EECP治疗对稳定型心绞痛患者运动耐量、LP-PLA2和hs-CRP水平的影响

发布时间：2018-07-31 11:12

【摘要】：目的:观察稳定型心绞痛患者EECP治疗前后的运动耐量及其血浆LP-PLA2、hs-CRP 7水平的变化,以期评估EECP治疗对稳定型心绞痛患者运动耐量的影响及探讨EECP的作用机制。方法:连续纳入2016年1月到2017年2月期间于福建中医药大学附属人民医院心血管内科住院,运动平板试验阳性、经冠脉造影检查确诊为冠心病,且未行血运重建的稳定型心绞痛患者78例。随机分为体外反搏+常规药物治疗组(简称EECP组)38例和常规药物组40例。另选取福建中医药大学附属人民医院体检中心健康体检者30例作为空白对照。常规药物组予:阿司匹林100mgqd;美托洛尔缓释片47.5-190mgqd(剂量根据患者心率调整);单硝酸异山梨酯缓释胶囊40mgqd;阿托伐他汀钙片20mgqn;曲美他嗪20mg po tid;必要时硝酸甘油片0.5mg舌下含服或硝酸甘油注射液1Oug/min静脉泵入;治疗6周。对于合并高血压、糖尿病患者常规对症处理。EECP组在与常规药物组的相同的常规药物治疗基础上每日行1次体外反搏治疗,每次1h,每周6天,36h为1疗程,共6周。试验前后分别记录两组患者的运动平板试验相关数据(总运动时间、最大运动当量、ST段下移0.1mV的出现时间及ST段下移幅度、诱发心绞痛例数)、血清LP-PLA2及hs-CRP值。比较两组治疗前后运动平板试验数据、血清LP-PLA2及hs-CRP值是否有差异,治疗后差值组间比较是否有差异。结果:(1)运动平板数据比较:①治疗6周后,EECP组共有3例患者运动平板试验由阳性转阴性,常规药物组有1例转阴性,均为冠脉病变较轻的患者(Gensini积分平均值为19.25),两组比较差异无统计学意义,P＞0.05。②EECP组和常规药物组治疗后总运动时间、运动耐量均较治疗前明显增加,P＜0.05,EECP组增加均较常规药物组明显,P＜0.05。③常规药物组ST段下移0.1mmV出现时间治疗前后比较无明显差异,P＞0.05;EECP组治疗后ST段下移0.1mV出现时间延迟,P＜0.05。④两组治疗后ST段下移幅度值均较前下降,P＜0.05;EECP组较常规药物组ST段下移幅度值下降明显,P＜0.05。⑤EECP组、常规药物组运动试验时心绞痛发生例数前后比较均无明显差异,P＞0.05。(2)治疗6周后,两组hs-CRP、LP-PLA2浓度均较治疗前下降,P＜0.05;EECP组hs-CRP、LP-PLA2浓度下降较常规药物组明显,P＜0.05。结论:(1)EECP能延长稳定型心绞痛患者的总运动时间,提高运动耐量;(2)EECP能降低稳定型心绞痛患者血浆Lp-PLA2、hs-CRP水平,起抗炎作用。
[Abstract]:Objective: to observe the changes of exercise tolerance and plasma LP-PLA2hs-CRP 7 levels in patients with stable angina pectoris before and after EECP treatment, in order to evaluate the effect of EECP treatment on exercise tolerance in patients with stable angina pectoris and to explore the mechanism of EECP. Methods: from January 2016 to February 2017, the patients were hospitalized in the Department of Cardiovascular Medicine, affiliated people's Hospital of Fujian University of traditional Chinese Medicine, with positive treadmill test. Coronary artery disease was diagnosed by coronary angiography. 78 patients with stable angina pectoris without revascularization. They were randomly divided into EECP group (38 cases) and routine drug group (40 cases). In addition, 30 healthy people in the people's Hospital affiliated to Fujian University of traditional Chinese Medicine were selected as blank control. Routine drug group: aspirin 100mgqd; metoprolol sustained release tablet 47.5-190mgqd (dose adjusted according to patient heart rate); isosorbide mononitrate sustained-release capsule 40mgqd; Atto vastatin calcium tablet 20mgqqn; trimetazidine 20mg po tid; nitroglycerin tablet 0.5mg sublingual when necessary Intravenous infusion of nitroglycerin or nitroglycerin injection (1Oug/min); Treatment for 6 weeks. For patients with hypertension, the EECP group was treated with external counterpulsation once a day, 6 days a week for a course of 6 weeks, on the basis of the same routine drug therapy as the conventional drug group. Before and after the trial, the data of treadmill test (total exercise time, maximum exercise equivalent St segment downward shift 0.1mV, St segment depression range, number of induced angina pectoris), serum LP-PLA2 and hs-CRP were recorded. The data of treadmill test before and after treatment were compared, whether there were differences in serum LP-PLA2 and hs-CRP values, and whether there were differences between the two groups after treatment. Results: (1) compared with the data of exercise plate, there were 3 patients in EECP group who turned negative from positive to negative after 6 weeks of treatment, and 1 patient turned negative in routine drug group. The mean value of Gensini score was 19.25 in the patients with mild coronary artery disease. There was no significant difference between the two groups in the total exercise time after treatment in the 0.05.2EECP group and the routine drug group. Exercise tolerance was significantly increased compared with before treatment P < 0.05 EECP group was significantly higher than that of routine drug group (P < 0.05.3). There was no significant difference before and after treatment with St segment downshift 0.1mV in routine drug group (P > 0.05 EECP group). The current time delay group (P < 0.05.4) was significantly lower than that of the former group (P < 0.05 4) than the control group (P < 0.05). The St segment depression amplitude of the two groups was significantly lower than that of the conventional drug group (P < 0.05), and that of the control group was significantly lower than that of the control group (P < 0.05). There was no significant difference in the number of angina pectoris in the routine drug group before and after exercise test (P > 0.05). (2) after 6 weeks of treatment, the concentration of hs-CRPnLP-PLA2 in the two groups was lower than that before treatment (P < 0.05) and the concentration of hs-CRPnLP-PLA2 in the EECP group was significantly lower than that in the conventional drug group (P < 0.05). Conclusion: (1) EECP can prolong the total exercise time and improve exercise tolerance in patients with stable angina pectoris, (2) EECP can decrease the plasma Lp-PLA2hs-CRP level in patients with stable angina pectoris and play an anti-inflammatory effect.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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