中医辨证结合西医常规治疗对稳定性冠心病患者冠状动脉狭窄程度的影响
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摘要
目的观察中医辨证结合西医常规治疗对稳定性冠心病患者冠状动脉狭窄程度的影响。方法采用单中心、自身前后对照的临床设计,入选2014年10月—2016年9月就诊于中国中医科学院西苑医院心血管专病门诊的67例稳定性冠心病患者,在西药规范化治疗基础上辨证加用中药汤剂口服,每次100～150m L,每日2次,每4周根据辨证调整处方1次,服药至少24周/年,观察1年。观察治疗前后患者冠状动脉狭窄程度、心绞痛计分及欧洲健康量表评分[包括健康五维描述系统(EQ-5D)、视觉模拟标尺得分(EQ-VAS)评分]。结果 1年随访中,3例患者未能坚持服用中药,4例患者未行冠状动脉计算机断层扫描造影(CTA)复查,最终纳入分析60例患者。治疗1年后与治疗前比较,患者冠状动脉Gensini评分、冠状动脉最重狭窄程度和心绞痛计分均降低(P <0. 05,P <0. 01),EQ-5D和EQ-VAS评分较治疗前提高(P <0. 01,P <0. 05)。结论中医辨证结合西医常规治疗可降低稳定性冠心病患者冠状动脉狭窄程度,改善心绞痛症状,提高患者生活质量。
Objective To observe the effect of combination of Chinese medicine and Western medical routine therapy on coronary stenosis of stable coronary heart disease( CHD) patients. Methods A self-control study was performed,67 diagnosed stable CHD patients were enrolled in Xiyuan Hospital from October 2014 to September 2016. The patients were treated with Chinese medicine and routine Western medicine,and Chinese medicine was administrated 100 ～ 150 m L each time,twice daily and adjusted every 4 weeks according to syndrome differentiation. The frequency of taking Chinese medicine was at least 24 weeks a year,and the period of follow-up was 1 year. The stenosis of coronary artery was observed,and the scores of angina,European Questionnaire 5 Dimension( EQ-5 D) as well as European Questionnaire Visual Analogue Scale( EQVAS) were calculated before and after 1 year treatment. Results During the follow-up,3 patients failed to insist on taking Chinese medicine and 4 patients did not reexamine coronary computed tomography angiography( CTA),and finally 60 stable CHD patients were included in the analysis. After 1 year's treatment,the scores of angina,Gensini and the most severe stenosis of coronary decreased(P < 0. 05,P < 0. 01),and the scores of EQ-5 D and EQ-VAS increased(P < 0. 05,P <0. 01). Conclusions Combination of Chinese medicine and Western medical routine therapy significantly reduced the stenosis of coronary and improved the life quality of stable CHD patients.
Objective To observe the effect of combination of Chinese medicine and Western medical routine therapy on coronary stenosis of stable coronary heart disease( CHD) patients. Methods A self-control study was performed,67 diagnosed stable CHD patients were enrolled in Xiyuan Hospital from October 2014 to September 2016. The patients were treated with Chinese medicine and routine Western medicine,and Chinese medicine was administrated 100 ～ 150 m L each time,twice daily and adjusted every 4 weeks according to syndrome differentiation. The frequency of taking Chinese medicine was at least 24 weeks a year,and the period of follow-up was 1 year. The stenosis of coronary artery was observed,and the scores of angina,European Questionnaire 5 Dimension( EQ-5 D) as well as European Questionnaire Visual Analogue Scale( EQVAS) were calculated before and after 1 year treatment. Results During the follow-up,3 patients failed to insist on taking Chinese medicine and 4 patients did not reexamine coronary computed tomography angiography( CTA),and finally 60 stable CHD patients were included in the analysis. After 1 year's treatment,the scores of angina,Gensini and the most severe stenosis of coronary decreased(P < 0. 05,P < 0. 01),and the scores of EQ-5 D and EQ-VAS increased(P < 0. 05,P <0. 01). Conclusions Combination of Chinese medicine and Western medical routine therapy significantly reduced the stenosis of coronary and improved the life quality of stable CHD patients.
引文
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[19]马晓娟,郭春雨,殷惠军,等.活血及活血解毒配伍中药对急性心肌梗死大鼠模型血小板活化、炎症反应及凝血状态的影响[J].中国中西医结合杂志,2014,34(11):1329-1334.
[20]程伟,Akex Bobik.活血化瘀方药——川芎嗪、复方丹参、血塞通注射液对人血管平滑肌细胞增殖干预作用的比较研究[J].中国中医药科技,2003,10(1):11-12.
[21]李伟,王德忠,朱宗涛,等.活血化瘀类中药对血管内皮细胞作用的研究进展[J].中国老年学杂志,2010,30(17):2554-2557.
[22]刘玥,殷惠军,史大卓,等.活血化瘀中药与抗血小板治疗[J].科学通报,2014,59(8):647-655.
[23]Shang H,Zhang J,Yao C,et al.Qi-Shen-Yi-Qi Dripping Pills for the secondary prevention of myocardial infarction:a randomised clinical trial[J].Evid-based Complement Alternat Med,2013,2013(7329):738391.
[24]张莹.活血解毒中药配伍抗血小板及炎症反应的研究[D].北京:北京中医药大学,2016.
[25]班艳红,马国庆,段志宇,等.益气活血化痰法治疗2型糖尿病合并冠心病的临床观察[J].中医药信息,2014,31(3):147-148.
[2]Windecker S,Alfonso F,Collet JP,et al.2014 ESC/EACTS Guidelines on myocardial revascularization The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS)[J].Eur Heart J,2014,31(4):264-267.
[3]王铭铭,薛梅,杨琳,等.益气活血中药配伍双联抗血小板药物对人脐静脉内皮细胞损伤和内皮血小板黏附的影响[J].中国中西医结合杂志,2016,36(7):842-848.
[4]曲华,郭明,柴华,等.冠心丹参滴丸对慢性稳定型心绞痛血瘀证患者血瘀证计分及血清相关黏附因子水平的影响[J].中医杂志,2017,58(5):394-397.
[5]冒慧敏,史大卓.活血化瘀中药调节急性冠状动脉综合征炎症反应的临床研究进展[J].辽宁中医杂志,2016,43(1):213-216.
[6]鹿小燕,史大卓,徐浩,等.芎芍胶囊干预冠心病介入治疗后再狭窄的研究[J].中国中西医结合杂志,2006,26(1):13-17.
[7]徐浩,史大卓,陈可冀,等.芎芍胶囊预防冠状动脉介入治疗后再狭窄的临床研究[J].中国中西医结合杂志,2000,20(7):494-497.
[8]Members TF,Montalescot G,Sechtem U,et al.2013 ESCguidelines on the management of stable coronary artery disease[J].Eur Heart J,2014,34(38):2949-3003.
[9]付长庚,高铸烨,王培利,等.冠心病血瘀证诊断标准研究[J].中国中西医结合杂志,2012,32(9):1285-1286.
[10]Jr SS,Allen J,Blair SN,et al.AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease:2006 update endorsed by the National Heart,Lung,and Blood Institute[J].J Am Coll Cardiol,2006,47(10):2130-2139.
[11]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[12]冠心病心绞痛及心电图疗效评定标准(中西医结合治疗冠心病心绞痛及心律失常座谈会,1979,上海)[J].中国药事,1987,1(2):17-20.
[13]伍红艳,孙利华.欧洲五维健康量表效用值积分体系构建方法及结果的国际比较[J].中国新药杂志,2012,21(6):587-591.
[14]Huang G,Zhao JL,Du H,et al.Coronary score adds prognostic information for patients with acute coronary syndrome[J].Circulation,2010,74(3):490-495.
[15]Zencirci AE,Zencirci E,Degirmencioglu A,et al.The relationship between gensini score and st-segment resolution in patients with acute st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Kardiol Pol,2014,72(6):494-503.
[16]Nurkalem Z,Hasdemir H,Ergelen M,et al.The relationship between glucose tolerance and severity of coronary artery disease using the Gensini score[J].Angiology,2010,61(8):751.
[17]Nicholls SJ,Ballantyne CM,Barter PJ,et al.Effect of two intensive statin regimens on progression of coronary[J].NEngl J Med,2011,365(22):2078-2087.
[18]徐浩,文川,陈可冀,等.川芎、赤芍及其有效部位配伍对载脂蛋白E基因缺陷小鼠动脉粥样硬化斑块稳定性影响的研究[J].中国中西医结合杂志,2007,27(6):513-518.
[19]马晓娟,郭春雨,殷惠军,等.活血及活血解毒配伍中药对急性心肌梗死大鼠模型血小板活化、炎症反应及凝血状态的影响[J].中国中西医结合杂志,2014,34(11):1329-1334.
[20]程伟,Akex Bobik.活血化瘀方药——川芎嗪、复方丹参、血塞通注射液对人血管平滑肌细胞增殖干预作用的比较研究[J].中国中医药科技,2003,10(1):11-12.
[21]李伟,王德忠,朱宗涛,等.活血化瘀类中药对血管内皮细胞作用的研究进展[J].中国老年学杂志,2010,30(17):2554-2557.
[22]刘玥,殷惠军,史大卓,等.活血化瘀中药与抗血小板治疗[J].科学通报,2014,59(8):647-655.
[23]Shang H,Zhang J,Yao C,et al.Qi-Shen-Yi-Qi Dripping Pills for the secondary prevention of myocardial infarction:a randomised clinical trial[J].Evid-based Complement Alternat Med,2013,2013(7329):738391.
[24]张莹.活血解毒中药配伍抗血小板及炎症反应的研究[D].北京:北京中医药大学,2016.
[25]班艳红,马国庆,段志宇,等.益气活血化痰法治疗2型糖尿病合并冠心病的临床观察[J].中医药信息,2014,31(3):147-148.