蒲参胶囊对颈动脉不稳定斑块的干预作用及机制探讨

Intervention Effect and Mechanism of Pushen Capsule on Unstable CAS Plague

目的:探讨蒲参胶囊治疗颈动脉不稳定斑块患者的临床疗效及对血管内皮功能、血小板活化的影响。方法:将158例患者随机分为对照组和观察组。对照组口服普伐他汀钠片,20 mg·d^(-1)。观察组在对照组基础上加用蒲参胶囊,4粒/次,3次/d,疗程16周。采用彩色多普勒超声测量治疗前后颈动脉内膜中层厚度(IMT),采用Crouse斑块积分法计算双侧颈动脉斑块积分;检测治疗前后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;检测治疗前后一氧化氮(NO),内皮素-1(ET-1)血管性假血友病因子(v WF)和可溶性血管内皮细胞蛋白C受体(s EPCR)水平;检测治疗前后血小板膜糖蛋白指标CD62p和CD63水平;随访6个月,记录不良心脑血管病事件发生情况。结果:治疗后观察组IMT厚度和Crouse斑块总积分均低于对照组(P<0.01);治疗后观察组HDL-C高于对照组,TG,TC水平低于对照组(P<0.01),治疗后观察组TG,TC,HDL-C异常例数少于对照组(P<0.05);治疗后观察组NO水平高于对照组,ET-1,v WF,s EPCR水平低于对照组(P<0.01);治疗后观察组CD62p,CD63水平低于对照组(P<0.01);观察组不良心脑血管病事件发生率为5.48%,对照组为16.67%,观察组低于对照组(P<0.05)。结论:蒲参胶囊能调节脂代谢紊乱,使斑块变薄,稳定和缩小颈动脉斑块,并能降低不良心脑血管病事件发生率,其作用机制可能通过改善血管内皮功能,降低血小板活性实现。

Objective： To discuss the clinical effect of Pushen capsule on patients with unstable carotid plaques and its influence on functions of vascular endothelium and platelet activation. Method： One hundred and fifty-eight patients were randomly divided into control group and observation group. Patients in control group received pravastatin sodium tablet,20 mg·d^（-1）. In addition to the therapy of control group,patients in observation group were also administered with Pushen capsule,4 granules/time,tid. The courses of treatment lasted for 16 weeks. Before and after the treatment,intima media thickness（ IMT） was detected by color doppler ultrasound,and integral bilateral carotid plaque was calculated by crouse integral method. Levels of triglyceride（ TG）,total cholesterol（ TC）,high density lipoprotein-cholesterol（ HDL-C）,low density lipoprotein-cholesterol（ HDL-C）,nitric oxide（ NO）,endothelin^（-1）（ ET-1）,von willebrand factor（ v WF）,soluble endothelial protein C receptor（ s EPCR）,platelet membrane glycoproteins CD62 p and CD63 were detected. The follow-up visit lasted for 6months. And adverse cardio-cerebrovascular disease eventswere recorded. Result： After the treatment,thickness of IMT and total score in observation group were lower than those in control group（ P〈0. 01）. Level of HDL-C in observation group was higher than that in control group,and levels of TG and TC were lower than those in control group（ P〈0. 01）. Cases of abnormal TG,TC and HDL-C in observation group were less than those in control group（ P〈0. 05）. Level of NO was higher than that in control group,and levels of ET-1,v WF,s EPCR,CD62 p and CD63 were lower than those in control group（ P〈0. 01）. The incidence of adversecardio-cerebrovascular disease eventsin observation group was 5. 48%,which was higher than 16. 67% in control group（ P〈0. 05）.Conclusion： Pushen capsule can regulate dyslipidemia,thin plaques,stabilize and shrink carotid plaques,reduce the incidence of adverse cardio-cerebrovascular disease events,and itsmechanism of actionmay be correlated with decrease in platelet activationby regulating vascular endothelial function.