蒲参胶囊联合阿托伐他汀钙治疗老年动脉粥样硬化
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摘要
目的探讨蒲参胶囊联合阿托伐他汀钙对老年动脉粥样硬化患者临床疗效。方法收集我院2015年12月至2016年12月收治的老年右侧颈动脉粥样硬化患者76例,按照随机数字表分为观察组和对照组(各38例)。其中对照组给予阿托伐他汀钙治疗,观察组在对照组基础上增加蒲参胶囊治疗,两组患者均连续治疗12个月。比较两组患者临床疗效及治疗期间不良反应发生情况。分析两组患者治疗前后血脂水平、颈动脉-中膜厚度(IMT)、颈动脉斑块面积、超敏C反应蛋白(hs-CRP)、VEGF、TGF-β1、VCAM-1以及P选择素水平变化情况。结果观察组为总有效率为94.74%,对照组为73.68%,差异具有统计学意义(P <0.05)。治疗前,两组患者血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)]水平、IMT、颈动脉斑块面积、血清hs-CRP、VEGF、TGF-β1、VCAM-1和P-选择素水平比较差异无统计学意义(P> 0.05);治疗后,两组患者TC、TG、LDL-C、IMT、颈动脉斑块面积、hs-CRP、VEGF、TGF-β1、VCAM-1和P-选择素水平均显著下降,HDL-C水平显著上升(P <0.05),且观察组相较于对照组,TC、TG、LDL-C、IMT、颈动脉斑块面积、hs-CRP、VEGF、TGF-β1、VCAM-1和P-选择素水平更低,HDL-C水平更高,差异具有统计学意义(P> 0.05)。治疗期间,两组患者均无不良反应现象发生。结论蒲参胶囊联合阿托伐他汀钙治疗老年动脉粥样硬化临床疗效较好,可改善患者血脂水平,调节内皮功能,下调炎性反应相关因子,稳定动脉粥样硬化斑块,安全性高。
Objective We aimed to investigate the effect of Pushen capsule combined with atorvastatin calcium on the clinical efficacy and VEGF, TGF-β1, VCAM-1 and P-selectin levels in elderly patients with atherosclerosis. Methods Seventy-six elderly patients with right carotid atherosclerosis admitted to our hospital from December 2015 to December 2016 were enrolled. The patients were divided into observation group( 38 cases) and control group(38 cases) according to the random number table. The control group was treated with atorvastatin calcium, while the observation group was treated with Pushen capsule and atorvastatin calcium. Both of two groups were treated continuously for 12 months. The clinical efficacy and the occurrence of adverse reactions during the treatment were compared between the two groups. We analyzed the changes of blood lipid, carotid-media thickness(IMT), carotid plaque area, hypersensitive C-reactive protein(hs-CRP), vascular endothelial growth factor(VEGF) transforming growth factor β1( TGF-β1), vascular cell adhesion factor( VCAM-1) and P-selectin levels before and after the treatment. Results The total effective rate was 94.74% in the observation group and 73.68%in the control group. The difference was statistically significant(P < 0.05). Before treatment, there were no statistical differences between the two groups inthe blood lipids(total cholesterol(TC), triglyceride(TG), Low-density lipoprotein( LDL-C), high-density lipoprotein(HDL-C) levels, IMT, carotid plaque area, serum hs-CRP,VEGF, TGF-β1, VCAM-1 and P-selectin levels respectively(P > 0.05). After treatment, TC, TG, LDL-C,IMT, carotid plaque area, hs-CRP, VEGF, TGF-β1, VCAM-land P-selectin levels were significantly decreased than baseline levels in both groups, while HDL-C levels increased significantly(P < 0.05). Compared with the control group, TC, TG, LDL-C, IMT, carotid plaque area, hs-CRP, VEGF, TGF-β1, VCAM-1 and P-selectin levels were lower in observation group, while the HDL-C levels were higher. The differences were statistically significant respectively(P < 0.05). During the treatment period, no adverse reactions occurred in participants of these two groups. Conclusion Combination therapy of Pushen capsule and atorvastatin calcium is effective in senile atherosclerosis. The combination regimen can improve blood lipid levels, regulate endothelial function, down-regulate inflammatory response-related factors and stabilize atherosclerotic plaque with high safety.
Objective We aimed to investigate the effect of Pushen capsule combined with atorvastatin calcium on the clinical efficacy and VEGF, TGF-β1, VCAM-1 and P-selectin levels in elderly patients with atherosclerosis. Methods Seventy-six elderly patients with right carotid atherosclerosis admitted to our hospital from December 2015 to December 2016 were enrolled. The patients were divided into observation group( 38 cases) and control group(38 cases) according to the random number table. The control group was treated with atorvastatin calcium, while the observation group was treated with Pushen capsule and atorvastatin calcium. Both of two groups were treated continuously for 12 months. The clinical efficacy and the occurrence of adverse reactions during the treatment were compared between the two groups. We analyzed the changes of blood lipid, carotid-media thickness(IMT), carotid plaque area, hypersensitive C-reactive protein(hs-CRP), vascular endothelial growth factor(VEGF) transforming growth factor β1( TGF-β1), vascular cell adhesion factor( VCAM-1) and P-selectin levels before and after the treatment. Results The total effective rate was 94.74% in the observation group and 73.68%in the control group. The difference was statistically significant(P < 0.05). Before treatment, there were no statistical differences between the two groups inthe blood lipids(total cholesterol(TC), triglyceride(TG), Low-density lipoprotein( LDL-C), high-density lipoprotein(HDL-C) levels, IMT, carotid plaque area, serum hs-CRP,VEGF, TGF-β1, VCAM-1 and P-selectin levels respectively(P > 0.05). After treatment, TC, TG, LDL-C,IMT, carotid plaque area, hs-CRP, VEGF, TGF-β1, VCAM-land P-selectin levels were significantly decreased than baseline levels in both groups, while HDL-C levels increased significantly(P < 0.05). Compared with the control group, TC, TG, LDL-C, IMT, carotid plaque area, hs-CRP, VEGF, TGF-β1, VCAM-1 and P-selectin levels were lower in observation group, while the HDL-C levels were higher. The differences were statistically significant respectively(P < 0.05). During the treatment period, no adverse reactions occurred in participants of these two groups. Conclusion Combination therapy of Pushen capsule and atorvastatin calcium is effective in senile atherosclerosis. The combination regimen can improve blood lipid levels, regulate endothelial function, down-regulate inflammatory response-related factors and stabilize atherosclerotic plaque with high safety.
引文
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[14]殷惠军,梁英姿,杜武勋.阿托伐他汀联合蒲参胶囊对慢性稳定性冠心病患者血脂指标的影响[J].中国中西医结合杂志,2017,37(12):1513-1514.
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[17]李巧薇,谭少华,李丽娟.中青年脑梗死患者颈动脉粥样硬化与同型半胱氨酸、高敏C反应蛋自及纤维蛋自原的关系[J].实用医学杂志,2015,31(13):2161-2163.
[2]AKGABUE E,THIBOUTOT J,CHENG J,et al.New and emerging risk factors for coronary heart disease[J].The American journal of the medical sciences,2014,347(2):151-158.
[3]GORDON S M,REMALEY A T.High density lipoproteins are modulators of protease activity:Implications in inflammation,complement activation,and ather othrombosis[J].Atherosclerosis,2017,259:104-113.
[4]OTSUKA F,YASUDA S,NOGUCHI T,et al.Pathology of coronary atherosclerosis and thrombosis[J].Cardiovasc Diagn Ther,2016,6(4):396-408.
[5]OU Z,ZHANG J.Atorvastatin promotes human monocyte differentiation toward alternative M2 macrophages through p38 mitogen-activated protein kinase-dependent peroxisome proliferatoractivated receptorγactivation[J].International Immunopharmacology,2015,26(1):58-64.
[6]李妍.蒲参胶囊联合阿托伐他汀治疗高脂血症(血瘀证)的临床观察[D].山西:山西医科大学,2017.
[7]张蕴颖,鲍黎明.黄芪多糖对冠心病患者血清TNF-cx,IL-6,P-选择素、VCAM-1以及VEGF水平的影响[J].中国生化药物杂志,2016,2(36):142-144.
[8]SZADE A,GROCHOT-PRZECZEK A,FLORCZYK U,et al.Cellular and molecular mechanisms of inflammation-induced angiogenesis[J].ILTBMB Life,2015,67(3):145-159.
[9]SALO M,OHKAWA R,YOSHIMOLO A,et al.Effects of serum amyloid A on the structure and antioxidant ability of highdensity lipoprotein[J].Biosci Rep,2016,36(4):1-9.
[10]邓明玲,郑卫莉,居来提.丹参联合川芎治疗老年动脉粥样硬化患者的临床疗效[J].中国老年学杂志,2017,37(14):3445-3447.
[11]张雪梅.蒲参胶囊治疗颈动脉粥样硬化的临床研究[J].中成药,2008,30(8):1105-1107.
[12]RUIZ-LIMON P,BARBARROJA N,PEREZ-SANCHEZ C,et al.Atherosclerosis and cardiovascular disease in systemic lupus erythematosus:effects of in vivo statin treatment[J].Ann Rheum Dis,2015,74(7):1450-1458.
[13]STONE N J,ROBINSON J G,LICHTENSTEIN A H,et al.2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force Practice Guidelines[J].Circulation,2014,129(25 Suppl 2):S1-45.
[14]殷惠军,梁英姿,杜武勋.阿托伐他汀联合蒲参胶囊对慢性稳定性冠心病患者血脂指标的影响[J].中国中西医结合杂志,2017,37(12):1513-1514.
[15]KAMINSKA J,KOPER O M,SIEDLECKA-CZYKIER E,et al.The utilily of inflammation and platelet biomarkers in patients with acute coronary syndromes[J].Saudi J Biol Sci,2016,10:1-9.
[16]SANTOS-GALLEGO C G,PICATOSTE B,BADIMON J J.Pathophysiology of Acute Coronary Syndrome[J].Curr Atheroscler Rep,2014,16(4):99-103.
[17]李巧薇,谭少华,李丽娟.中青年脑梗死患者颈动脉粥样硬化与同型半胱氨酸、高敏C反应蛋自及纤维蛋自原的关系[J].实用医学杂志,2015,31(13):2161-2163.