活血解毒降糖方对糖尿病急性冠脉综合征经皮冠脉介入术后心脏重构的影响

Effect of Huoxue Jiedu Jiangtang formulation on heart remodeling in diabetic patients with acute coronary syndrome after percutaneous coronary intervention

目的探讨活血解毒降糖方对糖尿病并发急性冠脉综合征（ACS）患者经皮冠脉介入术（PCI）后心脏重构以及心功能预后的影响，并探讨其可能作用机制。方法采用前瞻性研究方法，选择2014年2月至2015年8月广西壮族自治区右江民族医院附属医院中医科收治的65例已行PCI术的糖尿病ACS患者，按计算机随机排序法分为观察组33例和对照组32例。观察组在标准化西医治疗基础上加用活血解毒降糖方；对照组给予单纯的西医标准化治疗，疗程均为2个月。治疗前后用心脏彩色超声检测左心室舒张期末直径（LVEDD）、左室收缩期末直径（LVESD）、左室舒张期末室间隔厚度（LVEST）、左室后壁厚度（LVPWT）、左室短轴缩短率（AFS）、每搏量（SV）、心排血量（CO）、心排血指数（CI）、左室射血分数（LVEF）、二尖瓣快速充盈期与心房收缩期血流速度比值（E／A）；用酶联免疫吸附试验（ELISA）检测血清血管紧张素-Ⅱ（Ang-Ⅱ）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平，并评价心功能和临床疗效。结果观察组临床总有效率明显高于对照组[87．88％（29／33）比68．75％（22／32），P〈0．05]；两组治疗后血清炎性介质（IL-6、TNF-α、CRP）及Ang-Ⅱ水平均较治疗前明显降低，且观察组的降低程度较对照组更显著[IL-6（ng／L）：128．72±32．79比144．48±37．69，TNF-α（ng／L）：28．45±7．55比36．14±13．83，CRP（ng／L）：4．69±1．02比7．98±2．16，Ang-Ⅱ（ng／L）：72．98±18．53比83．47±22．39，均P〈0．05]；治疗后观察组左室形态学指标LVEDD、LVESD均低于对照组[LVEDD（mm）：51．85±2．82比58．45±2．93，LVESD（mm）：36．85±3．68比41．85±3．45．均P〈0．05]，而左室功能指标△Fs、SV、CO、CI、LVEF、E／A明显高于对照组[△FS（％）：32．86±5．02比26．7±4．86，SV（mL）：68．77±4．28比48．66±3．86，CO（L／min）：5．87±0．82比5．21±0．38，CI（mL·s^-1·m^-2）：55．56±8．82比47．85±8．38，LVEF：0．598±0．039比0．520±0．038，E／A：1．48±0．17比1．08±0．19，P〈0．05或P〈0．01]。结论活血解毒降糖方能够改善糖尿病ACS患者PCI术后心脏重构，提高心功能，从而改善预后，治疗作用部分来自于抗炎和调节Ang-Ⅱ水平。

Objective To explore the effects of Huoxue Jiedu Jiangtang formulation （HJJF） on heart remodeling as well as heart function prognosis in diabetic patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI） and to analyze its possible treatment mechanisms. Methods A prospective study was conducted. Sixty-five diabetic ACS patients who had received PCI therapy and admitted to Department of Traditional Chinese Medicine of Affiliated Hospital of Youjiang National Medical Colleged in Guangxi were enrolled, and they were randomly divided into a observation group （33 cases） and a control group （32 cases） by a computer from February 2014 to August 2015. On the basis of western medicine therapy, the observation group additionally received HJJF, while the control group was given standardized western medicine only. The therapeutic course for all was 2 months. Before and after treatment, the left ventricular morphology indexes [left ventricular end diastolic diameter （LVEDD）, left ventricular end systolic diameter （LVESD）, left ventrieular end-diastolic ventricular septal thickness （LVEST）, left ventrieular posterior wall thickness （LVPWT）] and the cardiac function data [left ventricular fractional shortening （A FS）, stroke volume （SV）, cardiac output （CO）, the cardiac index （CI）, left ventricle ejection fraction （LVEF）, maximum blood flow velocity of early diastolic/atrium late diastolic （E/A）] were detected with echocardiography to evaluate the heart function; the serum levels of angiotensin-Ⅱ （Ang-Ⅱ ）, C-reactive protein （CRP）, interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α） were tested with enzyme linked immunosorbent assay （ELISA） to assess the clinical effect of the two groups. Results The total effective rate in the observation group was higher than thatin the control group [87.88% （29/33） vs. 68.75% （22/32）, P 〈 0.05]; after treatment, serum inflammatory eytokines （IL-6, TNF-α, CRP） and the Ang-Ⅱ in two groups were significantly decreased compared with before treatment, the improvement degrees of above index in observation group were better than those in control group [IL-6 （ng/L）： 128.72±32.79 vs. 144.48±37.69, TNF-α （ng/L）： 28.45±7.55 vs. 36.14±13.83, CRP （ng/L）： 4.69±1.02 vs. 7.98±2.16, Ang-Ⅱ （ng/L）： 72.98 ± 18.53 vs. 83.47 ± 22.39, all P 〈 0.05]; the left ventricular morphology indexes （LVEDD, LVESD） in observation group were lower than those in the control group [LVEDD （mm）： 51.85±2.82 vs. 58.45 ± 2.93, LVESD （mm）： 36.85 ± 3.68 vs. 41.85 ± 3.45, all P 〈 0.05]; while cardiac fimction indexes （AFS, SV, CO, CI, LVEF, E/A） in observation group were higher than those in control group [ A FS （%）： 32.86 ± 5.02 vs. 26.7±4.86, SV （mL）： 68.77 ±4.28 vs. 48.66±3.86, CO （L/min）： 5.87±0.82 vs. 5.21 ±0.38, CI （mL·s^-1· m^-2）： 55.56 ± 8.82 vs. 47.85 ± 8.38, LVEF： 0.598 ± 0.039 vs. 0.520 ± 0.038, E/A： 1.48 ± 0.17 vs. 1.08 ± 0.19, P 〈 0.05 or P 〈 0.01]. Conclusion HJJF can improve heart remodeling and elevate heart function, resulting in better prognosis in diabetic ACS after PCI; its partial therapeutic effects might come from its anti-inflammatory action and regulation of Ang- Ⅱ level.