稳斑汤辅助治疗对急性冠状动脉综合征痰浊血瘀证患者血浆血栓调节蛋白基因启动子甲基化的影响

Effects of Adjuvant Therapy with Wenban Tang(稳斑汤) on Promoter Methylation of Plasmic Thrombomodulin Gene in Acute Coronary Syndrome Patients with Turbid Phlegm and Blood Stasis Syndrome

目的观察稳斑汤辅助治疗急性冠状动脉综合征(ACS)痰浊血瘀证患者的疗效及可能的作用机制。方法选取ACS痰浊血瘀证患者180例随机分为对照组和治疗组各90例,另选择健康志愿者40例作为正常组。对照组予经皮冠状动脉介入术及常规西药治疗,治疗组在此基础上联合中药稳斑汤口服,每日1剂,两组均治疗1个月。采用甲基化特异性PCR法检测正常组及两组患者治疗前后血浆血栓调节蛋白(TM)基因启动子甲基化水平,并观察治疗前后对照组及治疗组患者中医证候积分变化与临床疗效。结果两组患者TM基因启动子甲基化率为45.0%(81/180),显著高于正常组的17.5%(7/40)(P<0.05)。治疗后治疗组与对照组TM基因启动子甲基化率及中医证候积分均较本组治疗前显著降低,且治疗组均显著低于对照组(P<0.05)。治疗组临床疗效总有效率为91.11%,显著高于对照组的77.78%(P<0.05)。结论稳斑汤辅助西医治疗可显著降低ACS痰浊血瘀证患者中医证候积分,临床疗效优于单纯西医治疗,其作用机制可能与降低患者TM基因启动子甲基化水平有关。

Objective To observe the curative effects of action of adjuvant therapy with Wenban Tang（ 稳斑汤）on acute coronary syndrome（ ACS） patients with turbid phlegm and blood stasis syndrome and to study the possible mechanisms. Methods Totally 180 patients with ACS and turbid phlegm and blood stasis syndrome were chosen and randomly divided into the control group and the treatment group（ 90 cases in each group）; and 40 healthy volunteers were selected as the normal group. Both control group and treatment were given percutaneous coronary intervention and the routine western medicine. In addition to the above treatment,the treatment group also was given Wenban Tang once a day. Both groups were treated for one month. Methylation specific PCR method was used to detect plasma level of promoter methylation of thrombomodulin（ TM） gene in the normal group and the other two groups before and after treatment,and changes of Chinese medical syndrome scores and clinical curative effects in the control group and the treatment group were observed before and after treatment. Results TM gene promoter methylation rate was 45. 0%（ 81 /180） in both two patient groups,which was significantly higher than that in the normal group 17. 5%（ 7 /40）（ P〈0. 05）. After treatment,TM gene promoter methylation rate and Chinese medical syndrome scores in the treatment group and the control group were significantly lower than those in corresponding group before treatment,and those in the treatment group were significantly lower than those of the control group（ P〈0. 05）. The effective cases accounted for 91. 11% of all cases in the treatment group,which was significantly higher than 77. 78% in the control group（ P〈0. 05）. Conclusion The treatment of western medicine with adjuvant Wenban Tang may significantly reduce Chinese medical syndrome scores of ACS patients with turbid phlegm and blood stasis syndrome. Clinical curative effects of western medicine with adjuvant Wenban Tang were superior to western medicine alone. And its mechanism may be related to reduce promoter methylation level of TM gene.