大柴胡汤加减治疗痰浊血瘀型动脉粥样硬化临床前期病变的临床疗效及作用机制

Clinical efficacy and mechanism of Dachaihu Decoction in the treatment of phlegm and blood stasis type PCA

目的基于治未病理论探究大柴胡汤加减治疗痰浊血瘀型动脉粥样硬化临床前期病变(PCA)的临床疗效及对血清中血清亲环素A(CyPA)、基质金属蛋白酶9(MMP-9)水平的影响。方法采用随机对照方法收集我院痰浊血瘀型动脉粥样硬化临床前期病变(PCA)患者44例,将其分为安慰剂对照组20例,中药干预组24例;对照组采用生活方式干预+中药颗粒模拟剂,2袋日2次口服;中药干预组采用生活方式干预+大柴胡汤加减的颗粒剂,2袋日2次口服。比较两组治疗前后的疗效改善情况、临床生化血清学指标的变化,并对两组进行生存质量评价。结果治疗后,中药干预组临床总有效率为83.3%(20/24),对照组临床总有效率为45.0%(9/20),中药干预组临床总有效率高于对照组(P<0.05)。两组治疗后症状均有所改善(P<0.05);中药干预组治疗后心悸[(153.6±10.3)分vs(190.0±14.2)分]、乏力[(132.3±7.1)分vs(153.8±8.8)分]积分明显低于对照组(均P<0.05)。两组治疗后生活评分均有所改善,中药干预组生存质量评分明显高于对照组(均P<0.05)。对照组和中药干预组各项结果与治疗前比较,均有所改善,其中血脂代谢类指标变化显著(P<0.05),中药干预组血脂代谢类指标水平与对照组比较改善更为明显(P<0.05)。两组治疗后CyPA、MMP-9指标水平均下降,两组组内比较差异均有统计学意义(均P<0.05),治疗后中药干预组与对照组组间比较差异均有统计学意义(均P<0.05)。结论大柴胡汤加减联合生活方式干预治疗PCA效果显著,能够通过有效改善患者生存质量、血清生化学指标、CyPA、MMP-9等达到既病防变之治疗目的。

Objective To explore the clinical effect of Dachaihu Decoction on the treatment of preclinical lesions(PCA)of phlegm and blood stasis type atherosclerosis based on the theory of treating diseases,and its effect on serum cyclophilin A(CyPA)and matrix metalloproteinase 9(MMP-9).Methods A randomized controlled method was used to collect 44 patients with preclinical atherosclerotic lesions(PCA)of phlegm,turbidity and blood stasis in our hospital,and divided them into placebo control group of 20 patients and Chinese medicine intervention group of 24 patients.Mode intervention+Chinese medicine granule mimics,2 bags daily orally;the Chinese medicine intervention group was treated with lifestyle intervention+Dachaihu decoction granules,2 bags daily orally.The improvement of the curative effect before and after treatment,the level of clinical biochemical serological indicators were compared,and the quality of life of the two groups was evaluated.Results After treatment,the total clinical effective rate of the Chinese medicine intervention group was 83.3%(20/24)and that of the control group was 45.0%(9/20).The total clinical effective rate of the Chinese medicine intervention group was higher than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the symptoms of both groups were improved,and the difference within the group was statistically significant(P<0.05);palpitations[(153.6±10.3)points(190.0±14.2)points],fatigue after treatment in the Chinese medicine intervention group[(132.3±7.1)score(153.8±8.8)points].The score was significantly lower than the control group,and the differences were statistically significant(all P<0.05).After treatment,the life scores of the two groups were improved.The quality of life score of the Chinese medicine intervention group was significantly higher than that of the control group,and the differences were statistically significant(both P<0.05).The results of the control group and the Chinese medicine intervention group were improved compared with those before treatment.The blood lipid metabolism indexes changed significantly and the difference was statistically significant(P<0.05).The blood lipid metabolism indexes of the Chinese medicine intervention group were compared with the control group.The improvement was more obvious,and the difference was statistically significant(P<0.05).The levels of CyPA and MMP-9 decreased after treatment in the two groups.The differences between the two groups were statistically significant(both P<0.05).After treatment,the differences between the Chinese medicine intervention group and the control group were statistically significant(Both P<0.05).Conclusion Dachaihu Decoction combined with lifestyle interventions for pre-clinical atherosclerotic lesions(PCA)has a significant effect.It can effectively improve the quality of life,serum biochemical indicators,CyPA,MMP-9,etc.purpose.