丹参（冻干）注射液联合阿托伐他汀治疗冠脉慢血流的临床观察
发布时间：2018-08-07 21:06
【摘要】：背景：冠状动脉慢血流现象(CSFP)的概念最先于1972年由Tamble教授所提出,但此类现象在上世纪90年代末期被Mangieri和Diver等学者广泛关注：在部分胸痛患者进行冠状动脉造影术过程中,虽然无明显的冠状动脉病变(排除冠状动脉痉挛,心肌桥,冠状动脉囊性扩张、PCI术后和其他由心脏瓣膜疾病、结缔组织疾病所引起的冠脉阻塞性病变),但冠脉远端血液灌注却出现延迟的现象。近年来随着冠状动脉造影检查在我国的广泛开展,这一现象已经逐渐引起了心脏科临床医生的深度关注。在我院自2010年至2014年期间对部分不稳定性心绞痛、急性心肌梗死、稳定型心绞痛患者进行造影检查中发现,冠状动脉血流延迟现象发生率较高,给患者的正常生活和工作造成了极其严重的影响,但此类现象的发生机制目前尚无准确定论。因此,应加强对此疾病的治疗[1-2]势在必行。根据目前的临床多项相关研究提示：阿托伐他汀钙片,属HMG-CoA还原酶抑制剂,它的水解产物在体内竞争地抑制胆固醇合成的限速酶,降低胆固醇的合成,同时它能够促进肝细胞表面LDL受体合成的增加,进一步降低LDL的水平,除了调脂以外,它还存在稳定血管内皮等调脂以外的作用,则接受阿托伐他汀治疗冠状动脉慢血流应该可行性程度较高,然而还有一些相关的临床研究表明[3],单独使用阿托伐他汀治疗冠状动脉慢血流效果不佳。本研究采用中西医结合的方法,即阿托伐他汀治疗的基础上使用注射丹参多酚酸盐(丹参冻干注射)治疗冠状动脉慢血流。丹参多酚酸盐(丹参冻干注射液)是一种采用更现代中药制剂方法集中生产的丹参活性成分,其中丹参多酚酸盐醋酸镁为主要组成部分,它通过抗凝血,增加血流等机制治疗冠状动脉相关性疾病[4]。本研究旨在探讨丹参冻干注射液联合阿托伐他汀治疗冠状动脉慢血流的临床疗效和安全性,为临床治疗冠状动脉慢血流提供一种有效的方法。目的：研究丹参冻干注射液联合阿托伐他汀治疗冠状动脉慢血流的临床疗效和安全性。方法：80例冠状动脉血流缓慢患者,包括典型胸痛的不稳定心绞痛46例、稳定型劳力性心绞痛31例、急性心肌梗死3例。造影后按照1：1比例随机分为对照组和观察组各40例。对照组为单用口服阿托伐他汀治疗,观察组则在口服阿托伐他汀治疗的基础上联合冠脉内注射丹参冻干注射液的治疗组。比较两组治疗前后的临床疗效(前后症状发作频率及平均持续时间)、两组血脂水平的变化情况、心脏EF值的变化、两组治疗前后血管内皮功能指标水平(根据Celermajer等超声法测算)、两组治疗前后血尿酸及超敏-C反应蛋白水平、两组治疗后生活质量及不良反应发生率。结果：(1)治疗后,临床观察组的总效率与对照组相比更高,差异具有统计学意义(P0.05)；(2)两组治疗后症状发作频率及平均持续时间较治疗前明显缩短,差异均具有统计学意义(P0.05),且观察组治疗后症状发作频率及平均持续时间均显著低于对照组治疗后(P0.05),临床症状明显改善；(3)对照组治疗前后LVEF超声结果差异无统计学意义(P0.05),而观察组治疗后LVEF超声检查结果均显著大于对照组(P0.05),心肌灌注明显好转。(4)不同的脂质水平在对照组治疗前后无统计学意义(P0.05),但治疗后观察组TC和低密度脂蛋白水平在统计学上显著差异(P0.05),血脂中尤其总胆固醇于低密度脂蛋白含量升高,易发生慢血流现象。(5)两组治疗前后DO及NID水平差异均无统计学意义(P0.05),但两组治疗前后FMD水平差异均具有统计学意义(P0.05)；(6)两组治疗前后血清Hs-CRP水平差异均具有统计学意义(P0.05),但两组治疗后血清Hs-CRP水平差异无统计学意义(P0.05)；(7)对照组治疗前后UA水平差异无统计学意义(P0.05),观察组治疗前后UA水平具有统计学差异(P0.05),且观察组治疗后UA水平显著低于对照组治疗后(P0.05)；(8)根据生活质量评估量表,观察组治疗后的生活质量量表各维度(生理功能、心理功能、身体疼痛,一般健康、活力、社会功能、角色情感,心理健康,physical-related生活质量、心理相关的生活质量)分数明显高于治疗后,差异具有统计学意义(P0.05)；(9)8周后单用阿托伐他汀(对照组)发现两例患者的丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)增加超过正常上限的两倍,是停用阿托伐他汀片治疗的指征,两周复查上述指标后,患者的ALT和AST值均已回到正常水平。而阿托阿托伐他汀联合丹参冻干注射液组(观察组),没有发现肌炎、肌痛等横纹肌溶解相关的并发症。同时观察组亦未出现药物过敏、ALT、AST、CK、CKMB升高等药品不良反应的患者。结论：丹参(冻干)注射液结合阿托伐他汀改善冠状动脉慢血流现象,安全性高,可以作为有效的治疗冠状动脉慢血流的临床途径之一,为临床治疗此疾病提供了依据。
[Abstract]:Background: the concept of slow coronary artery flow (CSFP) was first proposed by Professor Tamble in 1972, but this phenomenon was widely concerned by scholars such as Mangieri and Diver in the late 90s of last century. In the course of coronary arteriography in patients with partial chest pain, there was no obvious coronary artery disease (excluding coronary spasm, heart) during coronary angiography. Muscle bridge, cystic dilatation of coronary arteries, after PCI and other coronary angiopathy caused by heart valve disease, connective tissue disease, but delayed blood perfusion in the distal coronary artery. In recent years, coronary angiography has been widely carried out in our country. This phenomenon has gradually caused the clinicians in the cardiology department. Deep concern. In our hospital from 2010 to 2014, we found that the incidence of coronary artery blood flow delayed in some patients with unstable angina, acute myocardial infarction and stable angina pectoris was higher, which had a severe impact on the normal life and work of the patients, but the mechanism of this kind of phenomenon is still still available. No quasi certainty. Therefore, it is imperative to strengthen the treatment of [1-2] for this disease. According to a number of current clinical studies, Atorvastatin Calcium Tablets, a HMG-CoA reductase inhibitor, its hydrolysates compete in the body to inhibit the speed limit enzyme of cholesterol synthesis, reduce the synthesis of cholesterol, and it can promote the liver cell surface. The increase in LDL receptor synthesis further reduces the level of LDL, in addition to lipid regulating, it still has the role of stabilizing the vascular endothelium, and it is more feasible to accept atorvastatin in the treatment of slow coronary artery blood flow. However, there are some related clinical studies that suggest that [3] alone is used for the treatment of coronary heart disease. The slow flow effect of the artery is not good. This study uses the combination of traditional Chinese and Western medicine, that is, the treatment of atorvastatin on the basis of injection of Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) in the treatment of slow coronary artery blood flow. Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) is a kind of active ingredient of Salvia miltiorrhiza, which is produced by the method of more modern Chinese medicine. The main component of Salvia miltiorrhiza polyphenolic acid magnesium acetate is to treat coronary artery related diseases through anticoagulant and increased blood flow mechanism [4].. The purpose of this study is to explore the clinical efficacy and safety of Salvia miltiorrhiza combined with atorvastatin in the treatment of slow coronary artery blood flow, and to provide a clinical treatment for slow coronary artery blood flow. Objective: To study the clinical efficacy and safety of Salvia miltiorrhiza freeze-dried injection combined with atorvastatin in the treatment of slow coronary artery blood flow. Methods: 80 patients with slow coronary artery blood flow, 46 cases of unstable angina pectoris with typical chest pain, 31 cases of stable angina pectoris, 3 cases of acute myocardial infarction. The cases were randomly divided into the control group and the observation group of 40 cases. The control group was treated with oral atorvastatin alone. The observation group combined with the treatment of atorvastatin on the basis of oral administration of Salvia miltiorrhiza injection in the treatment group. Compared the clinical efficacy of the two groups before and after treatment (the frequency of the onset of the onset and the average duration), and the two groups of blood lipids. Changes in level, changes in EF value of the heart, the level of vascular endothelial function before and after treatment (measured by Celermajer and other ultrasonic methods), the level of blood uric acid and hypersensitivity -C reaction protein before and after treatment in the two groups, the quality of life and the incidence of adverse reactions in the two groups after treatment. Results: (1) after treatment, the total efficiency of the clinical observation group and the control group Compared with higher, the difference was statistically significant (P0.05); (2) the frequency of symptom onset and the average duration of the two groups were significantly shorter than those before treatment (P0.05), and the frequency and duration of symptoms after treatment in the observation group were significantly lower than those of the control group (P0.05), and the clinical symptoms were significantly improved. 3) there was no significant difference in the results of LVEF ultrasound in the control group before and after treatment (P0.05), but the results of LVEF ultrasound examination in the observation group were significantly greater than those in the control group (P0.05), and the myocardial perfusion was obviously improved. (4) the different lipid levels were not statistically significant before and after treatment in the control group (P0.05), but the level of TC and low density lipoprotein in the observation group was in the observation group after treatment. Statistically significant difference (P0.05), blood lipid especially total cholesterol in low density lipoprotein content increased, prone to slow blood flow phenomenon. (5) there was no significant difference in the level of DO and NID before and after treatment in the two groups (P0.05), but the difference in FMD level between the two groups was all (P0.05), and (6) the level of Hs-CRP in the two groups before and after treatment. The difference was statistically significant (P0.05), but there was no significant difference in serum Hs-CRP level between the two groups (P0.05); (7) there was no significant difference in the level of UA in the control group before and after treatment (P0.05), and the level of UA in the observation group before and after treatment was statistically significant (P0.05), and the level of UA in the observation group was significantly lower than that of the control group after treatment (P0.05). (8) according to the quality of life assessment scale, the scores of each dimension (physiological function, psychological function, body pain, general health, vitality, social function, role emotion, mental health, physical-related quality of life, psychological related living quality) of the observation group were significantly higher than those of the treatment, and the difference was statistically significant (P0.05 (9) after 8 weeks, two cases of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be more than two times more than the normal upper limit of atorvastatin (control group). After two weeks of reexamination of the above indicators, the ALT and AST values of the patients were all returned to normal levels. Combined Salvia miltiorrhiza freeze-dried injection group (observation group), no myositis, myalgia and other rhabdomyolysis related complications were found. At the same time, the observation group had no drug allergy, ALT, AST, CK, CKMB liters of adverse drug reactions. Conclusion: Salvia miltiorrhiza injection combined with atorvastatin can improve the slow flow of coronary artery, it is safe and safe. As an effective way to treat coronary slow flow, it provides a basis for clinical treatment of this disease.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.3
本文编号：2171341
[Abstract]:Background: the concept of slow coronary artery flow (CSFP) was first proposed by Professor Tamble in 1972, but this phenomenon was widely concerned by scholars such as Mangieri and Diver in the late 90s of last century. In the course of coronary arteriography in patients with partial chest pain, there was no obvious coronary artery disease (excluding coronary spasm, heart) during coronary angiography. Muscle bridge, cystic dilatation of coronary arteries, after PCI and other coronary angiopathy caused by heart valve disease, connective tissue disease, but delayed blood perfusion in the distal coronary artery. In recent years, coronary angiography has been widely carried out in our country. This phenomenon has gradually caused the clinicians in the cardiology department. Deep concern. In our hospital from 2010 to 2014, we found that the incidence of coronary artery blood flow delayed in some patients with unstable angina, acute myocardial infarction and stable angina pectoris was higher, which had a severe impact on the normal life and work of the patients, but the mechanism of this kind of phenomenon is still still available. No quasi certainty. Therefore, it is imperative to strengthen the treatment of [1-2] for this disease. According to a number of current clinical studies, Atorvastatin Calcium Tablets, a HMG-CoA reductase inhibitor, its hydrolysates compete in the body to inhibit the speed limit enzyme of cholesterol synthesis, reduce the synthesis of cholesterol, and it can promote the liver cell surface. The increase in LDL receptor synthesis further reduces the level of LDL, in addition to lipid regulating, it still has the role of stabilizing the vascular endothelium, and it is more feasible to accept atorvastatin in the treatment of slow coronary artery blood flow. However, there are some related clinical studies that suggest that [3] alone is used for the treatment of coronary heart disease. The slow flow effect of the artery is not good. This study uses the combination of traditional Chinese and Western medicine, that is, the treatment of atorvastatin on the basis of injection of Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) in the treatment of slow coronary artery blood flow. Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) is a kind of active ingredient of Salvia miltiorrhiza, which is produced by the method of more modern Chinese medicine. The main component of Salvia miltiorrhiza polyphenolic acid magnesium acetate is to treat coronary artery related diseases through anticoagulant and increased blood flow mechanism [4].. The purpose of this study is to explore the clinical efficacy and safety of Salvia miltiorrhiza combined with atorvastatin in the treatment of slow coronary artery blood flow, and to provide a clinical treatment for slow coronary artery blood flow. Objective: To study the clinical efficacy and safety of Salvia miltiorrhiza freeze-dried injection combined with atorvastatin in the treatment of slow coronary artery blood flow. Methods: 80 patients with slow coronary artery blood flow, 46 cases of unstable angina pectoris with typical chest pain, 31 cases of stable angina pectoris, 3 cases of acute myocardial infarction. The cases were randomly divided into the control group and the observation group of 40 cases. The control group was treated with oral atorvastatin alone. The observation group combined with the treatment of atorvastatin on the basis of oral administration of Salvia miltiorrhiza injection in the treatment group. Compared the clinical efficacy of the two groups before and after treatment (the frequency of the onset of the onset and the average duration), and the two groups of blood lipids. Changes in level, changes in EF value of the heart, the level of vascular endothelial function before and after treatment (measured by Celermajer and other ultrasonic methods), the level of blood uric acid and hypersensitivity -C reaction protein before and after treatment in the two groups, the quality of life and the incidence of adverse reactions in the two groups after treatment. Results: (1) after treatment, the total efficiency of the clinical observation group and the control group Compared with higher, the difference was statistically significant (P0.05); (2) the frequency of symptom onset and the average duration of the two groups were significantly shorter than those before treatment (P0.05), and the frequency and duration of symptoms after treatment in the observation group were significantly lower than those of the control group (P0.05), and the clinical symptoms were significantly improved. 3) there was no significant difference in the results of LVEF ultrasound in the control group before and after treatment (P0.05), but the results of LVEF ultrasound examination in the observation group were significantly greater than those in the control group (P0.05), and the myocardial perfusion was obviously improved. (4) the different lipid levels were not statistically significant before and after treatment in the control group (P0.05), but the level of TC and low density lipoprotein in the observation group was in the observation group after treatment. Statistically significant difference (P0.05), blood lipid especially total cholesterol in low density lipoprotein content increased, prone to slow blood flow phenomenon. (5) there was no significant difference in the level of DO and NID before and after treatment in the two groups (P0.05), but the difference in FMD level between the two groups was all (P0.05), and (6) the level of Hs-CRP in the two groups before and after treatment. The difference was statistically significant (P0.05), but there was no significant difference in serum Hs-CRP level between the two groups (P0.05); (7) there was no significant difference in the level of UA in the control group before and after treatment (P0.05), and the level of UA in the observation group before and after treatment was statistically significant (P0.05), and the level of UA in the observation group was significantly lower than that of the control group after treatment (P0.05). (8) according to the quality of life assessment scale, the scores of each dimension (physiological function, psychological function, body pain, general health, vitality, social function, role emotion, mental health, physical-related quality of life, psychological related living quality) of the observation group were significantly higher than those of the treatment, and the difference was statistically significant (P0.05 (9) after 8 weeks, two cases of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be more than two times more than the normal upper limit of atorvastatin (control group). After two weeks of reexamination of the above indicators, the ALT and AST values of the patients were all returned to normal levels. Combined Salvia miltiorrhiza freeze-dried injection group (observation group), no myositis, myalgia and other rhabdomyolysis related complications were found. At the same time, the observation group had no drug allergy, ALT, AST, CK, CKMB liters of adverse drug reactions. Conclusion: Salvia miltiorrhiza injection combined with atorvastatin can improve the slow flow of coronary artery, it is safe and safe. As an effective way to treat coronary slow flow, it provides a basis for clinical treatment of this disease.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.3
【参考文献】
相关期刊论文 前1条
1 钱建东;于建刚;朱建琴;;阿托伐他汀钙对脑梗死患者颈动脉斑块的疗效观察[J];中国实用神经疾病杂志;2010年04期
，本文编号：2171341
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