心可舒治疗冠心病稳定型心绞痛（气滞血瘀证）的实验研究及临床观察

发布时间：2018-10-26 13:39

【摘要】：目的:从动物实验和临床研究两方面,探讨心可舒的临床疗效、安全性及其抗动脉粥样硬化的内在机制。(1)动物实验方法:36只新西兰大白兔随机分4组,分别为对照组、高脂AS模型组、氟伐他汀组及心可舒组,每组9只。通过HE染色评估粥样斑块的程度。应用免疫组化检测巨噬细胞、基质金属蛋白酶9(MMP-9)和α-平滑肌肌动蛋白(α-SMA)的表达,蛋白免疫印迹法分析斑块VCAM-1的表达水平。结果:1)HE示:心可舒组、氟伐他汀组、高脂组内膜都存在斑块的形成,以高脂组动脉斑块最为明显,而心可舒组及氟伐他汀组的斑块增厚相对较小,对照组血管形态正常。2)心可舒组VCAM-1的表达明显低于高脂组的水平(P0.01)。3)心可舒组巨噬细胞、基质金属蛋白酶9(MMP-9)及α-平滑肌肌动蛋白(α-SMA)的水平亦明显低于高脂组(P0.01)。(2)临床试验方法:从山东省立医院心内科及中医科门诊收集符合冠心病心绞痛气滞血瘀证诊断标准的患者,将这60例患者,按照随机分组的原则,分为2组。对照组30例,给予常规用药;治疗组30例,在常规用药上加服心可舒,一次四粒,每日三次,4周后进行临床疗效评定。分别对两组患者心绞痛程度、中医证候、心电图及安全性检测等综合分析,继而评价其疗效和安全性。结果:1)临床研究发现,在中医证候积分上,与对照组比较治疗组效果更显著(P0.01)。2)在心绞痛发作次数、持续时间,硝酸甘油用量,心电图变化,证候疗效方面,治疗组优于对照组(P0.05)。结论:临床研究发现,心可舒胶囊在临床治疗气滞血瘀型稳定型心绞痛初步取得一定疗效,是一个安全有效的方剂;基础研究证实,心可舒可通过抗炎作用保护血管内皮及抗动脉粥样硬化。总之,心可舒可以有效治疗冠心病稳定型心绞痛。
[Abstract]:Objective: to investigate the clinical efficacy, safety and anti-atherosclerosis mechanism of Xinkesu from animal experiment and clinical study. (1) Animal experiment methods: 36 New Zealand white rabbits were randomly divided into 4 groups, respectively, as control group. High fat AS model group, fluvastatin group and Xinkesu group, 9 rats in each group. The extent of atherosclerotic plaques was evaluated by HE staining. The expressions of macrophages, matrix metalloproteinase-9 (MMP-9) and 伪 -smooth muscle actin (伪 -actin) were detected by immunohistochemistry, and the expression of VCAM-1 in plaque was analyzed by Western blot. Results: 1) HE showed that there were plaques in the intima of Xinkeshu group, fluvastatin group and hyperlipidemia group, especially in high-fat group, but the plaque thickening was relatively small in Xinkeshu group and fluvastatin group. The expression of VCAM-1 in Xinkesu group was significantly lower than that in hyperlipidemia group (P0.01). 3) the macrophage expression in Xinkesu group was significantly lower than that in high fat group (P0.01). The levels of matrix metalloproteinase 9 (MMP-9) and 伪-smooth muscle actin (伪-SMA) were also significantly lower than those of high fat group (P0. 01). (2). Patients who meet the diagnostic criteria of angina pectoris with Qi stagnation and blood stasis syndrome of coronary heart disease, The 60 patients were divided into 2 groups according to the principle of random grouping. 30 cases in the control group were treated with routine medication, and 30 cases in the treatment group were treated with Xinkesu, four pills once a day, three times a day, and the clinical efficacy was evaluated after 4 weeks. The degree of angina pectoris, TCM syndromes, electrocardiogram and safety test were analyzed, and the efficacy and safety were evaluated. Results: 1) Clinical study showed that the effect of treatment group was more significant than that of control group (P0.01) in TCM syndromes score (P0.01). 2) in angina pectoris attack times, duration, nitroglycerin dosage, electrocardiogram changes, syndromes curative effect. The treatment group was superior to the control group (P0.05). Conclusion: clinical study shows that Xinkesu capsule is a safe and effective prescription for the treatment of stable angina pectoris with Qi stagnation and blood stasis type. Basic research confirmed that Xinkeshu can protect vascular endothelium and atherosclerosis through anti-inflammatory effect. In a word, Xinkesu can effectively treat stable angina pectoris of coronary heart disease.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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