温胆汤对急性冠脉综合征经皮冠状动脉介入术后患者脂蛋白磷脂酶A2的影响

Effect of Wendan Decoction on Lipoprotein Phospholipase A2 in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

【目的】探讨温胆汤对痰浊瘀阻型急性冠脉综合征(ACS)经皮冠状动脉介入(PCI)术后患者的治疗效果及其潜在作用机制。【方法】将200例痰浊瘀阻型ACS的PCI术后合并高脂血症、高尿酸血症的患者随机分为常规治疗组和温胆汤治疗组,每组各100例;另选取60例同期接受治疗的非ACS患者作为正常对照组。常规治疗组给予西医常规治疗,温胆汤治疗组在常规治疗组的基础上给予温胆汤加减治疗,疗程为4周。评估2组ACS患者的临床疗效,并观察各组患者血浆脂蛋白磷脂酶A2(Lp-PLA2)、低密度脂蛋白胆固醇(LDL-C)和尿酸(UA)水平的变化情况。【结果】(1)治疗过程中,常规治疗组脱落4例,实际纳入96例;温胆汤治疗组脱落7例,实际纳入93例。(2)心电图疗效方面:治疗后,温胆汤治疗组的总有效率为82.8%(77/93),常规治疗组为69.8%(67/96),组间比较,温胆汤治疗组的心电图疗效优于常规治疗组,差异有统计学意义(P<0.05)。(3)心绞痛疗效方面:治疗后,温胆汤治疗组的总有效率为91.4%(85/93),常规治疗组为79.2%(76/96),组间比较,温胆汤治疗组的心绞痛疗效优于常规治疗组,差异有统计学意义(P<0.05)。(4)治疗前,2组ACS组患者血浆Lp-PLA2、LDL-C、UA水平比较,差异均无统计学意义(P>0.05),均明显高于正常对照组水平(P<0.05)。治疗后,2组ACS组患者的血浆Lp-PLA2、LDL-C、UA水平均较治疗前明显降低(P<0.05),且温胆汤治疗组对血浆Lp-PLA2、LDL-C、UA水平的降低作用均明显优于常规治疗组,差异均有统计学意义(P<0.05)。【结论】ACS患者的血浆Lp-PLA2水平明显升高;温胆汤在痰浊瘀阻型ACS的PCI术后患者的临床治疗中疗效确切,其机制可能与降低血浆LDL-C、UA及Lp-PLA2水平有关。

Objective To investigate the therapeutic effect and the potential mechanism of Wendan Decoction for the treatment of patients with acute coronary syndrome(ACS)of turbid phlegm and blood stasis obstruction type after percutaneous coronary intervention(PCI).Methods A total of 200 ACS patients of turbid phlegm and blood stasis obstruction type and complicated with hyperlipidemia and hyperuricemia after PCI were randomly divided into conventional treatment group and Wendan Decoction treatment group,with 100 cases in each group.Another60 non-ACS patients who received treatment at the same time were selected as the normal control group.The conventional treatment group was given western medicine conventional treatment,while the Wendan Decoction treatment group was given modified Wendan Decoction orally together with western medicine conventional treatment.The course of treatment covered 4 weeks.The clinical efficacy in the two groups was evaluated,and the changes of plasma lipoprotein phospholipase A2(Lp-PLA2),low-density lipoprotein cholesterol(LDL-C)and uric acid(UA)levels in each group were observed.Results(1)During the treatment,4 patients in the conventional treatment group fell off,and a total of 96 patients were included.In Wendan Decoction treatment group,7 cases fell off,and a total of 93 cases were included.(2)Electrocardiography(ECG)efficacy:after treatment,the total effective rate of Wendan Decoction treatment group was 82.8%(77/93),and that of the conventional treatment group was 69.8%(67/96).The intergroup comparison showed that the ECG efficacy of Wendan Decoction treatment group was superior to that of the conventional treatment group,the difference being statistically significant(P<0.05).(3)Angina pectoris efficacy:after treatment,the total effective rate of Wendan Decoction treatment group was 91.4%(85/93),and that of the conventional treatment group was 79.2%(76/96).The intergroup comparison showed that the angina pectoris efficacy of Wendan Decoction treatment group was superior to that of the conventional treatment group,the difference being statistically significant(P<0.05).(4)Before treatment,there were no significant differences in plasma Lp-PLA2,LDL-C and UA levels in the two groups of ACS patients(P>0.05),and the levels in the two groups of ACS patients were significantly higher than those in the normal control group(P<0.05).After treatment,the levels of plasma Lp-PLA2,LDL-C and UA in the two groups of ACS patients were significantly decreased compared with those before treatment(P<0.05),and the effect of Wendan Decoction on decreasing plasma Lp-PLA2,LDL-C and UA was significantly superior to that of conventional treatment group,the differences being statistically significant(P<0.05).Conclusion The plasma Lp-PLA2 level of ACS patients is increased significantly.Wendan Decoction exerts certain curative effect for the treatment of ACS patients of turbid phlegm and blood stasis obstruction type after PCI,and its mechanism may be related to the reduction of plasma LDL-C,UA and Lp-PLA2 levels.