麝香保心丸治疗维持性血液透析患者无症状心肌缺血的疗效观察

Clinical effect of heart-protecting musk pill on silent myocardial ischemia in patients undergoing maintenance hemodialysis

目的 观察麝香保心丸治疗维持性血液透析患者无症状心肌缺血的临床疗效,探讨其作用机制.方法 78例维持性血液透析并发无症状心肌缺血患者按随机数字表法分为对照组（38例）和麝香保心丸组（40例）.78例患者达到充分透析标准后,对照组给予常规治疗.麝香保心丸组在对照组治疗基础上加服麝香保心丸45 mg,3次/d；2组疗程均为2个月.2组治疗前后于透析前1天测量血压、心率,查血清肌酐、尿素氮、空腹血糖、TC、TG、HDL-C、LDL-C、高敏C反应蛋白（hs-CRP）、白细胞介素（IL）-6和血常规,并于治疗前后透析前完成24h动态心电图监测,记录患者心肌缺血发作次数和心肌缺血持续时间.结果 ①治疗后麝香保心丸组和对照组患者血清hs-CRP、IL-6水平较治疗前均明显降低[（4.7±1.5）mg/L比（9.7±4.2）mg/L,（5.7±1.5）mg/L比（9.8±4.4） mg/L; （53±24） ng/L比（88±28） ng/L,（67±26） ng/L比（ 89±27） ng/L,均P＜0.01]；麝香保心丸组降低更明显,2组比较差异有统计学意义（P＜0.01）.②治疗后麝香保心丸组和对照组患者无症状心肌缺血发作次数减少[（14.7±4.7）次/24 h比（22.8±7.8）次/24 h,（18.7±5.8）次/24 h比（23.5±6.9）次/24 h]、缺血持续时间明显缩短[（65.4±15.2） min比（128.1±37.3）min,（78.6±13.8）min比（131.1±35.4）min],麝香保心丸组改善更明显,2组之间差异有统计学意义（P＜0.01）.③治疗后患者收缩压明显降低（P＜0.05）,但2组之间差异均无统计学意义（P＞0.05）；舒张压、心率、血脂、空腹血糖、肌酐水平及贫血程度有所改善,但2组之间差异无统计学意义（P＞0.05）.结论 麝香保心丸治疗维持性血液透析患者无症状心肌缺血具有良好的临床疗效,机制可能与抑制炎症反应有关.

Objective To investigate the clinical effect of heart-protecting musk pill （HMP） on silent myocardial ischemia （SMI） in maintenance hemodialysis patients.Methods Seventy-eight maintenance hemodialysis patients with SMI were randomly divided into HMP group （n =40; reated with HMP） and control group （n =38;treated with aspirin,metoprolol,valsartan,amlodipine besylate and fluvastatin）.The therapeutic course was two months.The serum level of Blood urea nitrogen （ BUN ）,creatinine （ CRE ）,glucose （GLU）,total cholesterol （TC）,triglyceride（ TG）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein（ LDL-C）,high sensitive C reactive protein（hs-CRP）,interleukin 6（IL-6） and red-cell count and hemoglobin were detected before and after treatment.The changes of SMI were observed by dynamic electrocardiogram.Results ①After therapy,the level of hs-CRP and IL-6 decreased markedly in HMP group and control group[ （4.7 ± 1.5）mg/L vs （9.7 ±4.2）mg/L,（ 5.7 ± 1.5 ） mg/L vs （ 9.8 ± 4.4） mg/L; （ 53 ± 24） ng/L vs （ 88 ± 28 ） ng/L,（ 67 ± 26 ） ng/L vs （ 89 ± 27 ） ng/L,P〈0.01 ],but it decreased more significantly in HMP group than in routine groups（ P 〈 0.01 ）.②Frequency and lasted time of SMI were decreased significantly in two groups （P 〈 0.01 ） after treatment,but it decreased more significantly in HMP group （ P 〈0.01 ）.③ Systole blood pressure were decreased significantly after treatment in two groups （ P 〈 0.05 ）.The level of TC,TG,LDL-C,HDL-C,BUN,CRE,FPG,red-cell count and hemoglobin were not significant different between two groups before and after treatment （ P 〉 0.05 ）.Conclusion HMP improves SMI in maintenance hemodialysis patients and the mechanism may be associated with the suppression of inflammatory response.