黄芪失笑散对介入术后ACS患者血管内皮功能及炎症因子的影响研究
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摘要
[目的]了解黄芪失笑散对介入术后急性冠脉综合征(acute coronary syndrome,ACS)患者的疗效,并探讨其对内皮功能及炎症因子的影响。[方法]选取2016年1月至2018年1月杭州市中医院心内科住院的ACS患者60例,以随机数字表法分为观察组及对照组,每组各30例。对照组患者行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)后予以常规治疗,观察组在此基础上予加用黄芪失笑散,1日1剂,分两次服用。两组患者连续治疗3个月后,统计两组临床症状疗效,比较两组中医证候积分改善情况;检测并比较两组治疗前后内皮功能指标内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)及炎症因子高敏C反应蛋白(high sensitivity-C reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的变化。[结果]观察组总有效率优于对照组(P<0.05);两组患者中医证候积分均较治疗前下降(P<0.05),且观察组疗效明显优于对照组(P<0.05)。两组患者ET-1水平均较治疗前下降,NO水平则较治疗前上升,差异均有统计学意义(P<0.05),观察组治疗后ET-1水平低于对照组,NO水平高于对照组,差异有统计学意义(P<0.05)。两组患者hs-CRP及TNF-α水平均较治疗前下降(P<0.05),观察组优于对照组,差异有统计学意义(P<0.05)。[结论]黄芪失笑散可改善ACS患者介入术后临床症状,其机制可能与改善血管内皮功能及抑制炎症因子释放有关。
[Objective] To investigate the therapeutic effect of Huangqi Shixiao Powder on acute coronary syndrome(ACS) patients after percutaneous coronary intervention(PCI), and to explore its mechanism in influencing endothelial function and inflammatory factors. [Methods] Sixty patients with ACS in the Department of Cardiology of Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to January 2018 were randomly divided into observation group and control group with 30 cases in each group. Control group was treated with routine medicine after PCI. On the basis of this,observation group was treated with Huangqi Shixiao Powder, one dose a day, twice a day. After 3 month of continuous treatment, the clinical efficacy of two groups was statistically analyzed, and the improvement of TCM syndrome score was compared. Expression of endothelin-1(ET-1), nitric oxide(NO), high sensitivity-C reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α)were detected, and compared before and after treatment. [Results] The total effective rate of clinical symptoms in observation group was better than that in control group( P<0.05). The scores of TCM syndromes in the two groups were lower than those before treatment(P<0.05), and the curative effect in observation group was better than that in control group( P<0.05). The levels of ET-1 in two groups were lower than those before treatment, while the levels of NO were higher than those before treatment, and there was statistical significance( P<0.05). The decrease of ET-1 and the increase of NO in observation group were significantly higher than those in control group, and the difference was statistically significant(P<0.05).The levels of hs-CRP and TNF-α in two groups were lower than those before treatment(P<0.05). After treament, the level of ET-1 in observation group was lower than control group, the level of NO in observation group was higher than control group and the difference was statistically significant(P <0.05). [Conclusion] Huangqi Shixiao Powder can improve the clinical symptoms of patients with ACS after PCI, and the mechanism may be related to improving vascular endothelial function and inhibiting the release of inflammatory factors.
[Objective] To investigate the therapeutic effect of Huangqi Shixiao Powder on acute coronary syndrome(ACS) patients after percutaneous coronary intervention(PCI), and to explore its mechanism in influencing endothelial function and inflammatory factors. [Methods] Sixty patients with ACS in the Department of Cardiology of Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to January 2018 were randomly divided into observation group and control group with 30 cases in each group. Control group was treated with routine medicine after PCI. On the basis of this,observation group was treated with Huangqi Shixiao Powder, one dose a day, twice a day. After 3 month of continuous treatment, the clinical efficacy of two groups was statistically analyzed, and the improvement of TCM syndrome score was compared. Expression of endothelin-1(ET-1), nitric oxide(NO), high sensitivity-C reactive protein(hs-CRP) and tumor necrosis factor-α(TNF-α)were detected, and compared before and after treatment. [Results] The total effective rate of clinical symptoms in observation group was better than that in control group( P<0.05). The scores of TCM syndromes in the two groups were lower than those before treatment(P<0.05), and the curative effect in observation group was better than that in control group( P<0.05). The levels of ET-1 in two groups were lower than those before treatment, while the levels of NO were higher than those before treatment, and there was statistical significance( P<0.05). The decrease of ET-1 and the increase of NO in observation group were significantly higher than those in control group, and the difference was statistically significant(P<0.05).The levels of hs-CRP and TNF-α in two groups were lower than those before treatment(P<0.05). After treament, the level of ET-1 in observation group was lower than control group, the level of NO in observation group was higher than control group and the difference was statistically significant(P <0.05). [Conclusion] Huangqi Shixiao Powder can improve the clinical symptoms of patients with ACS after PCI, and the mechanism may be related to improving vascular endothelial function and inhibiting the release of inflammatory factors.
引文
[1]李军,杨慧玲.阿托伐他汀对急性冠脉综合征患者介入治疗后血清IL-6、hs-CRP及血脂的影响[J].中国老年学杂志,2011,31(15):2846-2848.
[2]张大武,王承龙,王培利.益气活血中药干预介入后急性冠脉综合征患者的中医证候演变[J].中西医结合心脑血管病杂志,2013,11(4):385-388.
[3]谷丰.急性冠脉综合征患者介入治疗后中医证候要素与预后的相关性研究[D].北京:中国中医科学院,2011:171-175.
[4]王承龙,张大武,王培利,等.急性冠状动脉综合征中医证候要素分析[J].中医杂志,2011,52(19):1654-1657.
[5]杨巧宁,谷丰,高铸烨,等.介入治疗后ACS患者中医证候要素分布特征的现况调查[J].中国中医急症,2014,25(1):6-8.
[6]柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[7] Thyqesen K, Alpert J S, Jaffe A S, et al. Third universal definition of myocardial infarction[J].Glob Heart,2012,7(4):275-295.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:68-69.
[9]吕映华,何迎春,杨娟,等.冠心病心绞痛(气虚血瘀证)症状疗效评分量表的研究[J].中国临床药理学与治疗学,2008,13(7):786-791.
[10]赵亚玲,敖虎山.心肌缺血再灌注损伤的研究进展[J].中国循环杂志,2011,26(5):396-398.
[11] Toutouzas K, Colombo A, Stefanadis C. Inflammation and restenosis after percutaneous coronary interventions[J].Eur Heart J, 2004,25(19):1679-1687.
[12] Kwon J S, Kim Y S, Cho A S, et al. Origin of restenosis after drug-eluting stent implantation in hyperglycemia is inflammatory cells and thrombus[J].J Atheroscler Thromb,2011, 18(7):604-615.
[13] Perkins L E. Preclinical models of restenosis and their application in the evaluation of drug-eluting stent systems[J]. Vet Pathol, 2010,47(1):58-76.
[14]李健,杨治平,张国盛,等.血栓通联合低分子肝素治疗高龄急性冠脉综合征介入治疗术后患者临床分析[J].内科,2016,11(1):16-19.
[15]王飞,边云飞,杨慧宇,等.瑞舒伐他汀强化治疗对急性冠状动脉综合征患者经皮冠状动脉介入术后小而密低密度脂蛋白胆固醇水平及预后的影响[J].中国药物与临床,2015,15(6):836-839.
[16]唐群中,张学频,陈学智,等.丹参多酚酸盐联合阿托伐他汀对老年急性冠状动脉综合征患者经皮冠状动脉介入治疗术后血管内皮功能及炎性因子的影响[J].中国介入心脏病学杂志,2015,23(5):329-330.
[17]王培利,王承龙,王少丽,等.益气活血中药对急性冠脉综合征患者介入治疗后生存质量的影响[J].环球中医药,2012,5(12):881-885.
[18]葛永彬,李红,李彬,等.益气活血方治疗冠心病PCI术后再发心绞痛疗效观察[J].中西医结合心脑血管病杂志,2015,13(5):667-669.
[19]张蕾.益气活血中药对介入后急性冠脉综合征长期预后的影响[D].北京:中国中医科学院,2012:37-53.
[20]陈可冀,付长庚.黄芪在心血管疾病中的临床应用[J].中国循证心血管医学杂志,2014,6(5):509-511.
[21]刘亚静,刘长江,宁佳,等.黄芪总苷氯化钠注射液治疗冠心病的临床疗效观察[J].河北医药,2017,39(19):2989-2991.
[22]太平惠民和剂局.太平惠民和剂局方[M].北京:人民卫生出版社,2007:255.
[23]周卫,宿树兰,段金廒,等.失笑散传统功用与现代研究关联分析[J].中成药,2009,31(10):1602-1604.
[24]祝光礼,魏丽萍,方伟,等.黄芪失笑散对大鼠动脉粥样硬化的保护作用[J].中华中医药学刊,2008,26(8):1614-1617.
[25]祝光礼,魏丽萍,方伟,等.黄芪失笑散对血管内皮功能的影响[J].浙江临床医学,2008,10(8):1016-1018.
[26]魏丽萍,陈铁龙,赫小龙,等.黄芪失笑散对急性心肌梗死大鼠心功能及Caspase-8表达的影响[J].中国中医急症,2013,22(4):539-540.
[2]张大武,王承龙,王培利.益气活血中药干预介入后急性冠脉综合征患者的中医证候演变[J].中西医结合心脑血管病杂志,2013,11(4):385-388.
[3]谷丰.急性冠脉综合征患者介入治疗后中医证候要素与预后的相关性研究[D].北京:中国中医科学院,2011:171-175.
[4]王承龙,张大武,王培利,等.急性冠状动脉综合征中医证候要素分析[J].中医杂志,2011,52(19):1654-1657.
[5]杨巧宁,谷丰,高铸烨,等.介入治疗后ACS患者中医证候要素分布特征的现况调查[J].中国中医急症,2014,25(1):6-8.
[6]柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[7] Thyqesen K, Alpert J S, Jaffe A S, et al. Third universal definition of myocardial infarction[J].Glob Heart,2012,7(4):275-295.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:68-69.
[9]吕映华,何迎春,杨娟,等.冠心病心绞痛(气虚血瘀证)症状疗效评分量表的研究[J].中国临床药理学与治疗学,2008,13(7):786-791.
[10]赵亚玲,敖虎山.心肌缺血再灌注损伤的研究进展[J].中国循环杂志,2011,26(5):396-398.
[11] Toutouzas K, Colombo A, Stefanadis C. Inflammation and restenosis after percutaneous coronary interventions[J].Eur Heart J, 2004,25(19):1679-1687.
[12] Kwon J S, Kim Y S, Cho A S, et al. Origin of restenosis after drug-eluting stent implantation in hyperglycemia is inflammatory cells and thrombus[J].J Atheroscler Thromb,2011, 18(7):604-615.
[13] Perkins L E. Preclinical models of restenosis and their application in the evaluation of drug-eluting stent systems[J]. Vet Pathol, 2010,47(1):58-76.
[14]李健,杨治平,张国盛,等.血栓通联合低分子肝素治疗高龄急性冠脉综合征介入治疗术后患者临床分析[J].内科,2016,11(1):16-19.
[15]王飞,边云飞,杨慧宇,等.瑞舒伐他汀强化治疗对急性冠状动脉综合征患者经皮冠状动脉介入术后小而密低密度脂蛋白胆固醇水平及预后的影响[J].中国药物与临床,2015,15(6):836-839.
[16]唐群中,张学频,陈学智,等.丹参多酚酸盐联合阿托伐他汀对老年急性冠状动脉综合征患者经皮冠状动脉介入治疗术后血管内皮功能及炎性因子的影响[J].中国介入心脏病学杂志,2015,23(5):329-330.
[17]王培利,王承龙,王少丽,等.益气活血中药对急性冠脉综合征患者介入治疗后生存质量的影响[J].环球中医药,2012,5(12):881-885.
[18]葛永彬,李红,李彬,等.益气活血方治疗冠心病PCI术后再发心绞痛疗效观察[J].中西医结合心脑血管病杂志,2015,13(5):667-669.
[19]张蕾.益气活血中药对介入后急性冠脉综合征长期预后的影响[D].北京:中国中医科学院,2012:37-53.
[20]陈可冀,付长庚.黄芪在心血管疾病中的临床应用[J].中国循证心血管医学杂志,2014,6(5):509-511.
[21]刘亚静,刘长江,宁佳,等.黄芪总苷氯化钠注射液治疗冠心病的临床疗效观察[J].河北医药,2017,39(19):2989-2991.
[22]太平惠民和剂局.太平惠民和剂局方[M].北京:人民卫生出版社,2007:255.
[23]周卫,宿树兰,段金廒,等.失笑散传统功用与现代研究关联分析[J].中成药,2009,31(10):1602-1604.
[24]祝光礼,魏丽萍,方伟,等.黄芪失笑散对大鼠动脉粥样硬化的保护作用[J].中华中医药学刊,2008,26(8):1614-1617.
[25]祝光礼,魏丽萍,方伟,等.黄芪失笑散对血管内皮功能的影响[J].浙江临床医学,2008,10(8):1016-1018.
[26]魏丽萍,陈铁龙,赫小龙,等.黄芪失笑散对急性心肌梗死大鼠心功能及Caspase-8表达的影响[J].中国中医急症,2013,22(4):539-540.