益本活血方联合氯吡格雷对冠心病合并2型糖尿病患者认知功能和血管内皮功能的影响
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摘要
目的:观察益本活血方联合氯吡格雷治疗冠状动脉粥样硬化性心脏病(简称冠心病)合并2型糖尿病患者的临床疗效,并观察其对患者认知功能和血管内皮功能的影响。方法:92例冠心病合并2型糖尿病患者随机分为对照组和观察组各46例。对照组给予氯吡格雷治疗,观察组在对照组治疗基础上加用益本活血方。治疗后,比较两组患者临床疗效、中医证候积分、认知功能、血管内皮功能,同时记录不良反应。结果:治疗前,观察组与对照组中医证候积分比较,差异无统计学意义(P>0.05);治疗后两组中医证候积分均显著降低(P<0.05),且观察组治疗后显著低于对照组(P<0.05)。观察组有效率为95.65%,对照组有效率为71.74%,两组有效率比较,差异有统计学意义(P<0.05)。两组患者治疗前轻度认知障碍认知功能量表(montreal cognitive assessment,Mo CA)评分比较,差异无统计学意义(P>0.05);治疗后观察组MoCA评分显著升高(P<0.05),对照组无显著变化(P>0.05),观察组治疗后显著高于对照组(P<0.05)。两组患者治疗前血浆内皮素-1(endothelin-1,ET-1)、血管性血友病因子(von willebrand factor,vWF)、NO比较,差异无统计学意义(P>0.05);两组患者治疗后均显著改善(P<0.05);治疗后观察组ET-1、vWF显著高于对照组(P<0.05),NO显著低于对照组(P<0.05)。对照组不良反应率为6.52%,观察组为10.87%,两组比较,差异无统计学意义(P>0.05)。结论:益本活血方联合氯吡格雷可显著改善冠心病合并2型糖尿病患者认知功能和血管内皮功能,提高临床疗效。
Objective: To explore the clinical effect of Yiben Huoxue Formula combined with Clopidogrel on the cognitive function and vascular endothelial function in patients with coronary heart disease complicated with type 2 diabetes mellitus. Methods: Ninety-two cases of patients with coronary heart disease complicated with type 2 diabetes mellitus treated in our hospital were randomly divided into control group(46 cases) and study group(46 cases). The control group was treated with Clopidogrel,while the study group was treated with Yiben Huoxue Formula in addition to that of the control group. The clinical effect and the changes of TCM syndrome integral scores,cognitive function,and vascular endothelial function were compared between the two groups,and the adverse reactions were recorded in the process. Results: The difference in the TCM syndrome integral scores between the two groups was not statistically significant before treatment(P > 0. 05),and that was significantly decreased after treatment(P < 0. 05) and the score of the former was significantly lower than that of the latter(P < 0. 05). The difference in the level comparison of clinical effect between the two groups was statistically significant(P < 0. 05). The total effective rate in the study group was 95. 65%,which was significantly higher than that of 71. 74% in the control group(P < 0. 05). There was no significant difference in the Mo CA scores between the two groups before treatment(P > 0. 05) and after treatment that in the study group were significantly increased(P <0. 05). The scores in the control group had no obvious changes(P > 0. 05). The scores in the study group were significantly higher than those in the control group(P < 0. 05). The differences in the levels of ET,vWF and NO between the two groups were not statistically significant before treatment(P > 0. 05) and that was significantly improved after treatment respectively(P < 0. 05). The levels in the study group were significantly better than those in the control group(P < 0. 05). The incidence rate of adverse reactions in the control group was 6. 52%,which was lower than that of 10. 87% in the control group,and the difference was not statistically significant(P > 0. 05). Conclusion: Yiben Huoxue Formula combined with Clopidogrel can significantly improve the cognitive function and vascular endothelial function of patients with coronary heart disease complicated with type 2 diabetes,which can improve the treatment total effective rate with less adverse reactions,and is worthy of promotion and application.
Objective: To explore the clinical effect of Yiben Huoxue Formula combined with Clopidogrel on the cognitive function and vascular endothelial function in patients with coronary heart disease complicated with type 2 diabetes mellitus. Methods: Ninety-two cases of patients with coronary heart disease complicated with type 2 diabetes mellitus treated in our hospital were randomly divided into control group(46 cases) and study group(46 cases). The control group was treated with Clopidogrel,while the study group was treated with Yiben Huoxue Formula in addition to that of the control group. The clinical effect and the changes of TCM syndrome integral scores,cognitive function,and vascular endothelial function were compared between the two groups,and the adverse reactions were recorded in the process. Results: The difference in the TCM syndrome integral scores between the two groups was not statistically significant before treatment(P > 0. 05),and that was significantly decreased after treatment(P < 0. 05) and the score of the former was significantly lower than that of the latter(P < 0. 05). The difference in the level comparison of clinical effect between the two groups was statistically significant(P < 0. 05). The total effective rate in the study group was 95. 65%,which was significantly higher than that of 71. 74% in the control group(P < 0. 05). There was no significant difference in the Mo CA scores between the two groups before treatment(P > 0. 05) and after treatment that in the study group were significantly increased(P <0. 05). The scores in the control group had no obvious changes(P > 0. 05). The scores in the study group were significantly higher than those in the control group(P < 0. 05). The differences in the levels of ET,vWF and NO between the two groups were not statistically significant before treatment(P > 0. 05) and that was significantly improved after treatment respectively(P < 0. 05). The levels in the study group were significantly better than those in the control group(P < 0. 05). The incidence rate of adverse reactions in the control group was 6. 52%,which was lower than that of 10. 87% in the control group,and the difference was not statistically significant(P > 0. 05). Conclusion: Yiben Huoxue Formula combined with Clopidogrel can significantly improve the cognitive function and vascular endothelial function of patients with coronary heart disease complicated with type 2 diabetes,which can improve the treatment total effective rate with less adverse reactions,and is worthy of promotion and application.
引文
[1]仲崇星.北京市丰台区社区居民2011年冠心病流行病学调查分析[J].心血管康复医学杂志,2013,22(4):348-350.
[2]方芳,彭永德.糖尿病冠心病调脂药物干预结果评价[J].药品评价,2013,10(19):30-34.
[3]季学清,陈宝瑾,耿赟,等.益气养阴活血法治疗糖尿病冠心病的临床观察[J].上海中医药大学学报,2012,26(5):31-33.
[4]World Health Organization.Diagnostic criteria for diabetes mellitus[J].Disbetes Res Clin Pract,1999,44(1):21-26.
[5]中华医学会心血管病专业组.缺血性心脏病的命名及诊断标准[J].中华内科杂志,1981,20(4):253.
[6]郑筱萸.中药新药临床研究指导原则[M].中国医药科技出版社,2002:230-231.
[7]WONG A,LAW L S N,LIU W,et al.Montreal Cognitive Assessment[J].Physics Letters B,2015,42(4):342-349.
[8]PEREIRA A C,GOMEZ L M,BITTENCOURT M S,et al.Age,Gender,and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health(ELSA-Brasil)[J].Clin Cardiol,2016,15(16):258-259.
[9]JUNTTILA J.High-sensitivity troponin predicts coronary disease outcomes in type 2 diabetes but yields no benefit in selecting patients for revascularisation[J].Evid Based Med,2016,13(2):147-148.
[10]李显筑,李秀典,郭力,等.胸痹合剂对糖尿病冠心病大鼠内皮素和糖脂代谢影响的研究[J].中医药信息,2011,26(3):125-127.
[11]张园,陆欣,金玮.2型糖尿病患者血浆血管性血友病因子的表达及其与冠心病的关系[J].中国医药导报,2013,10(30):54-56,60.
[12]TEMOV K,SUN Z.Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease[J].Int J Cardiovasc Imaging,2016,13(25):458-459.
[13]杨玉辉,罗助荣,黄明方,等.合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素[J].岭南心血管病杂志,2014,20(3):285-289.
[14]廖波.高维持剂量氯吡格雷对合并糖尿病的冠心病患者接受经皮冠状动脉介入术后预防早期支架内血栓形成的疗效分析[J].右江民族医学院学报,2011,33(3):270-272.
[15]周景想,纪文岩,吉中强,等.冠心病心绞痛血瘀证证候特点及相关影响因素分析[J].中医学报,2015,30(1):123-124.
[16]张宁,杨孝芳.运用络病理论探讨慢性稳定性心绞痛发病机制及针灸治疗原则[J].中医临床研究,2015,7(1):26-28.
[17]曹岩,姚岚,方芳.糖尿病性冠心病中医治则研究与病机分析[J].现代中西医结合杂志,2015,24(19):2160-2163.
[18]张敦憨,陆志杰,陈宏秋,等.冠心病的中医病机及血脂异常与冠心病关系的临床研究进展[J].环球中医药,2014,7(S1):81.
[19]牛琳琳,琚保军.黄芪在心血管疾病中的药理及临床应用探究[J].中医临床研究,2012,4(7):46-47.
[20]张菊艳,张萃.荔枝核化学成分及其药理作用研究概况[J].广东药学院学报,2014,30(6):56-58.
[2]方芳,彭永德.糖尿病冠心病调脂药物干预结果评价[J].药品评价,2013,10(19):30-34.
[3]季学清,陈宝瑾,耿赟,等.益气养阴活血法治疗糖尿病冠心病的临床观察[J].上海中医药大学学报,2012,26(5):31-33.
[4]World Health Organization.Diagnostic criteria for diabetes mellitus[J].Disbetes Res Clin Pract,1999,44(1):21-26.
[5]中华医学会心血管病专业组.缺血性心脏病的命名及诊断标准[J].中华内科杂志,1981,20(4):253.
[6]郑筱萸.中药新药临床研究指导原则[M].中国医药科技出版社,2002:230-231.
[7]WONG A,LAW L S N,LIU W,et al.Montreal Cognitive Assessment[J].Physics Letters B,2015,42(4):342-349.
[8]PEREIRA A C,GOMEZ L M,BITTENCOURT M S,et al.Age,Gender,and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health(ELSA-Brasil)[J].Clin Cardiol,2016,15(16):258-259.
[9]JUNTTILA J.High-sensitivity troponin predicts coronary disease outcomes in type 2 diabetes but yields no benefit in selecting patients for revascularisation[J].Evid Based Med,2016,13(2):147-148.
[10]李显筑,李秀典,郭力,等.胸痹合剂对糖尿病冠心病大鼠内皮素和糖脂代谢影响的研究[J].中医药信息,2011,26(3):125-127.
[11]张园,陆欣,金玮.2型糖尿病患者血浆血管性血友病因子的表达及其与冠心病的关系[J].中国医药导报,2013,10(30):54-56,60.
[12]TEMOV K,SUN Z.Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease[J].Int J Cardiovasc Imaging,2016,13(25):458-459.
[13]杨玉辉,罗助荣,黄明方,等.合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素[J].岭南心血管病杂志,2014,20(3):285-289.
[14]廖波.高维持剂量氯吡格雷对合并糖尿病的冠心病患者接受经皮冠状动脉介入术后预防早期支架内血栓形成的疗效分析[J].右江民族医学院学报,2011,33(3):270-272.
[15]周景想,纪文岩,吉中强,等.冠心病心绞痛血瘀证证候特点及相关影响因素分析[J].中医学报,2015,30(1):123-124.
[16]张宁,杨孝芳.运用络病理论探讨慢性稳定性心绞痛发病机制及针灸治疗原则[J].中医临床研究,2015,7(1):26-28.
[17]曹岩,姚岚,方芳.糖尿病性冠心病中医治则研究与病机分析[J].现代中西医结合杂志,2015,24(19):2160-2163.
[18]张敦憨,陆志杰,陈宏秋,等.冠心病的中医病机及血脂异常与冠心病关系的临床研究进展[J].环球中医药,2014,7(S1):81.
[19]牛琳琳,琚保军.黄芪在心血管疾病中的药理及临床应用探究[J].中医临床研究,2012,4(7):46-47.
[20]张菊艳,张萃.荔枝核化学成分及其药理作用研究概况[J].广东药学院学报,2014,30(6):56-58.