益肾活血解毒汤对老年冠心病不稳定型心绞痛的临床观察及其对患者血管内皮功能、IL-18、和肽素的影响

发布时间：2018-10-25 10:15

【摘要】：目的:观察在常规西药的基础上加用益肾活血解毒汤对老年冠心病不稳定型心绞痛的临床疗效,以及对血管内皮功能、IL-18、和肽素(Copeptin)、hs-CRP等相关指标水平的影响,以探索其作用机制。方法:依据UA西医诊断及中医证候诊断标准,纳入老年冠心病不稳定型心绞痛(肾虚血瘀型)患者40例,按照随机数字表法分组,研究组和对照组各20例。对照组采用常规西药治疗,研究组在常规西药治疗的基础上加用益肾活血解毒汤,疗程为4周。观察治疗前后两组患者临床疗效和相关实验室指标变化结果:1.两组患者治疗后心绞痛症状及静息ECG表现均有改善。心绞痛疗效组间治疗后比较,研究组总有效率(95%)高于对照组(80%);静息ECG表现比较,研究组总有效率(80%)高于对照组(70%),但差异无有统计学意义(P㧐0.05)。2.两组患者治疗后中医证候积分均明显下降,差异有统计学意义(P0.05);治疗后研究组较对照组证候积分下降更显著(P0.01)。3.两组患者治疗后硝酸甘油的用量均减少,组间比较,研究组总停减率(90%)高于对照组(50%),差异具有统计学意义(P0.05)。4两组患者治疗后血管内皮功能均(NO、6-keto-PGF1α水平均升高,ET、TXB2水平均下降)改善,同组比较,统计学差异显著(P0.01);组间比较,研究组NO、6-keto-PGF1α水平升高更明显(P0.05),ET、TXB2水平下降更明显(P0.05)。5.两组患者治疗后IL-18、Copeptin和hs-CRP水平均显著下降(P0.01);组间比较,研究组IL-18、copeptin和hs-CRP水平下降更显著(P0.01)。结论:1.益肾活血解毒汤联合常规西药治疗较单纯西药治疗对肾虚血瘀型老年冠心病不稳定型心绞痛的疗效更确切,对患者中医证候改善、减少硝酸甘油用量方面,疗效优于常规西药治疗。对患者心绞痛症状及静息ECG表现均有一定程度改善,但组间差异无统计学意义(P㧐0.05)。2.益肾活血解毒汤联合常规西药治疗肾虚血瘀型老年冠心病不稳定型心绞痛能显著改善患者的血管内皮功能(升高NO、6-keto-PGF1α水平,降低ET、TXB2水平)、IL-18、Copeptin和hs-CRP等指标。说明益肾活血解毒汤具有改善血管内皮功能、保护血管内膜及抑制炎症反应等功能,产生稳定动脉粥样硬化斑块的作用,达到治疗老年冠心病不稳定型心绞痛的目的。
[Abstract]:Objective: to observe the clinical effect of Yishen Huoxue jiedu decoction on unstable angina pectoris of coronary heart disease (CHD) in elderly patients, and to observe the effect of Yishen Huoxue jiedu decoction on vascular endothelial function, IL-18, and peptide (Copeptin), hs-CRP in order to explore its mechanism. Methods: 40 patients with unstable angina pectoris (kidney deficiency and blood stasis type) were divided into two groups according to the method of random digital table, 20 cases in the study group and 20 cases in the control group according to the criteria of western medicine diagnosis and TCM syndrome diagnosis of UA. The control group was treated with routine western medicine and the study group was treated with Yishen Huoxue jiedu decoction for 4 weeks. Observe the two groups of patients before and after treatment of clinical efficacy and related laboratory indicators change results: 1. The symptoms of angina pectoris and resting ECG were improved in both groups. The total effective rate (95%) in the study group was higher than that in the control group (80%), the total effective rate in the study group (80%) was higher than that in the control group (70%), but there was no significant difference between the two groups (P0. 05). 2. Two groups of patients after treatment of TCM syndrome score significantly decreased, the difference was statistically significant (P0.05); after treatment, the study group than the control group syndrome score decreased more significantly (P0.01). After treatment, the dosage of nitroglycerin was decreased in both groups. The total reduction rate (90%) in the study group was higher than that in the control group (50%), the difference was statistically significant (P0.05). 4 the vascular endothelial function (NO,6-keto-PGF1 伪 level was increased and ET,TXB2 level was decreased) in the two groups. In the same group, the statistical difference was significant (P0.01), and the level of NO,6-keto-PGF1 伪 in the study group was higher than that in the study group (P0.05), and the level of ET,TXB2 decreased more significantly (P0.05). After treatment, the levels of IL-18,Copeptin and hs-CRP decreased significantly in both groups (P0.01), and the levels of IL-18,copeptin and hs-CRP decreased more significantly in the study group than in the control group (P0.01). Conclusion: 1. The therapeutic effect of Yishen Huoxue jiedu decoction combined with conventional western medicine on unstable angina pectoris of coronary heart disease in elderly patients with kidney deficiency and blood stasis is more accurate than that of western medicine alone. It can improve the TCM syndrome of patients and reduce the dosage of nitroglycerin. The curative effect is superior to that of conventional western medicine. The symptoms of angina pectoris and the manifestation of resting ECG were improved to some extent, but there was no significant difference between the two groups (P0. 05). 2. Yishen Huoxue jiedu decoction combined with routine western medicine in the treatment of unstable angina pectoris of coronary heart disease with kidney deficiency and blood stasis can significantly improve vascular endothelial function (raise the level of NO,6-keto-PGF1 伪 and decrease the level of ET,TXB2), IL-18,Copeptin and hs-CRP, etc. It is suggested that Yishen Huoxue jiedu decoction can improve the function of vascular endothelium, protect the intima of blood vessel and inhibit inflammatory reaction, so as to stabilize atherosclerotic plaques and achieve the purpose of treating unstable angina pectoris of coronary heart disease in the elderly.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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