调肝健脾通阳方治疗稳定型心绞痛的临床研究

发布时间：2018-12-18 03:32

【摘要】：目的:基于对冠心病稳定型心绞痛病因病机和辨证论治的认识和归纳,现观察验方“调肝健脾通阳方”对稳定型心绞痛证属肝郁脾虚、胸阳痹阻型患者的中医证候、临床症状及相关实验室检查变化等方面的改善情况,并对其安全性进行评价。方法:将符合纳入标准的稳定型心绞痛患者遵循随机数字表法划分为治疗组和对照组各36例,两组患者在性别、年龄、病程、合并疾病、基础用药、中医症候总积分、各单项症状积分、相关实验室检查上经统计学软件分析,均未有统计学差异,存在可比性。两组病例均予以西医常规基础治疗,但治疗组加用调肝健脾通阳方中药汤药治疗。连续给药14天,以治疗前后两组病例的中医症候疗效、中医症候积分、硝酸甘油停减率、心电图总有效率、超敏C反应蛋白(High sensitivity C reactive protein hs-CRP)、肿瘤坏死因子-α(Tumor Necrosis Factor alpha TNF-α)、白介素-6(Interleukin-6 IL-6)的变化情况等评价其疗效。研究结果:经过14天的临床观察,通过统计分析各项指标,研究结果表明:1、在改善中医症候疗效方面:治疗组显效率38.2%,总有效率88.2%,对照组显效率19.4%,总有效率72.2%,组间比较P=0.037(P0.05),差异有统计学意义,治疗组优于对照组。2、中医症候积分方面:治疗后两组患者中医症候总积分及各单项症状积分均较治疗前有显著改善(P0.01),治疗后治疗组的总积分及胸闷、心悸、疲倦乏力、善太息、口苦症状的改善情况均优于对照组(P0.05),胸痛的组间比较无统计学差异(P=0.155)。3、在硝酸甘油停减率方面:治疗组硝酸甘油停减率为82.4%,对照组为50%,组间比较P=0.010(P0.05),差异有统计学意义,治疗组优于对照组。4、在心电图总有效率方面:治疗组和对照组的心电图总有效率分别为76.5%和66.7%,治疗组总有效率优于对照组,但组间比较P=0.209(P0.05),无统计学差异。5、炎症因子方面:治疗后两组患者组内比较hs-CRP、TNF-α、IL-6水平均较治疗前有显著下调(P0.01),治疗后两组组间hs-CRP比较,P=0.039(P0.05),治疗组优于对照组;组间TNF-α、IL-6比较,P0.05,差异无统计学意义。6、安全性方面:两组患者治疗前后各实验室指标组内、组间均无统计学差异且均在正常范围内,未见任何不良反应,治疗期内两组用药均是安全的。结论:调肝健脾通阳方联合西药治疗肝郁脾虚、胸阳痹阻型稳定型心绞痛,能进一步改善患者临床症状、中医症候、硝酸甘油停减率、hs-CRP,并且治疗期内是安全的,值得临床推广运用及进一步研究。
[Abstract]:Objective: based on the understanding and induction of the etiology and pathogenesis of stable angina pectoris of coronary heart disease and differentiation of symptoms and signs, the author observed the TCM syndromes of "Tiaogan Jianpi Tongyang prescription" in treating stable angina patients with syndrome of liver stagnation and spleen deficiency, chest stagnation and yang obstruction. Clinical symptoms and related laboratory changes were improved and their safety was evaluated. Methods: the patients with stable angina pectoris according to the inclusive criteria were divided into treatment group (n = 36) and control group (n = 36). The patients in the two groups were divided into two groups: sex, age, course of disease, combined diseases, basic medication, total score of TCM symptoms. There was no statistical difference and comparability between the symptom scores of each item and the statistical software analysis on the related laboratory examination. The two groups were treated with routine western medicine, but the treatment group was treated with the decoction of regulating liver and invigorating spleen and tonifying yang. After 14 days of continuous administration, the two groups of patients were treated with TCM symptom efficacy, TCM symptom score, nitroglycerin reduction rate, total effective rate of electrocardiogram (ECG), hypersensitive C-reactive protein (High sensitivity C reactive protein hs-CRP). The changes of tumor necrosis factor-伪 (Tumor Necrosis Factor alpha TNF- 伪 and interleukin-6 (Interleukin-6 IL-6) were evaluated. Results: after 14 days of clinical observation, through statistical analysis of the indicators, the results show that: 1, in improving the efficacy of TCM symptoms: the treatment group effective rate of 38.2, the total effective rate of 88.2um, The effective rate of the control group was 19.4% and the total effective rate was 72.2%. The difference between the two groups was statistically significant (P0.05), and the treatment group was better than the control group (P < 0.05). The scores of TCM symptoms and symptoms in the two groups were significantly improved after treatment (P0.01). After treatment, the total score and chest tightness, palpitations, tiredness, fatigue, good information were improved in the treatment group, and there was no significant difference between the two groups in the scores of TCM symptoms and symptoms (P0.01). The improvement of oral bitter symptoms was better than that of the control group (P0.05), but there was no statistical difference between the two groups (P0. 155). 3. In the treatment group, the reduction rate of nitroglycerin was 82.4%, while in the control group it was 50%. The difference between the two groups was statistically significant. The treatment group was better than the control group. 4. The total effective rate of electrocardiogram in the treatment group and the control group was 76. 5% and 66. 7%, respectively. The total effective rate of the treatment group was better than that of the control group, but there was no significant difference between the two groups (P0.05). The level of IL-6 was significantly lower than that before treatment (P0.01). After treatment, compared with the two groups of hs-CRP, P0. 039 (P0.05), the treatment group was better than the control group; There was no significant difference in TNF- 伪 and IL-6 between the two groups (P0.05, P 0.05). 6. Safety: there was no significant difference between the two groups in laboratory indexes before and after treatment, and no adverse reactions were found in the two groups. Both groups were safe in the treatment period. Conclusion: Tiaogan Jianpi Tongyang prescription combined with western medicine in treating stable angina pectoris with liver stagnation and spleen deficiency, chest and yang obstruction can further improve the clinical symptoms, TCM symptoms, nitroglycerin stopping and decreasing rate, and hs-CRP, is safe during the treatment period. It is worthy of clinical application and further study.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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