冠状动脉再通膏对不稳定型心绞痛患者斑块稳定性、细胞凋亡因子及凝血指标变化的影响
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摘要
目的:观察冠状动脉再通膏治疗不稳定型心绞痛的临床疗效及对患者心肌细胞凋亡、凝血功能和斑块稳定性的影响。方法:将150例不稳定型心绞痛患者随机分为对照组和观察组,每组各75例。对照组患者采用常规西药治疗,观察组患者在对照组的基础上加用冠状动脉再通膏。比较两组患者的临床疗效,检测两组患者治疗前后细胞凋亡相关因子(s Fas、s Fas L含量和Fas/Apol活性)、斑块稳定性指标(斑块峰值强度、斑块增强强度、达峰时间、斑块起始增强时间和平均渡越时间)和凝血功能指标[凝血酶原时间(prothrombin time,PT)、部分活化凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT),血浆纤维蛋白原(plasma fibrinogen,Fib)和D-二聚体(D-Dimer D-D)]水平。结果:观察组有效率为92.00%,对照组有效率为74.67%,两组患者临床疗效比较,差异具有统计学意义(P<0.05)。两组患者治疗后s Fas、s Fas L和Fas/Apol均下降,并且观察组低于对照组,差异有统计学意义(P<0.05)。两组患者斑块峰值强度、斑块增强强度、达峰时间、斑块起始增强时间和平均渡越时间均降低,并且观察组斑块峰值强度、斑块增强强度、达峰时间、斑块起始增强时间和平均渡越时间低于对照组,差异有统计学意义(P<0.05)。两组患者PT、APTT、TT均延长,观察组PT、APTT、TT高于对照组;两组患者Fib、D-D均降低,并且观察组Fib、D-D少于对照组,差异有统计学意义(P<0.05)。结论:冠状动脉再通膏治疗不稳定型心绞痛患者疗效显著,作用机制可能与其通过改善患者凝血功能,下调细胞凋亡相关因子的水平,减少细胞凋亡,提高不稳定斑块的稳定性有关。
Objective:To observe the clinical efficacy of Coronary Artery Recanalization Paste in patients suffering from unstable angina pectoris( UAP) and the influence on participant's apoptotic factors,coagulation indicators,and plaque stability. Methods:A total of UAP 150 patients were randomly divided into control group and observation group,with 75 cases in each group. In the control group,conventional Western drug therapy was used,while in the observation group,on the basis of the control group,Coronary Artery Recanalization Paste was added. The clinical efficacy was compared and the factors in cell apoptosis such as the content of s Fas and s Fas L,and activity of Fas to Apol,indicators of plaque stability like plaque peak intensity,plaque enhanced intensity,time to peak,plaque initial enhanced time,and mean transit time,and coagulation indicators including prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),plasma fibrinogen(Fib),and D-dimer(D-D) were detected before and after treatment in the two groups. Results:The effectiveness rate in the observation group was 92. 00%,and74. 67% in the control group with a significant difference after comparison( P < 0. 05). After therapy,the indexes of s Fas,s Fas L,and the ratio of Fas to Apol were all decreased,and the decrease in the observation group was more remarkable with statistical significance( P < 0. 05). The indicators of plaque peak intensity,plaque enhanced intensity,time to peak,plaque initial enhanced time,and mean transit time were all decreased in the two groups,and decrease in the observation group was more significant compared to the control group( P < 0. 05). The PT,APTT,and TT were all prolonged,and these three indicators in the observation group were longer than those in the control group. Both Fib and D-D levels in the two groups were decreased,and the levels of these two indicators in the observation group were lower compared with those in the control group,which were displayed statistical significance( P < 0. 05). Conclusion:Coronary Artery Recanalization Paste can obtain a marked effect on UAP patients,and its potential mechanism might be related to improvement of coagulation function,down-regulation of apoptosis-related factors levels,reduction of cell apoptosis,and enhancement of the stability of unstable plaque.
Objective:To observe the clinical efficacy of Coronary Artery Recanalization Paste in patients suffering from unstable angina pectoris( UAP) and the influence on participant's apoptotic factors,coagulation indicators,and plaque stability. Methods:A total of UAP 150 patients were randomly divided into control group and observation group,with 75 cases in each group. In the control group,conventional Western drug therapy was used,while in the observation group,on the basis of the control group,Coronary Artery Recanalization Paste was added. The clinical efficacy was compared and the factors in cell apoptosis such as the content of s Fas and s Fas L,and activity of Fas to Apol,indicators of plaque stability like plaque peak intensity,plaque enhanced intensity,time to peak,plaque initial enhanced time,and mean transit time,and coagulation indicators including prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),plasma fibrinogen(Fib),and D-dimer(D-D) were detected before and after treatment in the two groups. Results:The effectiveness rate in the observation group was 92. 00%,and74. 67% in the control group with a significant difference after comparison( P < 0. 05). After therapy,the indexes of s Fas,s Fas L,and the ratio of Fas to Apol were all decreased,and the decrease in the observation group was more remarkable with statistical significance( P < 0. 05). The indicators of plaque peak intensity,plaque enhanced intensity,time to peak,plaque initial enhanced time,and mean transit time were all decreased in the two groups,and decrease in the observation group was more significant compared to the control group( P < 0. 05). The PT,APTT,and TT were all prolonged,and these three indicators in the observation group were longer than those in the control group. Both Fib and D-D levels in the two groups were decreased,and the levels of these two indicators in the observation group were lower compared with those in the control group,which were displayed statistical significance( P < 0. 05). Conclusion:Coronary Artery Recanalization Paste can obtain a marked effect on UAP patients,and its potential mechanism might be related to improvement of coagulation function,down-regulation of apoptosis-related factors levels,reduction of cell apoptosis,and enhancement of the stability of unstable plaque.
引文
[1]孙艳玲,韦要杰,王银娜,等.加服加减瓜蒌薤白半夏汤治疗不稳定性心绞痛的疗效观察[J].广西中医药,2010,30(6):19-20.
[2]魏明,叶萍,王居新,等.瓜蒌薤白半夏汤加减治疗不稳定型心绞痛[J].中西医结合心脑血管病杂志,2009,7(10):1218-1219.
[3]姚丽萍,苏伟.瓜蒌薤白半夏汤治疗痰浊闭阻型不稳定性心绞痛机制探讨[J].吉林中医药,2012,32(6):620-622.
[4]司金侠,殷子杰.瓜蒌薤白半夏汤加减治疗冠心病不稳定型心绞痛临床研究[J].中医学报,2012,27(9):1101-1102.
[5]史爱武.温阳益气、化瘀通络法治疗不稳定型心绞痛[J].河南中医,2014,34(7):1288-1289.
[6]陈孔斌.丹参酮ⅡA磺酸钠注射液对冠心病心绞痛患者血液流变学影响[J].浙江中医药大学学报,2008,32(6):744-745.
[7]孙静,姚凤祯.养心汤对家兔不稳定型心绞痛模型心肌细胞凋亡的影响[J].中医药信息,2008,25(3):62-63.
[8]刘元梅,张英杰.瓜蒌薤白半夏汤加味治疗不稳定型心绞痛60例[J].中西医结合心脑血管病杂志,2008,3(7):766.
[9]汪海苗.加味瓜蒌薤白半夏汤味治疗冠心病心绞痛的疗效[J].中西医结合心血管病电子杂志,2017,5(1):164.
[10]秦风华.瓜蒌薤白半夏汤联合西药治疗痰浊闭阻型冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2016,30(2):66-68.
[11]梅发光,王忠良,张义勤,等.瓜蒌皮注射液对不稳定型心绞痛患者斑块稳定性的影响[J].河南中医,2016,36(11):1913-1915.
[12]于明克,焦丽强.注射用丹参多酚酸盐对不稳定性心绞痛患者血浆高敏C反应蛋白、肿瘤坏死因子及可溶性细胞凋亡因子的影响[J].河北中医,2014,36(1):11-13,16.
[13]张辉,赵旭兰,王凤飞,等.氯吡格雷、低分子肝素与阿司匹林联用治疗不稳定型心绞痛临床观察[J].临床荟萃,2004,5(11):609-611.
[14]高萍.瓜蒌薤白半夏汤合温胆汤治疗不稳定性心绞痛痰浊壅塞证40例疗效观察[J].四川中医,2007,25(12):70-71.
[15]肖姗姗,唐冰.不稳定型心绞痛患者接受丹参多酚酸盐辅助治疗后的斑块稳定性、细胞凋亡及凝血指标变化[J].海南医学院学报,2017,23(5):680-683.
[2]魏明,叶萍,王居新,等.瓜蒌薤白半夏汤加减治疗不稳定型心绞痛[J].中西医结合心脑血管病杂志,2009,7(10):1218-1219.
[3]姚丽萍,苏伟.瓜蒌薤白半夏汤治疗痰浊闭阻型不稳定性心绞痛机制探讨[J].吉林中医药,2012,32(6):620-622.
[4]司金侠,殷子杰.瓜蒌薤白半夏汤加减治疗冠心病不稳定型心绞痛临床研究[J].中医学报,2012,27(9):1101-1102.
[5]史爱武.温阳益气、化瘀通络法治疗不稳定型心绞痛[J].河南中医,2014,34(7):1288-1289.
[6]陈孔斌.丹参酮ⅡA磺酸钠注射液对冠心病心绞痛患者血液流变学影响[J].浙江中医药大学学报,2008,32(6):744-745.
[7]孙静,姚凤祯.养心汤对家兔不稳定型心绞痛模型心肌细胞凋亡的影响[J].中医药信息,2008,25(3):62-63.
[8]刘元梅,张英杰.瓜蒌薤白半夏汤加味治疗不稳定型心绞痛60例[J].中西医结合心脑血管病杂志,2008,3(7):766.
[9]汪海苗.加味瓜蒌薤白半夏汤味治疗冠心病心绞痛的疗效[J].中西医结合心血管病电子杂志,2017,5(1):164.
[10]秦风华.瓜蒌薤白半夏汤联合西药治疗痰浊闭阻型冠心病心绞痛随机平行对照研究[J].实用中医内科杂志,2016,30(2):66-68.
[11]梅发光,王忠良,张义勤,等.瓜蒌皮注射液对不稳定型心绞痛患者斑块稳定性的影响[J].河南中医,2016,36(11):1913-1915.
[12]于明克,焦丽强.注射用丹参多酚酸盐对不稳定性心绞痛患者血浆高敏C反应蛋白、肿瘤坏死因子及可溶性细胞凋亡因子的影响[J].河北中医,2014,36(1):11-13,16.
[13]张辉,赵旭兰,王凤飞,等.氯吡格雷、低分子肝素与阿司匹林联用治疗不稳定型心绞痛临床观察[J].临床荟萃,2004,5(11):609-611.
[14]高萍.瓜蒌薤白半夏汤合温胆汤治疗不稳定性心绞痛痰浊壅塞证40例疗效观察[J].四川中医,2007,25(12):70-71.
[15]肖姗姗,唐冰.不稳定型心绞痛患者接受丹参多酚酸盐辅助治疗后的斑块稳定性、细胞凋亡及凝血指标变化[J].海南医学院学报,2017,23(5):680-683.