益气化痰活血方对冠脉不稳定斑块的作用及对血清TNF-α、IL-6、hs-CRP影响的研究

发布时间：2018-08-19 06:50

【摘要】：目的:通过研究益气化痰活血方对中医气虚痰阻血瘀型不稳定心绞痛患者的血清TNF-α、IL-6、hs-CRP等的炎症因子影响,来探讨益气化痰活血方对冠脉不稳定斑块的抗炎稳斑效应。方法:采取临床观察的办法,制定并分析临床病例报告表,选择2014年10月~2015年10月在河南中医药大学第一附属医院老年病科和心内科的门诊及住院且确诊为中医诊断:胸痹气虚痰阻血瘀证;西医诊断:冠心病不稳定型心绞痛的患者,共计60例。将患者按随机数字表法随机分为2组,对照组进行常规的抗血小板聚集、抗凝、抗缺血药物治疗并加服阿托伐他汀钙片20mg/d治疗。观察组在上述西药治疗的基础上加用中药复方益气化痰活血方。观察两组患者的中西医疗效、血脂和血清炎症因子TNF-a、IL-6、hs-CRP水平,多排冠脉螺旋CT检测斑块平均CT值、斑块最小CT值及斑块体积变化。通过统计软件包SPSS18.0建立数据库,进行数据管理与分析,并最终得出结果。结果:1.治疗前,两组患者各检测指标并无统计学差异(P0.05);2.治疗后,两组患者的中西医疗效、血脂、TNF-α、IL-6、hs-CRP,冠脉斑块指标与治疗前比较,具有统计学差异(P0.05);3.治疗后,观察组与对照组比较:(1)观察组心绞痛症状改善显效16例,有效13例,无效1例,总有效率96.67%,对照组显效10例,有效12例,无效8例,总有效率73.33%;中医证候积分改善方面,观察组79.32%,对照组53.28%;均具有显著差异(P0.05),观察组的改善均优于对照组。心电图疗效方面,两组比较无显著差异(P0.05);住院期间两组均未出现心绞痛症状加重的病人。(2)血脂:观察组的TC、TG、LDL-C明显低于对照组,HDL-C却明显高于对照组,并具有统计学差异(P0.05);(3)血清炎症因子:观察组的TNF-α、IL-6、hs-CRP水平明显低于对照组,并具有统计学差异(P0.05);(4)多排冠脉螺旋CT:平均CT值、最小CT值:组内比较,观察组斑块治疗后较治疗前显著增加(P0.05),对照组仅观察到有增加的态势,但尚无显著差异(P0.05);组间比较:治疗后两组斑块平均CT值、斑块最小CT值有显著差异,观察组较对照组显著增加(P0.05)。斑块体积:两组治疗前后比较可见缩小,但均未达到显著水平(P0.05)。结论:益气化痰活血方与阿托伐他汀联合能够降低不稳定型心绞痛患者的血清TNF-a、IL-6、hs-CRP等炎症的因子水平,可以更优地发挥出抗炎症免疫反应,从而提高了冠脉不稳定斑块的稳定性;不稳定型心绞痛患者的心肌缺血症状得到更好的缓解,进而改善了不稳定型心绞痛的临床预后;二者具有协同的治疗作用,可以为临床治疗冠脉不稳定斑块,降低不稳定型心绞痛患者的恶性心血管事件的发生率提供较为可靠的理论依据。
[Abstract]:Objective: to study the effect of Yiqi Huatan Huoxue recipe on inflammatory factors of serum TNF- 伪 and IL-6 hs-CRP in patients with unstable angina pectoris of Qi deficiency and phlegm obstruction and blood stasis type, so as to explore the anti-inflammatory and stable plaque effect of Yiqi Huatan Huoxue recipe on unstable plaque of coronary artery. Methods: clinical observation method was adopted to make and analyze the clinical case report form. From October 2014 to October 2015, the outpatients of geriatrics and cardiology in the first affiliated Hospital of Henan University of traditional Chinese Medicine were selected and diagnosed with TCM diagnosis: Qi deficiency of chest obstruction of phlegm and blood stasis syndrome; Western medicine diagnosis: patients with unstable angina pectoris of coronary heart disease. A total of 60 cases. Patients were randomly divided into two groups according to random digital table. The control group was treated with routine antiplatelet aggregation, anticoagulant, antiischemic drugs and Atto vastatin calcium tablet 20mg/d. Observation group on the basis of the above-mentioned western medicine treatment plus Chinese medicine compound Yiqi Huatan Huoxue prescription. The therapeutic effect of traditional Chinese and western medicine, the level of serum lipid and serum inflammatory factor TNF-a, IL-6hs-CRP, the mean CT value of plaque, the minimum CT value of plaque and the volume of plaque were detected by multi-slice spiral CT. The database is established by SPSS18.0, and the data is managed and analyzed. Finally, the results are obtained. The result is 1: 1. Before treatment, there was no statistical difference between the two groups (P0.05). After treatment, the therapeutic effect of traditional Chinese and western medicine, TNF- 伪 TNF- 伪 IL-6hs-CRPand coronary plaque index were significantly different between the two groups (P0.05). After treatment, the observation group compared with the control group: (1) the angina pectoris in the observation group improved significantly in 16 cases, effective in 13 cases, ineffective in 1 case, the total effective rate was 96.677.67, the control group had remarkable effect in 10 cases, effective in 12 cases, ineffective in 8 cases. The total effective rate was 73.33; the improvement of TCM syndromes integral, observation group 79.32, control group 53.28; there were significant differences (P0.05), the observation group is better than the control group. There was no significant difference in the effect of electrocardiogram between the two groups (P0.05); in the two groups, there was no exacerbation of angina pectoris during hospitalization. (2) Blood lipids: TCU TGG LDL-C in the observation group was significantly lower than that in the control group, but significantly higher than that in the control group. The levels of TNF- 伪 IL-6hs-CRP in the observation group were significantly lower than those in the control group (P0.05); (4). The plaque in the observation group increased significantly after treatment (P0.05), but there was no significant difference in the control group (P0.05). Comparison between the two groups: after treatment, the mean CT value of plaque and the minimum CT value of plaque were significantly different. Compared with the control group, the observation group significantly increased (P0.05). Plaque volume: two groups before and after treatment can be seen reduced, but did not reach a significant level (P0.05). Conclusion: the combination of Yiqi Huatan Huoxue recipe and Atto vastatin can reduce the level of inflammatory factors such as TNF-aji-IL-6hs-CRP in serum of patients with unstable angina pectoris, and can play a better role in anti-inflammatory immune response, thus improving the stability of unstable plaque of coronary artery. The symptoms of myocardial ischemia in patients with unstable angina pectoris were better alleviated, and the clinical prognosis of unstable angina pectoris was improved. Reducing the incidence of malignant cardiovascular events in patients with unstable angina pectoris provides a reliable theoretical basis.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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