基于血管功能及结构探讨瓜蒌薤白半夏汤对痰瘀互结型冠心病合并颈动脉斑块患者的临床疗效

Clinical research on patients of the pattern of phlegm and blood stasis with coronary artery heart disease and carotid plaque treated by Gualou Xiebai Banxia Decoction based on the function and structure of vascular

目的:评估瓜蒌薤白半夏汤对痰瘀互结型冠心病合并颈动脉斑块患者的临床疗效。方法:采用随机对照方法,将68例痰瘀互结型冠心病合并颈动脉斑块患者分为对照组(34例)和治疗组(34例)。对照组予常规西医治疗,治疗组在此基础上加用瓜蒌薤白半夏汤,疗程12周,比较两组颈动脉内中膜厚度(IMT)、斑块面积、脉搏波传导速度(PWV)、血脂、中医证候积分、终点事件发生率及安全性评价指标。结果:治疗前,两组间疗效指标比较均无显著性差异。治疗后,治疗组中医证候积分、TC、LDL-C较对照组更低,HDL-C较对照组更高(P<0.05)。两组间差值(治疗前-治疗后)比较,治疗组中医证候积分、斑块面积、PWV、TC、TG、LDL-C、VLDL-C差值较对照组更大,HDL-C差值较对照组更小(P<0.05)。治疗期间,两组安全性指标、不良反应发生率及终点事件发生率无明显差异。结论:瓜萎薤白半夏汤结合西医药常规治疗较单纯西医治疗可以延缓痰瘀互结型冠心病合并颈动脉斑块患者血管斑块面积、PWV进展,改善中医证候,调节血脂水平。

Objective： To evaluate clinical effects of Gualou Xiebai Banxia Decoction on vascular function and structure of patients of the syndrome of phlegm and blood stasis with coronary heart disease and carotid plaque. Methods： 68 patients of syndrome of phlegm and blood stasis with coronary heart disease and carotid plaque were randomly divided into the treatment group（34 cases） and the control group（34 cases） by random control method. Patients in the control group were given routine treatment of western medicine, while patients in the treatment group were treated with Gualou Xiebai Banxia Decoction additionally. After 12 weeks＇ treatment, carotid intima-media thickness（IMT）, carotid artery plaque area, the degree of plaque, pulse wave conduction velocity（PWV）, blood lipids, TCM syndrome integral, clinical end points and safety indexes in two groups were observed and compared. Results： Before the treatment, all curative effect indexes had no statistically significant difference between the two groups. After the treatment, the decline of plaque area and TCM syndrome integral were more significant in the treatment group than that in the control group, and the increase of PWV was more significant in the control group than that in the treatment group（P〈0.05）. Compared with the control group, TC and LDL-C were lower, and HDL-C was higher in the treatment group（P〈0.05）. During the treatment, there was no significant difference in the safety indicators, incidence of adverse reactions and clinical end points in two groups. Conclusion： Compared with purely western medicine treatment, integrated Chinese and western medicine can postpone the increase of plaque area and PWV, improve TCM symptoms and regulate lipid levels of patients with coronary heart disease and carotid plaque.