指标(V4、V5、V6导联T波振幅)、冠状动脉斑块各项指标[血管重塑指数(RI)、斑块偏心指数(EI)、坏死核心面积(NC)]的变化情况,并比较两组临床疗效。结果治疗组总有效率为85.0%,对照组为62.5%,两组比较差异具有统计学意义(P<0.05)。两组治疗后各项血脂指标、MAP、HR、心电图指标及冠状动脉斑块各项指标与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后TG、LDL-C、MAP、HR、心电图指标及冠状动脉斑块各项指标与对照组比较,差异均具有统计学意义(P<0.05)。结论针刺能明显改善冠心病患者血脂、血压、心率及心电图指标,减少冠状动脉斑块形成。
Objective To investigate the clinical effect of acupuncture in treating coronary heart disease (CHD) and its effect on coronary artery plaque. Method Eighty CHD patients were randomized to treatment and control groups, with 40 cases in each group. The control group was intervened by conventional medication, while the treatment group was additionally given acupuncture. Indicators of blood lipids [serum total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)], mean arterial pressure (MAP), heart rate (HR), indicator of electrocardiogram (T-wave amplitude in leads V4-V6) and indicators of coronary artery plaque [vascular remodeling index (RI), plaque eccentricity index (EI) and necrotic core (NC)] in the two groups were observed before and at the end of treatment, and the clinical efficacies of the two groups were compared. Result The total efficacy rate was 85.0% in the treatment group and 62.5% in the control group, and there was a statistically significant difference between the two groups (P<0.05). The indicators of blood lipids, MAP, HR, the indicator of electrocardiogram and the indicators of coronary artery plaque all showed a significant change after the treatment in the two groups (P<0.05). After the treatment, the indicators of blood lipids (TG, LDL-C), MAP, HR, the indicator of electrocardiogram and the indicators of coronary artery plaque in the treatment group were significantly different from those in the control group (P<0.05). Conclusion Acupuncture can significantly improve blood lipids, blood pressure, HR and the indicator of electrocardiogram in CHD patients, and reduce coronary artery plaque.
Objective To investigate the clinical effect of acupuncture in treating coronary heart disease (CHD) and its effect on coronary artery plaque. Method Eighty CHD patients were randomized to treatment and control groups, with 40 cases in each group. The control group was intervened by conventional medication, while the treatment group was additionally given acupuncture. Indicators of blood lipids [serum total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)], mean arterial pressure (MAP), heart rate (HR), indicator of electrocardiogram (T-wave amplitude in leads V4-V6) and indicators of coronary artery plaque [vascular remodeling index (RI), plaque eccentricity index (EI) and necrotic core (NC)] in the two groups were observed before and at the end of treatment, and the clinical efficacies of the two groups were compared. Result The total efficacy rate was 85.0% in the treatment group and 62.5% in the control group, and there was a statistically significant difference between the two groups (P<0.05). The indicators of blood lipids, MAP, HR, the indicator of electrocardiogram and the indicators of coronary artery plaque all showed a significant change after the treatment in the two groups (P<0.05). After the treatment, the indicators of blood lipids (TG, LDL-C), MAP, HR, the indicator of electrocardiogram and the indicators of coronary artery plaque in the treatment group were significantly different from those in the control group (P<0.05). Conclusion Acupuncture can significantly improve blood lipids, blood pressure, HR and the indicator of electrocardiogram in CHD patients, and reduce coronary artery plaque.
引文
[1]黄凤荣.冠心病合并2型糖尿病患者冠状动脉硬化斑块的影像学特征分析[J].四川医学,2017,38(4):392-395.
[2]罗红,李友钱.冠心病患者血清降钙素原、超敏C反应蛋白水平变化及其与冠状动脉斑块的相关性研究[J].实用心脑肺血管病杂志,2016,24(4):24-27.
[3]何志凌,何善康,王侠.冠心病痰浊证候与冠脉斑块组织学指标的相关性探讨[J].中西医结合心脑血管病杂志,2018,16(3):260-263.
[4]闫利敏,刘志诚,徐斌.针刺加叩刺治疗肥胖并发高脂血症肝郁脾虚型患者疗效观察[J].针灸临床杂志,2016,32(8):1-4.
[5]郭继鸿,王志鹏,张海澄,等.临床实用心血管病学[M].北京:北京大学医学出版社,2015:206-212.
[6]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:1-5.
[7]Dalen JE,Alpert JS,Goldberg RJ,et al.The epidemic of the 20(th)century:coronary heart disease[J].Am J Med,2014,127(9):807-812.
[8]Zhu KF,Wang YM,Zhu JZ,et al.National prevalence of coronary heart disease and its relationship with human development index:A systematic review[J].Eur J Prev Cardiol,2016,23(5):530-543.
[9]Das De S,Krishna S,Jethwa A.Iron status and its association with coronary heart disease:systematic review and meta-analysis of prospective studies[J].Atherosclerosis,2015,238(2):296-303.
[10]Zhou X,Li XT,Liu XQ,et al.Assessment of Intermingled Phlegm and Blood Stasis Syndrome in Coronary Heart Disease:Development of a Diagnostic Scale[J].Evid Based Complement Alternat Med,2018:4683431.
[11]周方,赵志刚,潘化平,等.电针联合有氧运动对冠心病患者心率及运动能力的影响[J].中国康复医学杂志,2016,31(6):647-653.
[12]Pols AD,Adriaanse MC,van Tulder MW,et al.Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression:data from the Step-Dep cluster randomised controlled trial[J].BMJ Open,2018,8(10):e020412.
[13]Grabovac I,Hochfellner L,Rieger M,et al.Impact of Austria's 2009 trans fatty acids regulation on all-cause,cardiovascular and coronary heart disease mortality[J].Eur J Public Health,2018,28(suppl_2):4-9.
[14]Leening MJG,Cook NR,Franco OH,et al.Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women[J].J Am Heart Assoc,2018,7(19):e007514.
[15]Forbes C,Quek RG,Deshpande S,et al.Relationship between changes in coronary atherosclerotic plaque burden measured by intravascular ultrasound and cardiovascular disease out comes:a systematic literature review[J].Curr Med Res Opin,2016,32(6):1143-1150.
[16]Zhou J,Gao Q,Wang J,et al.Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions:a cross-sectional study from China[J].BMJ Open,2018,8(10):e022974.
[17]Pack QR,Priya A,Lagu TC,et al.Short-Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease[J].J Am Heart Assoc,2018,7(18):e009424.
[18]李承家,杨冠男,公维军.灵台、神道穴留针对心绞痛患者心电图ST-T即时效应的影响[J].上海针灸杂志,2016,35(1):27-29.
[19]贾丹,王议彬,樊旭.针药并用治疗心血瘀阻型冠心病心绞痛患者疗效观察[J].辽宁中医药大学学报,2016,18(3):117-119.
[20]王桂平.针药结合运动疗法康复治疗冠心病的临床疗效及生活质量改善情况分析[J].中医临床研究,2018,10(21):98-100.
[21]石向东,吴耀持,赵捷,等.针刺配合推拿治疗痰阻心脉型冠心病疗效观察[J].上海针灸杂志,2013,32(5):361-362.
[22]周亮,付阳阳,韩秀伟.针药结合治疗冠心病心绞痛的效果探讨[J].中西医结合心血管病杂志,2017,5(5):31.
[23]严萍.隔附子饼灸配合药物治疗冠心病稳定型心绞痛疗效观察[J].上海针灸杂志,2017,36(3):276-278.
[24]史胜哲,杨延超,李阳,等.电针内关对冠心病患者围术期细胞炎性因子的影响[J].现代生物医学进展,2017,17(9):1659-1662.
[25]王永刚,钟伟,于远望,等.冠心病中医证型与血脂及冠脉造影所见的相关性分析[J].中西医结合心脑血管病杂志,2013,11(7):770-771.
[26]王彦琦,张培影.冠心病与血脂异常的认识进展[J].中西医结合心脑血管病杂志,2015,13(11):1287-1289.
[27]石立鹏,杜旭勤,赵凤林,等.针刺联合补阳还五汤治疗气虚血瘀证冠心病稳定型心绞痛疗效及对血脂水平的影响[J].现代中西医结合杂志,2017,26(35):3880-3882,3966.
[28]陈琳,吴巧凤,柏琳,等.基于不同分子水平探讨针刺改善心肌缺血的机制[J].辽宁中医杂志,2016,43(1):199-202.
[29]陈金友,高越,王晓楠.冠心病患者应用针刺疗法对临床治疗即时效果的影响观察[J].中国中医急症,2016,25(7):1410-1412.
[30]Menotti A,Puddu PE,Lanti M,et al.Epidemiology of typical coronary heart disease versus heart disease of uncertain etiology(atypical)fatalities and their relationships with classiccoronary risk factors[J].Int JCardiol,2013,168(4):3963-3967.
[2]罗红,李友钱.冠心病患者血清降钙素原、超敏C反应蛋白水平变化及其与冠状动脉斑块的相关性研究[J].实用心脑肺血管病杂志,2016,24(4):24-27.
[3]何志凌,何善康,王侠.冠心病痰浊证候与冠脉斑块组织学指标的相关性探讨[J].中西医结合心脑血管病杂志,2018,16(3):260-263.
[4]闫利敏,刘志诚,徐斌.针刺加叩刺治疗肥胖并发高脂血症肝郁脾虚型患者疗效观察[J].针灸临床杂志,2016,32(8):1-4.
[5]郭继鸿,王志鹏,张海澄,等.临床实用心血管病学[M].北京:北京大学医学出版社,2015:206-212.
[6]郑筱萸.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:1-5.
[7]Dalen JE,Alpert JS,Goldberg RJ,et al.The epidemic of the 20(th)century:coronary heart disease[J].Am J Med,2014,127(9):807-812.
[8]Zhu KF,Wang YM,Zhu JZ,et al.National prevalence of coronary heart disease and its relationship with human development index:A systematic review[J].Eur J Prev Cardiol,2016,23(5):530-543.
[9]Das De S,Krishna S,Jethwa A.Iron status and its association with coronary heart disease:systematic review and meta-analysis of prospective studies[J].Atherosclerosis,2015,238(2):296-303.
[10]Zhou X,Li XT,Liu XQ,et al.Assessment of Intermingled Phlegm and Blood Stasis Syndrome in Coronary Heart Disease:Development of a Diagnostic Scale[J].Evid Based Complement Alternat Med,2018:4683431.
[11]周方,赵志刚,潘化平,等.电针联合有氧运动对冠心病患者心率及运动能力的影响[J].中国康复医学杂志,2016,31(6):647-653.
[12]Pols AD,Adriaanse MC,van Tulder MW,et al.Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression:data from the Step-Dep cluster randomised controlled trial[J].BMJ Open,2018,8(10):e020412.
[13]Grabovac I,Hochfellner L,Rieger M,et al.Impact of Austria's 2009 trans fatty acids regulation on all-cause,cardiovascular and coronary heart disease mortality[J].Eur J Public Health,2018,28(suppl_2):4-9.
[14]Leening MJG,Cook NR,Franco OH,et al.Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women[J].J Am Heart Assoc,2018,7(19):e007514.
[15]Forbes C,Quek RG,Deshpande S,et al.Relationship between changes in coronary atherosclerotic plaque burden measured by intravascular ultrasound and cardiovascular disease out comes:a systematic literature review[J].Curr Med Res Opin,2016,32(6):1143-1150.
[16]Zhou J,Gao Q,Wang J,et al.Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions:a cross-sectional study from China[J].BMJ Open,2018,8(10):e022974.
[17]Pack QR,Priya A,Lagu TC,et al.Short-Term Safety of Nicotine Replacement in Smokers Hospitalized With Coronary Heart Disease[J].J Am Heart Assoc,2018,7(18):e009424.
[18]李承家,杨冠男,公维军.灵台、神道穴留针对心绞痛患者心电图ST-T即时效应的影响[J].上海针灸杂志,2016,35(1):27-29.
[19]贾丹,王议彬,樊旭.针药并用治疗心血瘀阻型冠心病心绞痛患者疗效观察[J].辽宁中医药大学学报,2016,18(3):117-119.
[20]王桂平.针药结合运动疗法康复治疗冠心病的临床疗效及生活质量改善情况分析[J].中医临床研究,2018,10(21):98-100.
[21]石向东,吴耀持,赵捷,等.针刺配合推拿治疗痰阻心脉型冠心病疗效观察[J].上海针灸杂志,2013,32(5):361-362.
[22]周亮,付阳阳,韩秀伟.针药结合治疗冠心病心绞痛的效果探讨[J].中西医结合心血管病杂志,2017,5(5):31.
[23]严萍.隔附子饼灸配合药物治疗冠心病稳定型心绞痛疗效观察[J].上海针灸杂志,2017,36(3):276-278.
[24]史胜哲,杨延超,李阳,等.电针内关对冠心病患者围术期细胞炎性因子的影响[J].现代生物医学进展,2017,17(9):1659-1662.
[25]王永刚,钟伟,于远望,等.冠心病中医证型与血脂及冠脉造影所见的相关性分析[J].中西医结合心脑血管病杂志,2013,11(7):770-771.
[26]王彦琦,张培影.冠心病与血脂异常的认识进展[J].中西医结合心脑血管病杂志,2015,13(11):1287-1289.
[27]石立鹏,杜旭勤,赵凤林,等.针刺联合补阳还五汤治疗气虚血瘀证冠心病稳定型心绞痛疗效及对血脂水平的影响[J].现代中西医结合杂志,2017,26(35):3880-3882,3966.
[28]陈琳,吴巧凤,柏琳,等.基于不同分子水平探讨针刺改善心肌缺血的机制[J].辽宁中医杂志,2016,43(1):199-202.
[29]陈金友,高越,王晓楠.冠心病患者应用针刺疗法对临床治疗即时效果的影响观察[J].中国中医急症,2016,25(7):1410-1412.
[30]Menotti A,Puddu PE,Lanti M,et al.Epidemiology of typical coronary heart disease versus heart disease of uncertain etiology(atypical)fatalities and their relationships with classiccoronary risk factors[J].Int JCardiol,2013,168(4):3963-3967.