冠心丹参滴丸对冠心病稳定性心绞痛血瘀证患者炎症因子干预作用研究

发布时间：2018-08-26 19:35

【摘要】：研究目的:通过观察冠心丹参滴丸对冠心病稳定性心绞痛血瘀证患者血清炎症因子水平、心绞痛疗效和血瘀证的影响,从抑制炎症反应、抗氧化、保护内皮等方面探讨冠心丹参滴丸治疗冠心病稳定性心绞痛的可能机制。研究方法:收集2015年12月-2016年9月期间,在中国中医科学院广安门医院就诊的72例冠心病稳定性心绞痛血瘀证患者,按照随机数字表法,将纳入病例分为对照组和治疗组,每组各36例。对照组给予冠心病常规治疗,治疗组在对照组用药基础上加用冠心丹参滴0.4g,舌下含服,3次/天,连续治疗4周。比较治疗前后治疗组和对照组各炎症因子、内皮功能指标及氧化应激指标的变化,包括高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、单核细胞趋化蛋白-1(MCP-1)、基质金属蛋白酶-9(MMP-9)、内皮素-1(ET-1)、可溶性血管细胞黏附分子-1(sVCAM-1)、超氧化物歧化酶(SOD)以及丙二醛(MDA);比较治疗前后Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)以及汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评分变化;同时比较治疗前后心绞痛积分、中医证候积分、血瘀证积分改善及中医症状改善情况。研究结果:1.经过4周治疗后,与对照组比较,治疗组血清炎症因子hs-CRP、IL-6、TNF-α,内皮功能指标ET-1以及氧化应激指标SOD、MDA均明显降低,效果优于对照组(P0.05),但炎症因子MMP-9、MCP-1及内皮指标sVCAM-1下降程度不明显,差异无统计学意义(P0.05)。2.经过4周治疗后,与对照组相比,治疗组SAS、HAMA、SDS与HAMS评分均明显降低,差异具有统计学意义(P0.05)。3.经过4周治疗后,治疗组心绞痛疗效优于对照组(81.25%vs 47.06%,P0.05),与对照组相比,治疗组心绞痛积分、中医证候积分及血瘀证积分均明显降低,同时心绞痛发作次数、硝酸甘油使用情况及胸痛、胸闷、气短、心烦等症状改善情况治疗组亦明显优于对照组,差异具有统计学意义(P0.05)。研究结论:1.冠心丹参滴丸治疗冠心病血瘀证,能够降低血清hs-CRP、IL-6、TNF-α、ET-1、SOD和MDA水平,说明冠心丹参滴丸具有良好的抗炎、抗氧化、保护内皮的作用,其治疗冠心病心绞痛的机制可能与此密切相关。2.冠心丹参滴丸能够降低冠心病患者的SAS、HAMA、SDS与HAMD评分,说明冠心丹参滴丸具有改善冠心病患者焦虑抑郁等情志障碍的作用。3.冠心丹参滴丸可以降低冠心病患者心绞痛积分、中医证候积分、血瘀证积分等,说明冠心丹参滴丸可以改善冠心病血瘀证患者心绞痛疗效及血瘀证症状,并且调节患者胸痛、胸闷、气短、心烦等临床症状,冠心丹参滴丸具有良好的临床疗效,通过活血化瘀的方法可以改善冠心病心绞痛。
[Abstract]:Objective: to observe the effects of Guanxin Danshen dropping pills on serum inflammatory factor level, angina pectoris curative effect and blood stasis syndrome in patients with stable angina pectoris and blood stasis syndrome of coronary heart disease. To explore the possible mechanism of Guanxin Danshen dropping pills in the treatment of stable angina pectoris of coronary heart disease. Methods: from December 2015 to September 2016, 72 patients with stable angina pectoris and blood stasis syndrome of coronary heart disease were collected and divided into control group and treatment group. There were 36 cases in each group. The control group was treated with routine therapy of coronary heart disease, and the treatment group was treated with Guanxin salvia miltiorrhiza (0.4 g) on the basis of the medicine used in the control group, 3 times a day under the tongue for 4 weeks. The changes of inflammatory factors, endothelial function index and oxidative stress index before and after treatment were compared between the treatment group and the control group. Comparison of Gao Min C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor- 伪 (TNF- 伪), monocyte chemotactic protein 1 (MCP-1), matrix metalloproteinase-9 (MMP-9), endothelin 1 (ET-1), soluble vascular cell adhesion molecule 1 (sVCAM-1), superoxide dismutase (SOD) and malondialdehyde (MDA) (MDA); Before and after treatment, Zung's self-rating anxiety scale (SAS) / Zung), self-rating depression scale (SDS) and Hamilton anxiety scale (HAMA), (HAMD) score of Hamilton depression scale were changed. At the same time, the improvement of angina pectoris score, TCM syndrome score, blood stasis syndrome score and TCM symptom improvement were compared before and after treatment. The result of the study was: 1. After 4 weeks of treatment, compared with the control group, the serum inflammatory factor hs-CRP,IL-6,TNF- 伪, endothelial function index ET-1 and oxidative stress index SOD,MDA in the treatment group were significantly lower than those in the control group (P0.05), but the degree of the decrease of the inflammatory factor MMP-9,MCP-1 and the endothelial index sVCAM-1 was not obvious. The difference was not statistically significant (P0.05). After 4 weeks of treatment, compared with the control group, the SAS,HAMA,SDS and HAMS scores in the treatment group were significantly lower than those in the control group (P0.05). 3. After 4 weeks of treatment, the therapeutic effect of angina pectoris in the treatment group was better than that in the control group (81.25%vs 47.06). Compared with the control group, the scores of angina pectoris, TCM syndromes and blood stasis syndrome in the treatment group were significantly lower than those in the control group. The use of nitroglycerin and chest pain, chest tightness, shortness of breath, upset and other symptoms of the treatment group was also significantly better than the control group, the difference was statistically significant (P0.05). Conclusion: 1. Guanxin Danshen dropping pills can reduce the levels of hs-CRP,IL-6,TNF- 伪 ET-1 and MDA in blood stasis syndrome of coronary heart disease, indicating that Guanxin Danshen dropping pill has good anti-inflammatory, antioxidant and protective effects on endothelium. The mechanism of Guanxin Danshen dropping pill in treating angina pectoris of coronary heart disease may be closely related to this. Guanxin Danshen dropping pills can reduce the scores of SAS,HAMA,SDS and HAMD in patients with coronary heart disease, indicating that Guanxin Danshen dropping pills can improve anxiety and depression in patients with coronary heart disease. Guanxin Danshen dropping pills can reduce angina pectoris score, TCM syndrome score, blood stasis syndrome integral and so on. It shows that Guanxin Danshen dropping pill can improve the angina curative effect and blood stasis syndrome symptoms of coronary heart disease patients with blood stasis syndrome, and regulate the chest pain of patients. Guanxin Danshen dropping pill has good clinical effect and can improve angina pectoris of coronary heart disease by activating blood circulation and removing blood stasis.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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