麝香保心丸对严重冠状动脉狭窄患者侧支循环的影响

The effect of Shexiang Baoxin Pill on collateral circulation in patients with severe coronary artery stenosis

目的：探讨麝香保心丸对严重冠状动脉狭窄患者侧支循环的影响以及与血清二甲基精氨酸（ADMA）浓度的关系。方法根据冠脉造影的结果选择150例严重冠心病的患者，采用 Rentrop 方法对冠状动脉侧支循环进行分级，CCC0级为侧支循环未形成组（n ＝85），1～3级为侧支循环形成组（n ＝65）。150例患者随机分为 A、B 两组，两组患者在服用药物前测定 ADMA 的浓度。A 组患者服用麝香保心丸6个月，B 组患者服用安慰剂6个月，6个月后两组患者复查冠脉造影，并对冠脉侧支循环进行分级评价，同时测定 ADMA的浓度。结果A 组服用麝香保心丸6个月后，CCC0级组19例、CCC1级组40例、CCC2级组16例，其中CCC0级组病例数减少，CCC1级组及 CCC2级组病例数增加，各组服药后侧支循环分级都差异有统计学意义（χ^2＝13．96，P ＝0．003）；B 组服药前后 CCC 分级差异无统计学意义。A 组服药前后 ADMA 水平差异有统计学意义（P ＝0．01～0．03），B 组服药前后 ADMA 水平差异无统计学意义（P ＞0．05），CCC1级与 CCC0级组ADMA 浓度的比较，CCC1级浓度明显低于 CCC0组（P ＝0．002）。结论麝香保心丸可能具有促进严重冠状动脉狭窄患者侧支循环的形成，保护缺血心肌，减小梗死范围的作用。

Objective To investigate the effect of Shexiang Baoxin Pill on collateral circulation in patients with severe coronary artery stenosis and the relationship with the serum levels of ADMA Methods Subjects included 1 50 patients with severe coronary artery disease who underwent coronary angiography.Development of coronary collat-eral circulation was classified by Rentrop Score.According to the collateral degree,patients were divided into two groups.Group A：poorly developed group （grade CCC0,n =85）,Group B：well developed group （grade 1 -3 level, n =65）.The concentration of serum ADMA were measured for all the patients.The patients in group A and group B were given B were given Shexiang Baoxin Pill and placebo for 6 months,respectively.After the 6 -month treatment, the patients from two groups underwent coronary angiography and the ADMA level was measured.Results After the 6-month treatment of Shexiang Baoxin Pill in group A,there were 1 9,40,and 1 6 cases in grade CCC0 group,grade CCC1 group,and grade CCC2 group,respectively.The case in grade CCC0 group was decresed and that in grade CCC1 and CCC2 was increased,with a significant difference in the classification of collateral circulation （χ^2 =1 3.96,P =0.003）;There were no significant difference in CCC classification in group B before and after medication.The chan-ges in serum ADMA level before and after the medication in group A was statistically significant （P =0.01 ~0.03）, but not in group B.The serum ADMA level was siginificanly lower in grade CCC1 group than that in grade CCC0 group （P =0.002）.Conclusion Shexiang Baoxin Pill group may be involed in the promotion of the formation of col-lateral circulation in patients with severe coronary artery stenosis,protection of the ischemic myocardium and reduction of infarct range.