蛭龙活血通瘀胶囊对冠心病患者PCI术后心脏保护作用研究
发布时间：2018-08-24 19:35
【摘要】：目的:观察蛭龙活血通瘀胶囊对PCI术后患者的血清一氧化氮(NO)、内皮素(ET)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)及心脏左心射血分数(LVEF)的影响,并记录不良心血管事件(MACE)发生情况,探讨蛭龙活血通瘀胶囊对PCI术后患者的心脏保护作用机制。方法:(1)病例的选择:2015年11月到2016年4月在西南医科大学附属中医医院心脑病科住院的拟行PCI手术的冠心病患者60例。随机分成对照组和实验组,两组患者在基本情况(年龄、性别)、既往病史(高血压病、糖尿病、高脂血症)、用药情况(β受体阻滞剂、ARB、CCB、ACEI)、危险因素(吸烟、饮酒)等方面无统计学差异,具有可比性。(2)治疗方案:两组患者在PCI术后均给予西医常规治疗即抗凝(低分子肝素5000U q12使用3天)、抗血小板聚集(拜阿司匹林100mg qd,硫酸氢氯吡格雷75mg qd)及调脂(阿托伐他汀钙片20mg qn或者瑞舒伐他汀5mg qn)等。实验组除了常规治疗外,加用蛭龙活血通瘀胶囊(1.2g,tid),疗程6个月。(3)观察指标:分别在PCI术前、术后24小时、术后72小时检测cTnI、CK-MB、hs-CRP;分别在PCI术前、术后24小时、术后1月检测NO、ET;分别在PCI术前、术后3月检查心脏彩超,以观察左心射血分数(lvef);术后6月进行电话随访,以记录不良心血管事件发生情况。(4)统计软件spss20.0用于相关数据的统计描述与分析。结果:(1)hs-crp:pci术前,对照组与实验组hs-crp比较差异无统计学意义(p0.05)。pci术后两组hs-crp均有所升高,在术后72小时hs-crp有所降低,与术前相比,差异有统计学意义(p0.05);与对照组相比,实验组hs-crp降低更为明显,差异有统计学意义(p0.05);(2)ck-mb:pci术前,对照组与实验组ck-mb比较差异无统计学意义(p0.05)。pci术后两组ck-mb均有所升高,在术后72小时ck-mb有所下降,与术前比较,差异有统计学意义(p0.001);与对照组相比,实验组ck-mb降低更为明显,差异有统计学意义(p0.001);(3)ctni:pci术前,对照组与实验组ctni比较差异无统计学意义(p0.05)。pci术后两组ctni均有所升高,在术后72小时ctni有所下降,与术前比较,差异具有统计学意义(p0.001);与对照组比较,实验组ctni下降更为明显,差异具有统计学意义(p0.01);(4)no:pci术前,对照组与实验组no比较差异无统计学意义(p0.05)。pci术后24小时,两组no均有所下降,与术前比较,差异具有统计学意义(p0.001);与对照组比较,实验组no略低于对照组,但差异无统计学意义(p0.05);pci术后1月,两组no均升高,与术前比较,差异具有统计学意义(p0.001);与对照组比较,实验组no升高幅度明显高于对照组,差异有统计学意义(p0.001);(5)et:pci术前,对照组与实验组et比较差异无统计学意义(p0.05)。pci术后24小时,两组et均有所升高,与术前比较,差异具有统计学意义(p0.001);与对照组比较,实验组et略高于对照组,但差异无统计学意义(p0.05);pci术后1月,两组et均下降,与术前比较,差异具有统计学意义(p0.001);与对照组比较,实验组et降低幅度明显大于对照组,差异有统计学意义(p0.001);(6)lvef:pci术前,对照组与实验组lvef比较差异无统计学意义(p0.05)。pci术后3月,对照组lvef有升高的趋势,但与术前比较,差异无统计学意义(p0.05);实验组lvef有明显升高,与术前及对照组比较,差异均有统计学意义(p0.05);(6)lvef:pci术前,对照组与实验组lvef比较差异无统计学意义(p0.05)。pci术后3月,对照组lvef有升高的趋势,但与术前比较,差异无统计学意义(p0.05);实验组lvef有明显升高,与术前及对照组比较,差异均有统计学意义(p0.05);(7)mace随访情况:pci术后6月,实验组在不良心血管事件单项及总数方面均低于对照组,但差异无统计学意义(p0.05);(8)no、et与心肌损伤标志物之间的相关性:pci术后1月no与ck-mb及ctni均成负相关关系(p0.05),et与ctni成正相关关系(p0.001);(9)hs-crp与心肌损伤标志物之间的相关性:术后24小时,hs-crp与ck-mb及ctni呈正相关关系(p0.001);术后72小时,hs-crp与ctni均成正相关关系(p0.05)。结论:1.冠心病患者pci术后可出现心肌的损伤、炎症反应及血管内皮功能的损伤,术后24小时最为明显。心肌损伤与血管内皮功能及炎症反应密切相关,炎症越轻、血管内皮功能越好,则心肌损伤越轻;反之则越重。2.蛭龙活血通瘀胶囊对PCI术后患者的心脏功能有一定的保护作用,减少不良心血管事件发生。疗效优于常规西药治疗。3.蛭龙活血通瘀胶囊胶囊对心脏保护作用的机制,可能与其降低CK-MB、cTnI;降低ET、升高NO及抑制炎症反应有关。
[Abstract]:Objective: To observe the effects of Zhilong Huoxue Tongyu Capsule on serum nitric oxide (NO), endothelin (ET), creatine kinase isoenzyme (CK-MB), troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP) and left ventricular ejection fraction (LVEF) in patients after PCI, and to record the occurrence of adverse cardiovascular events (MACE). Methods: (1) Case selection: From November 2015 to April 2016, 60 patients with coronary heart disease undergoing PCI were randomly divided into two groups: control group and experimental group. Urinary disease, hyperlipidemia, drug use (beta blockers, ARB, CCB, ACEI), risk factors (smoking, drinking) and other aspects of no statistical difference, comparable. (2) Treatment: two groups of patients after PCI were given conventional Western medicine treatment that anticoagulation (low molecular weight heparin 5000U Q12 for 3 days), anti-platelet aggregation (aspirin 100mg qd, sulfuric acid) Hydroclopidogrel 75 mg QD and lipid lowering (atorvastatin calcium tablets 20 mg QN or rosuvastatin 5 mg qn). The experimental group was given Zhilong Huoxue Tongyu capsule (1.2 g, tid) for 6 months in addition to routine treatment. (3) Observation indicators: cTnI, CK-MB, hs-CRP were detected before PCI, 24 hours after PCI, 72 hours after PCI, respectively. No and ET were detected at 1 month after PCI, left ventricular ejection fraction (lvef) was observed at 3 months after PCI, and adverse cardiovascular events were recorded at 6 months after PCI. (4) Statistical software SPSS 20.0 was used to describe and analyze the related data. Results: (1) Before hs-crp: pci, the control group and the experimental group had hs-cr. There was no significant difference between the two groups (p0.05). after pci, the hs-CRP of the two groups were increased, and at 72 hours after pci, the hs-CRP decreased, compared with the preoperative, the difference was statistically significant (p0.05); compared with the control group, the experimental group hs-CRP decreased more significantly, the difference was statistically significant (p0.05); (2) before pci, ck-mb: pci, the control group and the experimental group CK-MB was worse than the experimental group ck-mb. There was no significant difference between the two groups (p0.05). after pci, CK-MB increased in both groups, and at 72 hours after pci, CK-MB decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group CK-MB decreased more significantly, the difference was statistically significant (p0.001); (3) before ctni: pci, there was no statistical difference between the control group and the experimental group ctni. The cTnI of the two groups increased after pci, and decreased 72 hours after pci, compared with the preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group cTnI decreased more significantly, the difference was statistically significant (p0.01); (4) no: PCI preoperative, the control group and the experimental group no difference was not statistically significant (p0.05). (pci) 24 hours after surgery, the two groups of no decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no slightly lower than the control group, but there was no significant difference (p0.05); PCI 1 month after surgery, the two groups of no increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no increased. High amplitude was significantly higher than the control group, the difference was statistically significant (p0.001); (5) et: PCI preoperative, the control group and the experimental group et difference was not statistically significant (p0.05). 24 hours after pci, the two groups et increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et slightly higher than the control group, but the difference was not uniform. (p0.05); one month after pci, the two groups et decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et decreased significantly greater than the control group, the difference was statistically significant (p0.001); (6) lvef: PCI before the operation, the control group and the experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, on LVEF in the control group increased, but there was no significant difference compared with preoperative (p0.05); LVEF in the experimental group increased significantly, compared with preoperative and control group, the difference was statistically significant (p0.05); (6) lvef: PCI preoperative, the control group and experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, LVEF in the control group increased. However, there was no significant difference between the two groups (p0.05); LVEF in the experimental group was significantly higher than that in the control group (p0.05); (7) mace follow-up: 6 months after pci, the number of adverse cardiovascular events in the experimental group was lower than that in the control group, but there was no significant difference (p0.05); (8) no, ET and heart rate. Correlation between myocardial injury markers: no was negatively correlated with CK-MB and cTnI 1 month after PCI (p0.05), ET was positively correlated with cTnI (p0.001); (9) correlation between hs-CRP and myocardial injury markers: 24 hours after pci, hs-CRP was positively correlated with CK-MB and cTnI (p0.001); 72 hours after pci, hs-CRP was positively correlated with cTnI (p0.001). Conclusion: 1. Myocardial injury, inflammation and vascular endothelial function damage can occur in patients with coronary heart disease after pci, the most obvious 24 hours after pci. Myocardial injury is closely related to vascular endothelial function and inflammation. The lighter inflammation, the better vascular endothelial function, the lighter myocardial injury; otherwise, the more serious. 2. Zhilong Huoxue Tongyu Capsule is right. The effect of Zhilong Huoxue Tongyu Capsule on cardioprotective effect may be related to the decrease of CK-MB, cTnI, ET, NO and inflammation.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
[Abstract]:Objective: To observe the effects of Zhilong Huoxue Tongyu Capsule on serum nitric oxide (NO), endothelin (ET), creatine kinase isoenzyme (CK-MB), troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP) and left ventricular ejection fraction (LVEF) in patients after PCI, and to record the occurrence of adverse cardiovascular events (MACE). Methods: (1) Case selection: From November 2015 to April 2016, 60 patients with coronary heart disease undergoing PCI were randomly divided into two groups: control group and experimental group. Urinary disease, hyperlipidemia, drug use (beta blockers, ARB, CCB, ACEI), risk factors (smoking, drinking) and other aspects of no statistical difference, comparable. (2) Treatment: two groups of patients after PCI were given conventional Western medicine treatment that anticoagulation (low molecular weight heparin 5000U Q12 for 3 days), anti-platelet aggregation (aspirin 100mg qd, sulfuric acid) Hydroclopidogrel 75 mg QD and lipid lowering (atorvastatin calcium tablets 20 mg QN or rosuvastatin 5 mg qn). The experimental group was given Zhilong Huoxue Tongyu capsule (1.2 g, tid) for 6 months in addition to routine treatment. (3) Observation indicators: cTnI, CK-MB, hs-CRP were detected before PCI, 24 hours after PCI, 72 hours after PCI, respectively. No and ET were detected at 1 month after PCI, left ventricular ejection fraction (lvef) was observed at 3 months after PCI, and adverse cardiovascular events were recorded at 6 months after PCI. (4) Statistical software SPSS 20.0 was used to describe and analyze the related data. Results: (1) Before hs-crp: pci, the control group and the experimental group had hs-cr. There was no significant difference between the two groups (p0.05). after pci, the hs-CRP of the two groups were increased, and at 72 hours after pci, the hs-CRP decreased, compared with the preoperative, the difference was statistically significant (p0.05); compared with the control group, the experimental group hs-CRP decreased more significantly, the difference was statistically significant (p0.05); (2) before pci, ck-mb: pci, the control group and the experimental group CK-MB was worse than the experimental group ck-mb. There was no significant difference between the two groups (p0.05). after pci, CK-MB increased in both groups, and at 72 hours after pci, CK-MB decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group CK-MB decreased more significantly, the difference was statistically significant (p0.001); (3) before ctni: pci, there was no statistical difference between the control group and the experimental group ctni. The cTnI of the two groups increased after pci, and decreased 72 hours after pci, compared with the preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group cTnI decreased more significantly, the difference was statistically significant (p0.01); (4) no: PCI preoperative, the control group and the experimental group no difference was not statistically significant (p0.05). (pci) 24 hours after surgery, the two groups of no decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no slightly lower than the control group, but there was no significant difference (p0.05); PCI 1 month after surgery, the two groups of no increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no increased. High amplitude was significantly higher than the control group, the difference was statistically significant (p0.001); (5) et: PCI preoperative, the control group and the experimental group et difference was not statistically significant (p0.05). 24 hours after pci, the two groups et increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et slightly higher than the control group, but the difference was not uniform. (p0.05); one month after pci, the two groups et decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et decreased significantly greater than the control group, the difference was statistically significant (p0.001); (6) lvef: PCI before the operation, the control group and the experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, on LVEF in the control group increased, but there was no significant difference compared with preoperative (p0.05); LVEF in the experimental group increased significantly, compared with preoperative and control group, the difference was statistically significant (p0.05); (6) lvef: PCI preoperative, the control group and experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, LVEF in the control group increased. However, there was no significant difference between the two groups (p0.05); LVEF in the experimental group was significantly higher than that in the control group (p0.05); (7) mace follow-up: 6 months after pci, the number of adverse cardiovascular events in the experimental group was lower than that in the control group, but there was no significant difference (p0.05); (8) no, ET and heart rate. Correlation between myocardial injury markers: no was negatively correlated with CK-MB and cTnI 1 month after PCI (p0.05), ET was positively correlated with cTnI (p0.001); (9) correlation between hs-CRP and myocardial injury markers: 24 hours after pci, hs-CRP was positively correlated with CK-MB and cTnI (p0.001); 72 hours after pci, hs-CRP was positively correlated with cTnI (p0.001). Conclusion: 1. Myocardial injury, inflammation and vascular endothelial function damage can occur in patients with coronary heart disease after pci, the most obvious 24 hours after pci. Myocardial injury is closely related to vascular endothelial function and inflammation. The lighter inflammation, the better vascular endothelial function, the lighter myocardial injury; otherwise, the more serious. 2. Zhilong Huoxue Tongyu Capsule is right. The effect of Zhilong Huoxue Tongyu Capsule on cardioprotective effect may be related to the decrease of CK-MB, cTnI, ET, NO and inflammation.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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