丹参多酚酸盐辅助治疗非ST段抬高性型急性冠脉综合征的临床观察研究

Clinical Study of Auxiliary Treatment of Salvianolate in Non-ST Segment Elevation Acute Coronary Syndrome

目的:观察丹参多酚酸盐辅助治疗非ST段抬高性型急性冠脉综合征(NSTEACS)的临床疗效。方法:选择2013年1月—2014年9月收治的88例NSTEACS患者,随机分为观察组(n=42例)和对照组(n=42例),对照组给予抗血小板抗凝、调脂、扩冠等常规治疗,观察组在常规治疗的基础上给予丹参多酚酸盐治疗(200 mg·d-1),治疗7 d;记录两组患者治疗前后的心电图中ST段变化情况,检测两组治疗前后的BNP、左室射血分数(LEVF)、超敏C反应蛋白(hs-CRP)及肌酐蛋白I(c Tn I),D-二聚体(D-D)、血液流变学指标等;记录住院期间发生主要心脏不良事件(MACE)的发生率。结果:与对照组比较,观察组在治疗后12 h^7 d的ST段下移程度及缺血导联数目均降低(P<0.05);观察组患者治疗后BNP、c Tn I、hs-CRP水平均低于对照组(P<0.05),而LEVF高于对照组(P<0.05),且治疗前后BNP、c Tn I、hs-CRP的下降幅度(△BNP、△c Tn I、△hs-CRP),LEVF上升幅度(△LEVF)均高于对照组(P<0.05);观察组治疗后血浆黏度、DD、血小板聚集指数及红细胞变形指数均低于对照组(P<0.05),且治疗前后各项指标下降幅度高于对照组(P<0.05);观察组住院期间MACE的发生率低于对照组(9.1%vs 25.0%;χ2=3.938,P=0.047);多因素Logistic回归分析显示:年龄、GRACE危险评分与MACE的发生呈正相关(P<0.05),而△BNP、△c Tn I及△hs-CRP与MACE的发生呈负相关(P<0.05)。结论:丹参多酚酸盐辅助治疗NSTEACS临床疗效显著,对降低住院期间MACE的发生率有一定意义,其机制可能是通过降低NSTACS患者炎症反应及高凝状态,改善血液流变学、心肌缺血及心功能有关。

Objective ： To observe clinical curative effect of salvianolate treatment on non - ST segment elevation acute coronary syndrome（NSTEACS）. Methods：Totally 88 eases of NSTEACS patients in our hospital from January 2013 to September 2013 were randomly divided into observation group （42 cases） and control group （42 cases）. The control group was given conventional treatment such as anti - platelet anticoagulation, regulating lipid and expansion of coronary artery. The observation group received an intravenous injection of salvianolate （200 mg,onee a day）. ST segment,BNP, left ventricular ejection fraction （LEVF）, hypersensitive c -reactive protein （hs - CRP） protein and creatinine I （eT- nI） , D -dimer （D -D） and hemorheology indexes were recorded before and after treatment. The incidence of major ad- verse cardiac events （MACE） was also recorded during hospitalization. Results：Compared with control group, down de- gree of ST segment and number of ischemia lead of observation group were lower after 12 h - 7 d treatment （P 〈 0. 05）. BNP, cTnI and hs - CRP levels of observation group were lower than those of control group after treatment （ P 〈 0.05 ） while LEVF was higher than that of the control group （ P 〈 0.05 ）. a BNP, Δ cTnI, Δhs - CRP and Δ LEVF of observa- tion group were higher than those of the control group （P 〈 0.05）. Plasma viscosity in observation group after treatment including D - D, platelet aggregation index and erythrocyte deformation index were lower than those of the control group （P 〈 O. 05 ）. The incidence of MACE of observation group during hospitalization was lower than the control group＇s （9.1% vs 25.0% X2 =3. 938 ,P =0.047）. Multiariable Logistic regression analysis showed that age and GRACE riskscore were positively correlated with the incidence of MACE （ P 〈 0.05 ） while Δ BNP, Δ cTnI and Δ hs - CRP were negatively correlated with the occurrence of MACE （ P 〈 0. 05 ）. Conclusion ： Auxiliary treatment of salvianolate in NSTEACS has good clinical curative effects,which is of some significance to reduce the incidence rate of MACE during hospitalization and its mechanism may be through reducing inflammation reaction and high condensation state of NSTACS patients so as to improve the blood rheology,myocardial ischemia and cardiac function.