解毒活血方对非ST段抬高型急性冠状动脉综合征瘀毒证患者血清Lp-PLA2、TNF-α、PIGF表达水平的影响

Effect of Jiedu Huoxue Decoction(解毒活血方)in the Treatment of Non-ST Segment Elevation Acute Coronary Syndrome with Syndrome of Stasis-Toxin and Influence on Expression Levels of Serum Lp-PLA2,TNF-α,PIGF

目的观察解毒活血方治疗非ST段抬高型急性冠状动脉综合征(NSTE-ACS)瘀毒证患者的临床疗效及对血清脂蛋白磷脂酶A2(Lp-PLA2)、肿瘤坏死因子-α(TNF-α)、胎盘生长因子(PIGF)表达水平的影响。方法选取2018年10月—2019年12月于阜新市第二人民医院心血管内科就诊的116例NSTE-ACS瘀毒证患者作为研究对象,采用随机数字表法将其分为中医综合治疗组和常规西药对照组,每组各58例。常规西药对照组予替格瑞洛片口服,中医综合治疗组联合解毒活血方口服,两组患者均连续治疗4周。比较两组患者的中医证候积分、心肌酶谱指标水平、心绞痛发作情况、主要不良心血管事件(MACE)发生情况以及血清Lp-PLA2、TNF-α、PIGF水平。结果治疗结束后,中医综合治疗组临床有效率(89.65%)明显高于常规西药对照组(74.14%),差异比较具有统计学意义(P<0.05)。治疗结束后,两组患者的中医证候积分、心绞痛发作持续时间与心绞痛发作频率、心肌酶谱指标水平以及血清Lp-PLA2、TNF-α、PIGF水平均较治疗前明显降低(P<0.05);且中医综合治疗组对NSTE-ACS瘀毒证患者上述指标的下降程度明显优于常规西药对照组(P<0.05)。治疗结束后,两组患者的缺血性胸痛再入院、急性心肌梗死、心源性休克、心力衰竭、全因性死亡发生率比较,差异无统计学意义(P>0.05),中医综合治疗组总MACE事件发生率(3.45%)显著低于常规西药对照组(22.41%),差异具有统计学意义(P<0.05)。结论解毒活血方治疗NSTE-ACS瘀毒证患者临床疗效显著,可有效改善中医症状、心绞痛发作持续时间与发作频率,降低心肌酶谱指标与MACE发生率,亦可降低血清Lp-PLA2、TNF-α、PIGF水平以抑制炎症反应,临床应用安全性较高,具有一定的推广价值。

Objective To observe the clinical efficacy of Jiedu Huoxue Decoction(解毒活血方,JDHXD)in the treatment of non-ST segment elevation acute coronary syndrome(NSTE-ACS)with syndrome of stasis-toxin and influence on expression levels of lipoprotein phospholipase A2(Lp-PLA2),tumor necrosis factor-α(TNF-α)and placental growth factor(PIGF)in serum.Methods 116 patients of NSTE-ACS with syndrome of stasis-toxin in the cardiovascular department of Fuxin second people's hospital from October 2018 to December 2019 were randomly divided into TCM comprehensive treatment group and conventional western medicine control group,58 cases in each group.The conventional Western medicine control group was treated with Ticagrelor Tablets.The TCM comprehensive treatment group combined with JDHXD.Patients in two groups were treated for 4 weeks.The TCM syndrome score,myocardial enzyme,the incidence of angina pectoris,the incidence of major adverse cardiovascular events(MACE)and serum Lp-PLA2,TNF-α,PIGF levels were compared between the two groups.Results After treatment,the clinical effective rate of TCM comprehensive treatment group(89.65%)was significantly higher than that of the conventional Western medicine control group(74.14%)(P<0.05).After treatment,the TCM syndrome score,the degree of the frequency and duration of angina pectoris,myocardial enzyme and serum Lp-PLA2,TNF-α,PIGF levels of the two groups were significantly lower than those before treatment(P<0.05);and the decline degree of the above indicators in the TCM comprehensive treatment group was significantly better than those of the conventional Western medicine control group(P<0.05).After treatment,the incidence of ischemic chest pain readmission,acute myocardial infarction,cardiogenic shock,heart failure and all-cause death between two groups were no significant difference(P>0.05);the incidence of MACE in the TCM comprehensive treatment group(3.45%)was significantly lower than that of the conventional Western medicine control group(22.41%)(P<0.05).Conclusion JDHXD has significant clinical effect in the treatment of NSTE-ACS with syndrome of stasis-toxin,which can effectively improve symptoms and the degree of the frequency and duration of angina pectoris,reduce myocardial enzyme and the incidence of MACE,and also reduce the serum levels of Lp-PLA2,TNF-α,PIGF to inhibit the inflammatory reaction.Its clinical application is safe and has certain promotion value.