温阳活血方治疗急性冠状动脉综合征不稳定型心绞痛42例临床研究

Clinical Study on Wenyang Huoxue Formula for Treating 42 Patients with Unstable Angina Pectoris of Acute Coronary Syndrome

目的 观察温阳活血方治疗急性冠状动脉综合征(ACS)不稳定型心绞痛的疗效并探讨其作用机制。方法 将86例ACS不稳定型心绞痛阳虚血瘀证患者随机分为治疗组42例及对照组44例。对照组给予西药常规治疗,治疗组在西药常规治疗的同时加用温阳活血方。观察并记录两组患者治疗前和治疗后1周、2周、3周、4周临床症状、体征、中医证候积分及实验室指标,随访1个月。结果 治疗后两组临床症状水平和症状积分与治疗前比较均明显改善(P<0.05或P<0.01);且治疗组临床疗效优于对照组;治疗后治疗组肌红蛋白水平较治疗前降低(P<0.05);血栓素B2(TXB2)、6-酮-前列腺素F1α(6-keto-PGF1α)水平与治疗前比较改善明显(P<0.05),且治疗组在降低TXB2水平及升高6-keto-PGF1α方面优于对照组(P<0.05)。治疗过程及随访中,两组患者均未发现心率、心律、血压等的药物性异常变化及血常规、尿常规、肝功能、肾功能的改变(P>0.05)。结论 温阳活血方治疗ACS不稳定型心绞痛安全有效,可明显改善患者的临床症状,其治疗机制可能是通过调节血管内皮功能发挥作用。

Objective To study the effect and mechanism of Wenyang Huoxue Formula （Formula for warming yang and activating blood circulation） on the unstable angina pectoris of acute coronary syndrome （ACS）. Methods Eighty-six cases of unstable angina pectoris of ACS in TCM syndrome of yang deficiency with blood stasis were randomized into treatment group, 42 cases, and control group, 44 cases. Both groups were treated with standard management, and the treatment group was administered Wenyang Huoxue Formula additionally. The clinical symptoms and signs, scores of TCM syndromes and laboratory indexes were observed and recorded before treatment and 1 week, 2 weeks, 3 weeks, and 4 weeks after treatment, and 1 month＇s follow-up was given. Results After treatment, the clinical symptoms and symptom scores of both groups were significantly improved （P〈0.05 or P0.01）, and the clinical curative effect of the treatment group was better than that of the control group. After treatment, the level of myohemoglobin in the treatment group was reduced （P〈0.05）. The levels of thromboxane B2 （TXB2） and 6-keto-prostaglandin F1α （6-keto-PGF1α） in the treatment group were significantly improved compared with before treatment （P〈0.05）, and the improvement of the treatment group was superior （P〈0.05）. In the duration of treatment and follow-up, there were no drug-induced changes of heart rate and rhythm, blood pressure, abnormal changes in routine blood and urine examinations, and liver and kidney functions of the patients of the two groups. Conclusion Wenyang Huoxue Formula is safe and effective in treating unstable angina pectoris of ACS, and it improves the clinical symptoms significantly. Its therapeutic mechanism is possibly related to the regulation of angioendothelial function.