丹参片在冠状动脉支架介入治疗后应用的初步观察

Preliminary observation on oral DanShenPian after coronary artery stenting

目的观察丹参片与抗血小板药物联合应用对冠状动脉支架介入治疗后血栓等术后冠状动脉事件的预防作用。方法选择支架植入成功的冠心病患者82例,随机分为治疗组(42例)和对照组(40例),两组均服用支架植入术常规用抗血小板药,治疗组加用丹参片,每次4片,每日3次。采用双缩尿法、激光散射比浊法和流式细胞术检测两组患者行支架植入术前、术后即刻和术后30 d时的血浆纤维蛋白原(Fg)、C反应蛋白(CRP) 和血小板膜糖蛋白((3P)Ⅱb／Ⅲa、P选择素(CD62P)的变化。结果与对照组比较,治疗组血浆CRP显著下降 (P<0．05),GPⅡb／Ⅲa和CD62P也有降低的趋势。经6个月临床随访,治疗组心绞痛复发5例(11．9%),未发生支架术后再狭窄;对照组心绞痛复发21例(52．5％),支架术后再狭窄9例,心肌梗死3例;治疗组心绞痛复发率显著低于对照组(P<0．05)。结论丹参片与抗血小板药联合应用能预防冠状动脉支架血栓等术后冠状动脉事件,且疗效优于单用抗血小板药。

Objective To appraise the preventive effect of antiplatelet regimen combined with DanShenPian （DSP）on coronary artery thrombosis after coronary stenting. Methods 82 patients with successful implantation of coronary stenting were randomly allocated into treated group （n = 42） and control group （n = 40）. The treated group received DSP and antiplatelet therapy, whereas the control group received antiplatelet regimen only. Platelet activation was assessed before and immediately after stenting by flow cytometry measurement of CD62 P （P-selectin） expression and glycoprotein（GP） Ⅱ b/Ⅲ a receptor. These were reassessed on the thirtieth day after stenting. Plasma fibrinogen （Fg） and C-reaction protein （CRP） were measured by biuret and laser scattering turbidimetry respectively at the same time. Results Comparing with the control group, plasma CRP was markedly reduced （P〈0.05） in the treated group with also a tendency of decrease of plasma （GP） Ⅱ b/Ⅲ a, CD62P. Survey after six-month follow-up found 11.9% relapse of angina pectoris with one in-stent restenosis proved by angiograpm in the treated group, but the relapse of angina pectoris in the control group was 52.5% with 3 cases of myocardial infarction, 9 cases of in-stent restenosis proven by angiogram and one died. Conclusion Combination of DSP and antiplatelet regimen can prevent coronary events including stent thrombosis which is superior to antiplatelet treatment only.