心可舒联合脉血康对二磷酸腺苷诱导的血小板聚集率偏高的冠心病患者的疗效

Effect of maixuekang capsule and Xinkeshu tablet on high platelet aggregation index and prognosis in patients with coronary heart disease under percutaneous coronary intervention

目的研究心可舒联合脉血康胶囊对经皮冠状动脉介入治疗(PCI)术后二磷酸腺苷(ADP)介导血小板聚集率偏高患者的疗效,探讨心可舒联合脉血康胶囊对ADP介导血小板聚集率、高敏C-反应蛋白(hs-CRP)、血脂、临床症状及预后的影响。方法采用前瞻性随机对照研究,连续入选2011年4～9月在首都医科大学附属北京安贞医院住院PCI术后的患者60例,其中男38例,女22例,所有患者均为冠心病单支病变,ADP介导血小板聚集率偏高(>50%),被随机分为治疗组(TG,n=30)和对照组(CG,n=30),CG组患者口服氯吡格雷,150 mg/次,1次/d;西洛他唑100 mg/次,2次/d;瑞舒伐他汀片10 mg/次,1次/d等西医常规治疗方法。TG组在CG组治疗方案的基础上加用脉血康胶囊每次4粒,每日3次口服;心可舒片每次4片,每日3次口服;均连续治疗6个月。两组在性别、年龄等一般资料差异无统计学意义,具有可比性。检测其治疗前及治疗后6个月的ADP介导血小板聚集率水平、血清hs-CRP浓度及血脂等指标,同时进行6个月临床随访,记录心脑血管事件的发生情况。结果经治疗6个月后TG组的ADP介导血小板聚集率水平明显低于CG组[(50.85±14.37)%vs.(60.26±14.35)%,P=0.01];治疗组血清hs-CRP明显低于对照组[(5.02±1.25)mg/L vs.(6.89±1.63)mg/L,P=0.02];治疗组的血脂(TG、TC、LDL)与对照组比较显著降低,TG[(0.9±0.32)mmol/L vs.(1.43±0.23)mmol/L,P=0.03],TC[(3.05±0.76)mmol/L vs.(3.51±0.71)mmol/L,P=0.01],LDL-C[(2.32±0.71)mmol/L vs.(2.83±0.54)mmol/L,P=0.03];而治疗组HDL较对照组升高,HDL-C[(1.45±0.24)mmol/L vs.(1.26±0.24)mmol/L,P=0.03]。TG组再发心肌梗死率和再住院率均显著低于CG组(3.3%vs.10.0%,13.3%vs.30.0%,P<0.05);两组差异有统计学意义;而且TG组心绞痛症状缓解的总有效率明显高于CG组(96.7%vs.83.3%,P<0.05);TG组心电图改善的总有效率明显高于CG组(93.3%vs.76.7%,P<0.05)。结论心可舒联合脉血康胶囊显著改善PCI术后ADP介导血小板聚集率偏高患者的临床预后。两药联合治疗可能是该组冠心病患者治疗的新选择。

Objective To study effect of maixuekang capsule and Xinkeshu tablet on high platelet aggregation index and prognosis in patients with coronary heart disease under percutaneous coronary intervention(PCI).To discuss the effect of maixuekang capsule and Xinkeshu tablet on ADP-induced platelet aggregation,high-sensitive C-reactive protein(hs-CRP),blood lipid,the clinical symptoms and prognosis.Methods The randomly compared researching method was used,sixty consecutive patients with coronary heart disease under PCI were randomized into treatment group(TG,n=30)and control group(CG,n=30).The CG group was administered with clopidogrel(150 mg for once per day),cilostazol(100 mg for tiwce per day),rosuvastatin calcium tablets(10 mg for once per day),under western medicine routine therapy.The treatment group was administered with maixuekang(4 capsules for three times per day)and xinkeshu tablet(4 capsules for three times per day),on the basis of western medicine treatment regimens.Two groups were treated for 6 months continuously.There were no statistical differences in the basic clinical characteristics between both groups.Adenosine diphosphate(ADP)-induced platelet aggregation index,hs-CRP,lipid were observed in 6 months.Adverse cardiocerebrovascular events were recorded with six-month clinical following up.Results ADP-induced platelet aggregation index,lipid and hs-CRP concentration were significantly decreased after six-month treatment with maixuekang capsule and Xinkeshu tablet,as follows,ADP-induced platelet aggregation index[(50.85±14.37)% vs.(60.26±14.35)%,P=0.01];hs-CRP[(5.02±1.25)mg/L vs.(6.89±1.63)mg/L,P=0.02].The treatment group of blood lipid(TG,TC,LDL)compared with controls significantly reduced,TG[(0.9±0.32)mmol/L vs.(1.43±0.23)mmol/L,P=0.03],TC[(3.05±0.76)mmol/L vs.(3.51±0.71)mmol/L,P=0.01],LDL-C[(2.32±0.71)mmol/L vs.(2.83±0.54)mmol/L,P=0.03];and HDL in TG was higher than CG,HDL-C[(1.45±0.24)mmol/L vs.(1.26±0.24)mmol/L,P=0.03].And in the meanwhile,during the course of clinical following up,the incidence of adverse cardiocerebrovascular events was much lower in TG group than in CG group,myocardial infarction(3.3% vs.10.0%,P<0.05),rehospitalization rate(13.3% vs.30.0%,P<0.05),angina symptoms and electrocardiogram(ECG)had been improved obviously,the effective rate of angina symptoms(96.7% vs.83.3%,P<0.05),the effective rate of ECG(93.3% vs.76.7%,P<0.05).Conclusions Maixuekang capsule and Xinkeshu tablet improved the prognosis of patients after PCI with high adenosine diphosphate(ADP)-induced platelet aggregation index probably by inhibiting platelet aggregation,targeting inflammation and ameliorating vascular endothelial function.