调脂汤治疗冠心病稳定型心绞痛合并高脂血症临床研究

Clinical Observation of Tiaozhi Decoction for Treatment of Coronary Heart Disease Induced Stable Angina Complicated with Hyperlipemia

【目的】探讨调脂汤治疗冠心病稳定型心绞痛(SAP)合并高脂血症的临床疗效及其对血清炎症因子的影响。【方法】将符合要求的100例患者随机分为观察组和对照组各50例。2组均参照"慢性稳定型心绞痛诊断与治疗指南"给予西医常规基础治疗,对照组给予辛伐他汀口服,观察组在对照组的基础上给予调脂汤治疗,2组疗程均为8周。检测治疗前后血脂6项水平[包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(Apo A)及载脂蛋白B(Apo B)],记录治疗期间2组每周心绞痛发作次数及硝酸甘油片的用量,并进行治疗前后心电图检查,评定2组的降脂疗效和心电图疗效;检测2组治疗前后超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、同型半胱氨酸(Hcy)、脂联素(APN)、氧化低密度脂蛋白(ox-LDL)水平。【结果】(1)经Ridit分析,观察组降脂疗效和心电图疗效均优于对照组(P<0.05);(2)治疗后,观察组对TG、HDL-C、Apo B和Apo A的改善作用优于对照组(P<0.01);(3)观察组每周心绞痛发作次数和硝酸甘油使用剂量均少于对照组(P<0.01);(4)治疗后,观察组hs-CRP、IL-6、Hcy和ox-LDL水平显著低于对照组,APN水平显著高于对照组(P<0.01)。【结论】调脂汤对SAP合并高脂血症患者的脂代谢有改善作用,并能减少心绞痛发作次数,其降脂疗效及心绞痛疗效均较显著,这可能与其调节患者的血清炎症因子水平有关。

Objective To investigate the therapeutic effect of Tiaozhi Decoction for the treatment of coronary heart disease induced stable angina complicated with hyperlipemia, and to observe its effect on serum inflammatory factors. Results One hundred qualified patients were evenly randomized into treatment group and control group. Both groups were given conventional western medical treatment with reference to Guide for Diagnosis and Treatment of Chronic Stable Angina, and additionally, the control group was given oral use of Simvastatin and the treatment group was given Tiaozhi Decoction orally. The treatment of the two groups covered 8 weeks. Before and after treatment, blood lipid levels of total cholesterol （ TC） , triglyceride （ TG） , low-density lipoprotein cholesterol （ LDL-C） , high- density lipoprotein cholesterol （ HDL-C） , apolipoprotein A （ApoA） and apolipoprotein B （ApoB） were observed. The frequency of angina pectoris attack and the dosage of Nitroglycerin Tablets per week in both groups were recorded during the treatment. Therapeutic effect on lowering blood lipid and on improving electrocardiogram was evaluated after treatment. Serum levels of hypersensitivity C-reactive protein （hs-CRP）, interleukin-6 （IL-6）, homocysteic acid （Hcy）, adiponectin （APN）, and oxidized low-density lipoprotein （ox-LDL） were detected before and after treatment. Results（1） The results of Ridit analysis showed that the treatment group had better therapeutic effect on lowering blood lipid and on improving electrocardiogram than the control group （ P〈0.05） . （ 2） After treatment, TG, HDL-C, ApoB and ApoA levels were much improved in the treatment group compared with those in the control group （P〈0.01） . （ 3） The frequency of angina pectoris attack and the dosage of Nitroglycerin Tablets per week were reduced in the treatment group compared with those in the control group （P〈0.01） . （4） After treatment, the treatment group had lower hs-CRP, IL-6, Hcy and ox-LDL levels, and higher APN level than the control group （P〈0.01） . Conclusion Tiaozhi Decoction is effective for the treatment of coronary heart disease induced stable angina complicated with hyperlipemia through improving lipid metabolism and reducing angina pectoris attack, and the mechanism may be related with the regulation of inflammatory factors.