心和颗粒剂保护冠心病患者血管内皮损伤的临床研究

The Protective Action of Xin He Ke Li Ji on Endothelial Injury in Coronary Diseases——A Clinical Study

选择不稳定心绞痛病人,符合中医郁热伤络、营阴亏虚辨证分型,根据心绞痛病情轻重分级,随机分为治疗组(45例,采用自拟心和颗粒剂合并常规西药治疗)对照组(42例,单纯采用常规西药治疗)。治疗前后测定静脉血中P—选择素(Ps)、肿瘤坏死因子(TNF)、白细胞介素—1(IL—1)并与10例健康人对比。结果表明,治疗组心绞痛总有效率86.7％,心电图总有效率53.3％,中医症状总有效率88.9％,后两者均优于对照组,差异有显著性(P<0.05或P<0.01);患者血中Ps、TNF、IL—1水平明显高于健康人,治疗后均有下降,治疗组优于对照组,两组比较差异有显著性(P<0.01)。提示郁热伤络是胸痹心痛(冠心病心绞痛)的重要病机之一。心和颗粒剂的疗效机理与降低血中粘附分子Ps、细胞因子TNF、IL—1等炎症因子水平,保护血管内皮损伤,进而防止动脉痉挛、血栓形成、不稳定斑块的破裂等有关。

Patients with unstable angina pectoris who conform with the category of impairment of the channels and collaterals due to stagnated heat and insufficiency of ying - yin were enrolled in the study and randomly assigned to treatment and control groups. In the treatment group (N = 45) Xin He Ke Li Ji, a prescription of our own, was administered with routine Western drugs: in the control group (N = 42) only with routine drugs. The baseline values of P - selectin, tumor necrotizing factor (TNF) and interleukin - 1 (IL - 1) were higher than normal subjects (N=10). The total effective rate of angina pectoris was 86. 6%. that in EKG examination, 53. 3% and that in symptoms in TCM terms, 88. 9% after treatment and was significantly better than in control group (P <0. 05 or 0. 01). The blood P -selectin, TNF and IL -1 of the patients were decreased both in the treatment and control group and the decrease in the treatment group was significantly greater than that of the control group (P<0. 01). The results suggested that impairment of the channels and collaterals due to stagnated heat is one of the important mechanisms in occurrence of angina. It is showed that Xin He Ke Li Ji can decrease the content of P -selectin, TNF and IL-1. protect the endothelium against injury and further against vascular spasm, thrombus formation and the rupture of the unstable plaques.