黄芪保心汤治疗冠心病心绞痛的临床观察

Clinical observation of Huangqi Baoxin Decoction in treating patients with coronary heart disease and angina pectoris

目的:观察黄芪保心汤治疗冠心病心绞痛的临床疗效,并探讨其相关作用机制。方法:纳入痰瘀互结证冠心病心绞痛患者126例,随机分为治疗组和对照组,每组各63例。对照组患者给予西医常规治疗,治疗组患者在西医常规治疗基础上加服黄芪保心汤,两组治疗周期均为8周。评价两组患者的中医证候疗效;检测患者的血浆黏度、红细胞压积、全血低切黏度、全血高切黏度、纤维蛋白原(Fg)等血液流变学指标,检测天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及血浆内皮素(ET)、血栓素B2(TXB2)、前列腺素F1α(PGF1α)水平。结果:治疗后,治疗组的中医证候疗效总有效率为90.48%,对照组为84.13%,治疗组疗效优于对照组(P<0.05)。治疗后,治疗组患者的血浆黏度、红细胞压积、全血低切黏度、全血高切黏度、Fg水平均明显降低(P<0.05,P<0.01),对照组患者的全血低切黏度、Fg水平亦明显降低(P<0.05,P<0.01),且治疗组患者的血浆黏度、全血低切黏度、全血高切黏度水平低于对照组(P<0.01)。治疗后,两组患者的CK-MB、CK、LDH水平均显著降低(P<0.05,P<0.01),治疗组患者的AST水平亦降低(P<0.01),且治疗组患者的CK-MB、CK、LDH、AST水平低于对照组(P<0.05,P<0.01);治疗后,两组患者的TXB2、ET水平均显著降低(P<0.01),PGF1α水平升高(P<0.01),且治疗组患者的TXB2、ET水平低于对照组(P<0.05),PGF1α水平高于对照组(P<0.01)。结论:黄芪保心汤结合西医常规疗法治疗痰瘀互结证冠心病心绞痛患者,能够较好改善患者的中医证候,降低患者的心肌酶水平,减轻心肌细胞损伤,其作用机制可能与改善患者的血液流变学,提高血浆PGF1α及降低TXB2、ET水平有关。

Objective: To observe the clinical efficacy of Huangqi Baoxin Decoction in treating patients with coronary heart disease( CHD) and angina pectoris,and explore its related mechanisms. Methods: One hundred and twenty-six patients of CHD and angina pectoris with syndrome of intermingled phlegm and blood stasis were selected and randomly divided into the treatment group and the control group,63 cases in each group. The patients in the control group were treated with conventional western medical therapy,and the patients in the treatment group were treated with Huangqi Baoxin Decoction on the basis of conventional western medical therapy,with a course of 8 weeks. The efficacy of Chinese medical syndrome in both groups was evaluated,and the indexes of hemorheology including plasma viscosity,hematocrit,whole blood low shear viscosity,whole blood high shear viscosity and fibrinogen( Fg),the indexes of myocardial enzyme including aspartate aminotransferase( AST),creatine kinase( CK),creatine kinase isoenzyme( CK-MB) and lactate dehydrogenase( LDH),and the plasma levels of endothelin( ET),thromboxanes B2( TXB2) and prostaglandin F1α( PGF1α) were detected. Results: After treatment,the total effective rates of Chinese medical syndrome in the treatment group and the control group were90.48% and 84. 13% respectively,and the efficacy of the treatment group was better than that of the control group( P<0.05). After treatment,the levels of plasma viscosity,hematocrit,whole blood low shear viscosity,whole blood high shear viscosity and Fg in the treatment group were significantly decreased( P<0.05,P<0.01),the levels of whole blood low shear viscosity and Fg in the control group were also significantly decreased( P<0.05,P<0.01),and the levels of plasma viscosity,whole blood low shear viscosity and whole blood high shear viscosity in the treatment group were lower than those in the control group( P<0.01). After treatment,the levels of CK-MB,CK and LDH in both groups were significantly decreased( P<0.05,P<0.01),the level of AST in the treatment group was also decreased( P<0.01),and the levels of CK-MB,CK,LDH and AST in the treatment group were lower than those in the control group( P<0.05,P<0.01). After treatment,the levels of TXB2 and ET were significantly decreased in both groups( P<0.01),and the level of PGF1α was increased( P<0.01). The levels of TXB2 and ET in the treatment group were lower than those in the control group( P<0.05),and the level of PGF1α in the treatment group was higher than that in the control group( P<0.01). Conclusion: Huangqi Baoxin Decoction combined with conventional western medical therapy can better improve the Chinese medical syndrome,decrease the levels of myocardial enzymes and reduce the myocardial cell damage in the treatment of CHD and angina pectoris with syndrome of intermingled phlegm and blood stasis. Its mechanisms may be related to improving the hemorheology,increasing the plasma level of PGF1α and decreasing the levels of TXB2 and ET.