丹参多酚酸盐治疗老年不稳定型心绞痛的疗效与机制研究

Study on curative effect and mechanisms of Salvianolate in treatment for unstable angina pectoris in elder patients

目的研究丹参多酚酸盐治疗老年不稳定型心绞痛(UAP)的临床疗效以及对血清细胞因子水平的影响。方法选择18例健康老年人为正常对照组,将63例老年UAP患者随机分为丹红注射液治疗组(丹红组)及丹参多酚酸盐治疗组(丹参多酚酸盐组),观察治疗前后心绞痛疗效、常规心电图ST改变、血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及肝肾功能等指标的变化,同时观察药物不良反应。结果丹红组和丹参多酚酸盐组心绞痛症状、缺血心电图均明显改善(P均<0.05),2组治疗后均未见明显不良反应。治疗前患者血清IL-1、IL-6和TNF-α水平较正常对照组明显升高(P均<0.01),丹红组治疗后血清IL-1、IL-6和TNF-α较治疗前降低(P均<0.05),丹参多酚酸盐组的上述3种细胞因子水平均较治疗前明显降低(P<0.01),且TNF-α下降程度优于丹红组(P<0.05)。结论IL-1、IL-6和TNF-α可能不同程度参与老年UAP的病理生理进程。丹红注射液和丹参多酚酸盐均能缓解老年UAP患者的症状,改善心肌缺血,所用治疗剂量安全有效;且能显著降低IL-1I、L-6和TNF-α水平,而且丹参多酚酸盐的降低TNF-α作用较丹红注射液显著,此可能是两者的免疫药理学机制及其差别之一。

objective It is to explore the clinical curative effect of Salvianolate on elder unstable angina pectoris（UAP）,and its effect on serum cytokines.Methods 18 healthy elders were chosen as normal control group.63 elder patients with UAP were divided randomly into therapy group treated with Danhong injection（Danhong group） and treatment group treated with Salvianolate（Salvianolate group）.The curative effect on angina pectoris,ST segment changes of ECG and changes of indexes such as IL-1,IL-6,TNF-α and liver-kidney function were observed before and after therapy.Meanwhile,side effects of the drugs were observed.Results Symptoms of angina pectoris and ischemic ECG were all obviously improved in Danhong group and Salvianolate group（P0.05） without significant side effect after treatment.The levels of serum IL-1,IL-6 and TNF-α in the patients with UAP were higher than that in the control group（P0.01）,and the levels were all decreased after treatment in both Danhong group（P0.05） and Salvianolate group（P0.01） with more significant effect in the inhibiting degree of TNF-α in the salvianolate group compared with Danhong group（P0.05）.Conclusion It suggests that IL-1,IL-6 and TNF-α may involve in the pathophysiology development of unstableangina pectoris in the elderly,and both Danhong injection and Salvianolate can relieve clinical symptoms and myocardial ischemia without significant side effect,and can low down the levels of IL-1,IL-6 and TNF-α significantly.One of the immunological mechanisms of the two agents may be by lowering the secretion of the three cytokins with more significant inhibiting effect of Salvianolate on the expression of TNF-α.