养心氏片治疗不稳定型心绞痛典型病例分析
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摘要
目的观察养心氏片对冠心病不稳定性心绞痛患者外周血单核细胞表型及功能的影响,探讨养心氏片治疗冠心病的可能机制。方法选择冠心病不稳定性心绞痛典型患者1例,分别记录入选者的基本信息及血脂、肝功、肾功、血清胱抑素C等指标。检测单核细胞CD163、CD206、白细胞介素10(IL-10)、白细胞介素12(IL-12)的表达,酶联免疫吸附实验(ELISA)法检测血清中白细胞介素10、白细胞介素12及肿瘤坏死因子α(TNF-α)浓度,并对患者进行综合生活质量评分:西雅图心绞痛调查量表(SAQ)、广泛性焦虑自评量表(GAD-7)、9条目患者健康问卷(PHQ-9)评估。结果经过养心氏片联合常规药物治疗后,患者单核细胞CD14~+CD163~+CD206~+表达上调,而CD14~+CD163~- CD206~-表达下调;促炎症因子白细胞介素12、肿瘤坏死因子α表达下降,而抗炎因子白细胞介素10较治疗前表达升高,改善西雅图量表评分,降低广泛性焦虑自评量表、抑郁量表评分。结论养心氏片可以促进巨噬细胞表型转变,改变冠心病患者的炎症状态,延缓动脉粥样硬化的发展,治疗冠心病不稳定型心绞痛,同时能够达到双心治疗的目的。
Objective To explore the possible mechanism of Yangxinshi Tablets(YXST) for the treatment of coronary heart disease by observing the effect of YXST on the phenotype and function of peripheral blood mononuclear cells in patients with unstable angina pectoris of coronary heart disease.Methods One typical patient with unstable angina pectoris of coronary heart disease was selected.The basic information,blood lipid,liver function,kidney function and serum cystatin C were recorded.Monocytes were extracted from peripheral venous blood,and the expression of CD163,CD206,IL-10 and IL-12 in monocytes were detected by flow cytometry.The levels of IL-10,IL-12 and TNF-alpha in serum were measured by ELISA.The patients were assessed by comprehensive quality of life scale:Seattle Angina Questionnaire(SAQ),General Anxiety Self-Rating Scale(GAD-7),and 9-item Patient Health Questionnaire(PHQ-9).Results After YXST combination of conventional drugs treatment,the expression of CD14~+CD163~+CD206~+ in monocytes was up-regulated,while the expression of CD14~+CD163~-CD206~-was down-regulated.The expression of pro-inflammatory factors IL-12 and TNF-alpha decreased,while the expression of anti-inflammatory factor IL-10 increased compared with before treatment.The Seattle Scale score was improved,and the scores of GAD-7 General Anxiety Scale and Depression Scale were decreased.Conclusion YXST play an anti-atherosclerosis role by may promoting the phenotype transformation of macrophages,changing the inflammatory state of patients with coronary heart disease.YXST have the effect of double heart treatment.
Objective To explore the possible mechanism of Yangxinshi Tablets(YXST) for the treatment of coronary heart disease by observing the effect of YXST on the phenotype and function of peripheral blood mononuclear cells in patients with unstable angina pectoris of coronary heart disease.Methods One typical patient with unstable angina pectoris of coronary heart disease was selected.The basic information,blood lipid,liver function,kidney function and serum cystatin C were recorded.Monocytes were extracted from peripheral venous blood,and the expression of CD163,CD206,IL-10 and IL-12 in monocytes were detected by flow cytometry.The levels of IL-10,IL-12 and TNF-alpha in serum were measured by ELISA.The patients were assessed by comprehensive quality of life scale:Seattle Angina Questionnaire(SAQ),General Anxiety Self-Rating Scale(GAD-7),and 9-item Patient Health Questionnaire(PHQ-9).Results After YXST combination of conventional drugs treatment,the expression of CD14~+CD163~+CD206~+ in monocytes was up-regulated,while the expression of CD14~+CD163~-CD206~-was down-regulated.The expression of pro-inflammatory factors IL-12 and TNF-alpha decreased,while the expression of anti-inflammatory factor IL-10 increased compared with before treatment.The Seattle Scale score was improved,and the scores of GAD-7 General Anxiety Scale and Depression Scale were decreased.Conclusion YXST play an anti-atherosclerosis role by may promoting the phenotype transformation of macrophages,changing the inflammatory state of patients with coronary heart disease.YXST have the effect of double heart treatment.
引文
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[14] 陈金艳,田翔宇,贺璐璐,等.M2型巨噬细胞向M1型巨噬细胞的转化及其意义[J].中华实验外科杂志,2016,33(4):953-955.
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[16] 陈晓丽,宋玉萍,孙宏伟,等.冠心病共患抑郁症的现状和影响因素及治疗方法研究进展[J].中国全科医学,2016,19(23):2747 -2751.
[17] SUZUKI T,SHIGA T,KUWAHARA K,et al.Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure[J].J Cardiol,2014,64(6):456-462.
[18] SOKORELI I,DE VRIES J J G,PAUWS S C,et al.Depression and anxiety as predictors of mortality among heart failure patients:systematic review and meta-analysis[J].Heart Fail Rev,2016,21(1):49-63.
[19] DRAGO A,CRISAFULLI C,CALABRó M,et al.Enrichment pathway analysis.The inflammatory genetic background in bipolar disorder[J].J Affect Disord,2015(179):88-94.
[20] 中国中西医结合学会心血管病专业委员会双心学组.双心疾病中西医结合诊治专家共识[J].中国全科医学,2017,20(14):1659-1662
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[22] 陈安妮,高越,刘世钰,等.养心氏片抗抑郁症的药理作用[J].中成药,2017,39(6):1256-1260.
[2] 杨园园,高旭杰,闫建玲,等.中医药治疗冠心病稳定型心绞痛研究进展[J].光明中医,2018,33(8):1099-1101.
[3] 丁彦春,张淑楠,杨丽娜,等.冠心病病人血清LL-37的表达变化及养心氏片的干预作用[J].中西医结合心脑血管病杂志,2017,15(22):2859-2863.
[4] 侯亮,路英进,丁彦春.养心氏对巨噬细胞极化及活化的调节[J].中西医结合心脑血管病杂志,2016,14(15):1722-1726.
[5] 刘同想,孔素平,廖忠友,等.西雅图心绞痛调查量表对冠心病患者机体功能及生活质量的评估研究[J].中国行为医学科学,1997,6(2):127-129.
[6] 陈智凡.中西医结合治疗心绞痛临床疗效观察[J].数理医药学杂志,2009,22(1):48-49.
[7] 梁洁玲,王洋洋,司艳辉,等.促炎症机制在动脉粥样硬化中的研究进展[J].黑龙江医学,2017,41(2):190-191.
[8] 刘丽,张腾,陈瑜.免疫系统与动脉粥样硬化发病机制的研究进展[J].中西医结合心脑血管病杂志,2015,13(8):1000-1003.
[9] ANDRéS V,PELLO O M,SILVESTRE-ROIG C.Macrophage proliferation and apoptosis in atherosclerosis[J].CurrOpinLipidol,2012,23(5):429-438.
[10] DA ROCHA R F,DE BASTIANI M A,KLAMT F.Bioinformatics approach to evaluate differential gene expression of M1/M2 macrophage phenotypes and antioxidant genes in atherosclerosis[J].Cell Biochem Biophys,2014,70(2):831-839.
[11] 马雅銮,蔺洁,秦明照,等.单核-巨噬细胞亚型与动脉粥样硬化[J].中华临床医师杂志,2010,4(5):658-660.
[12] 李康,郭强,王翠妮,等.M1和M2型巨噬细胞表型的比较分析[J].现代免疫学,2013,28(3):177-183.
[13] TEDESCO S,BOLEGO C,TONIOLO A,et al.Phenotypic activation and pharmacologicaloutcomes of spontaneously differentiated human monocyte-derived macrophages[J].Immunobiology,2015,220(5):545-554.
[14] 陈金艳,田翔宇,贺璐璐,等.M2型巨噬细胞向M1型巨噬细胞的转化及其意义[J].中华实验外科杂志,2016,33(4):953-955.
[15] 刘正跃,赵云霞.冠心病患者焦虑症状的心理护理研究[J].中国社区医师(医学专业),2011,13(14):243.
[16] 陈晓丽,宋玉萍,孙宏伟,等.冠心病共患抑郁症的现状和影响因素及治疗方法研究进展[J].中国全科医学,2016,19(23):2747 -2751.
[17] SUZUKI T,SHIGA T,KUWAHARA K,et al.Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure[J].J Cardiol,2014,64(6):456-462.
[18] SOKORELI I,DE VRIES J J G,PAUWS S C,et al.Depression and anxiety as predictors of mortality among heart failure patients:systematic review and meta-analysis[J].Heart Fail Rev,2016,21(1):49-63.
[19] DRAGO A,CRISAFULLI C,CALABRó M,et al.Enrichment pathway analysis.The inflammatory genetic background in bipolar disorder[J].J Affect Disord,2015(179):88-94.
[20] 中国中西医结合学会心血管病专业委员会双心学组.双心疾病中西医结合诊治专家共识[J].中国全科医学,2017,20(14):1659-1662
[21] 邵中兴.养心氏治疗冠心病心绞痛伴抑郁症的疗效观察[J].世界中医药,2016,11(11):2329-2332.
[22] 陈安妮,高越,刘世钰,等.养心氏片抗抑郁症的药理作用[J].中成药,2017,39(6):1256-1260.