速效救心丸干预心血瘀阻证冠脉临界病变患者心肌缺血的随机对照研究
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摘要
目的利用门控心肌灌注显像法观察速效救心丸对心血瘀阻证冠状动脉临界病变患者心肌供血的干预作用。方法纳入2010年1月—2013年12月就诊于中国中医科学院广安门医院心内科的101例前降支单支病变和多支病变冠脉临界病变患者,中医辨证为心血瘀阻证,按照随机数字表法分为治疗组54例,对照组47例,并分为前降支单支病变亚组和多支病变亚组。两组均常规每日服用拜阿司匹林100 mg,治疗组服用速效救心丸每次5粒,3次/日,对照组服用硝酸异山梨酯片,每次10 mg,3次/日,两组均连续服用6个月。将左心室图像划分为17节段,以门控心肌灌注断层显像方法评估不同心肌区段治疗前后的心肌供血改变情况。结果与本亚组治疗前比较,对照组病变亚组第7(左心室中部前壁)、13(左心尖部前壁)、14(左心尖部室间隔)节段心肌供血降低(P<0.05),治疗组多支病变亚组第13、14、16(左心尖部侧壁)、17(左心尖部)节段心肌供血降低(P<0.01),治疗组前降支单支病变亚组第11节段(左心室中部下侧壁)心肌供血增加(P<0.05)。与对照组同亚组同期比较,治疗组多支病变组治疗后第16节段心肌供血降低(P<0.05)。结论速效救心丸可改善冠状动脉临界病变期前降支单支病变患者心室中部下侧壁心肌供血,速效救心丸和硝酸异山梨酯片均不能有效改善冠脉临界病变多支病变患者心肌供血。
Objective To study the effect of Suxiao Jiuxin Pill on myocardium blood-supplying in moderate coronary stenosis patients with blood stasis syndrome by gated myocardial perfusion imaging. Methods Totally 101 moderate coronary stenosis blood stasis syndrome patients with anterior descending branch lesion and multi branches lesions were randomly assigned to treatment group and control group according to the table of random numbers from Jan 2010 to Dem 2013 in department of cardiology, Guang'anmen Hospital. According to different blood vessels lesions, the treatment group and control group were divided into anterior descending branch subgroup and multi-branch lesions subgroup respectively. The treatment group, 54 patients,took 100 mg asplin every day and Suxiao Jiuxin Wan, 5 pills every time, three times per day. The control group, 47 patients,took 100 mg asplin every day and dinitrosorbide 10 mg every time, three times per day. The course of treatment was 6 months. Gated myocardial perfusion imaging will evaluate myocardium blood-supply for 17 districts of heart ventricle. Results In multi-branch lesions subgroup of controlgroup, myocardium blood-supplying in 7(Medial anterior wall of left ventricle), 13(apex anterior wall of left ventricle), 14(apical septum of left ventricle) districts decreased after treatment(P<0.05). In multi-branch lesions subgroup of treatment group, myocardium blood-supplying in 13, 14, 16(apical lateral wall of left ventricle), 17(apex of left ventricle) districts decreased after treatment(P<0.01). In manterior descending branch subgroup of treatment group, myocardium blood-supplying in 11(middle inferior wall of left ventricle) districts increased after treatment(P<0.05). Compared with the same subgroup, myocardium blood-supplying in 16 districts decreased in multi-branch lesions subgroup of treatment group(P<0.01). Conclusions Suxiao Jiuxin Pill can increase middle inferior wall of left ventricle myocardium blood-supply in anterior descending branch lesion moderate coronary stenosis patients. For multi-branches lesions moderate coronary stenosis patients, Suxiao Jiuxin Pill and dinitrosorbide both can not increase the myocardium blood-supplying.
Objective To study the effect of Suxiao Jiuxin Pill on myocardium blood-supplying in moderate coronary stenosis patients with blood stasis syndrome by gated myocardial perfusion imaging. Methods Totally 101 moderate coronary stenosis blood stasis syndrome patients with anterior descending branch lesion and multi branches lesions were randomly assigned to treatment group and control group according to the table of random numbers from Jan 2010 to Dem 2013 in department of cardiology, Guang'anmen Hospital. According to different blood vessels lesions, the treatment group and control group were divided into anterior descending branch subgroup and multi-branch lesions subgroup respectively. The treatment group, 54 patients,took 100 mg asplin every day and Suxiao Jiuxin Wan, 5 pills every time, three times per day. The control group, 47 patients,took 100 mg asplin every day and dinitrosorbide 10 mg every time, three times per day. The course of treatment was 6 months. Gated myocardial perfusion imaging will evaluate myocardium blood-supply for 17 districts of heart ventricle. Results In multi-branch lesions subgroup of controlgroup, myocardium blood-supplying in 7(Medial anterior wall of left ventricle), 13(apex anterior wall of left ventricle), 14(apical septum of left ventricle) districts decreased after treatment(P<0.05). In multi-branch lesions subgroup of treatment group, myocardium blood-supplying in 13, 14, 16(apical lateral wall of left ventricle), 17(apex of left ventricle) districts decreased after treatment(P<0.01). In manterior descending branch subgroup of treatment group, myocardium blood-supplying in 11(middle inferior wall of left ventricle) districts increased after treatment(P<0.05). Compared with the same subgroup, myocardium blood-supplying in 16 districts decreased in multi-branch lesions subgroup of treatment group(P<0.01). Conclusions Suxiao Jiuxin Pill can increase middle inferior wall of left ventricle myocardium blood-supply in anterior descending branch lesion moderate coronary stenosis patients. For multi-branches lesions moderate coronary stenosis patients, Suxiao Jiuxin Pill and dinitrosorbide both can not increase the myocardium blood-supplying.
引文
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[13] 王斌,韩雅玲,荆全民,等.马冠状动脉前降支近段临界靶病变的血管内超声影像学特点研究[J].中国实用内科杂志,2014,34(10):1004-1007.
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[15] 何作祥.心肌灌注显像的临床应用[J].中华心血管病杂志,2004,32(7):665-667.
[16] 刘艳凯,刘圣君,张玉平,等.川芎嗪、当归注射液对急性微循环障碍大鼠血小板功能和器官血流量的影响[J].中国医学物理学杂志,2005,22(5):660-662.
[17] 何维来,陈如坤,周汝元.川芎嗪对结扎犬LAD损伤冠脉内皮及心肌的保护作用[J].第四军医大学学报,2005,26(23):2153-2155.
[18] 黄萍,吴清和,荣向路,等.冰片与川芎配伍对脑缺血再灌注损伤的保护作用[J].广州中医药大学学报,2000,17(4):323-327.
[19] 冯玲,韩涛.速效救心丸治疗冠心病心绞痛临床疗效总结[J].中国中医急症,2000,9(1):4-6.
[20] 冯玲,王阶,陈双厚,等.速效救心丸对大鼠心肌梗死模型血管新生作用的影响[J].中国中药杂志,2009,34(6):748-750.
[21] 冯玲,胡元会,陈双厚,等.速效救心丸对鸡胚尿囊膜血管生成的影响[J].中西医结合心脑血管病杂志,2009,7(3):291-292.
[22] Cohn JN,Tam SW,Anand IS,et al.Isosorbide dinitrate and hydralazine in a fixed-dose combinationproduces further regression of left ventricular remodeling in a well-treated black population with heart failure:results from A-HeFT[J].J Card Fail,2007,13:331-339.
[23] 戚文航.硝酸酯治疗新进展[J].中华心血管病杂志,2002,30(3):187-189.
[2] Ghekiere O,Bielen J,Leipsic J,et al.Correlation of FFR-derived from CT and stress perfusion CMR with invasive FFR in intermediate-grade coronary artery stenosis[J].Int J Cardiovasc Imaging,2018,doi:10.1007/s10554-018-1464-4.
[3] Pijls NH,De Bruyne B,Peels K,et al.Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses[J].N Engl J Med,1996,334(26):1703-1708.
[4] Tonino PA,Fearon WF,De Bruyne B,et al.Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation [J].J Am Coll Cardiol,2010,55(25):2816-2821.
[5] 王巍巍,黄元升,卓琳.速效救心丸与硝酸异山梨酯片治疗冠心病心绞痛效果比较的Meta分析[J].中国循证心血管医学杂志,2015,7(3):298-303.
[6] 阮小芬,王肖龙,李益萍.速效救心丸治疗急性冠脉综合征临床疗效的Meta 分析[J].中国中医急症,2016,25(3):380-384.
[7] 郑筱萸主编.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:41-44.
[8] Cerqueira MD,Weissman NJ,Dilsizian V,et al.Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart:a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association [J].Circulation,2002,105(4):539-542.
[9] 杨志健.临界病变评价及介入治疗[J].海南医学,2002,13(12):36-37.
[10] Zimmermann FM,Ferrara A,Johnson NP,et al.Deferral vs.performance of percutaneous coronary intervention of functionally non-significantcoronary stenosis:15-year follow-up of the DEFER trial[J].Eur Heart J,2015,36(45):3182-3188.
[11] 程训民,何国祥,仝识非,等.冠状动脉造影指标对中度狭窄病变功能意义的判断价值[J].第三军医大学学报,2004,26(24):2261-2263.
[12] 王贤进,王砚青,陈群,等.单支临界冠状动脉病变斑块性质的危险因素分析[J].安徽医科大学学报,2017,52(10):1540-1545.
[13] 王斌,韩雅玲,荆全民,等.马冠状动脉前降支近段临界靶病变的血管内超声影像学特点研究[J].中国实用内科杂志,2014,34(10):1004-1007.
[14] 谭天秩主编.临床核医学[M].第2版.北京:人民卫生出版社,2003:397-528.
[15] 何作祥.心肌灌注显像的临床应用[J].中华心血管病杂志,2004,32(7):665-667.
[16] 刘艳凯,刘圣君,张玉平,等.川芎嗪、当归注射液对急性微循环障碍大鼠血小板功能和器官血流量的影响[J].中国医学物理学杂志,2005,22(5):660-662.
[17] 何维来,陈如坤,周汝元.川芎嗪对结扎犬LAD损伤冠脉内皮及心肌的保护作用[J].第四军医大学学报,2005,26(23):2153-2155.
[18] 黄萍,吴清和,荣向路,等.冰片与川芎配伍对脑缺血再灌注损伤的保护作用[J].广州中医药大学学报,2000,17(4):323-327.
[19] 冯玲,韩涛.速效救心丸治疗冠心病心绞痛临床疗效总结[J].中国中医急症,2000,9(1):4-6.
[20] 冯玲,王阶,陈双厚,等.速效救心丸对大鼠心肌梗死模型血管新生作用的影响[J].中国中药杂志,2009,34(6):748-750.
[21] 冯玲,胡元会,陈双厚,等.速效救心丸对鸡胚尿囊膜血管生成的影响[J].中西医结合心脑血管病杂志,2009,7(3):291-292.
[22] Cohn JN,Tam SW,Anand IS,et al.Isosorbide dinitrate and hydralazine in a fixed-dose combinationproduces further regression of left ventricular remodeling in a well-treated black population with heart failure:results from A-HeFT[J].J Card Fail,2007,13:331-339.
[23] 戚文航.硝酸酯治疗新进展[J].中华心血管病杂志,2002,30(3):187-189.