防栓胶囊防治冠状动脉介入术心肌及血管内皮损伤研究

Preventive Effect of Fangshuan Capsule on PCI-induced Myocardial Damage and Vascular Endothelial Injury in Patients with Unstable Angina Pectoris

目的观察防栓胶囊对不稳定型心绞痛患者冠状动脉介入治疗所致心肌和血管损伤的保护作用。方法选择100例行冠脉介入治疗冠心病不稳定型心绞痛患者,采用随机数字表法分为对照组和治疗组,每组50例,两组均采用常规西药治疗,治疗组加用防栓胶囊6粒,3次/日。术前至少常规服用2天。两组疗程均为2周。观察两组临床疗效,比较两组治疗前后静息状态下HR、SBP及心肌耗氧量(HR×SBP,k Pa/min)变化,检测治疗前、治疗后6 h、12 h、24 h、3 d、7 d cTnI、CK-MB、MYO、ET、NO水平。结果治疗组中医证候积分显效率[54%(17/50)]及总有效率[94%(47/50)]高于对照组[显效率26%(13/50),总有效率88%(44/50),P<0.01]。与本组治疗前比较,两组治疗后HR、SBP、心肌耗氧量、血浆ET水平降低(P<0.05,P<0.01),NO水平升高(P<0.05,P<0.01),对照组治疗后6 h、12 h、24 h、3 d cTnI升高(P<0.05,P<0.01),6 h、12 h、24 h CK-MB升高(P<0.05,P<0.01),6 h、12 h MYO升高(P<0.01);治疗组治疗后12 h、24 h cTnI升高(P<0.05,P<0.01),6 h、12 h CK-MB升高(P<0.05),6 h MYO升高(P<0.01)。与对照组同期比较,治疗组治疗后HR、心肌耗氧量、ET水平降低(P<0.05),治疗后6 h、12 h、24 h cTnI降低(P<0.05),12 h CK-MB降低(P<0.05),6 h、12 h MYO降低(P<0.05)。结论防栓胶囊能有效改善PCI术后患者中医证候积分,降低心肌耗氧量,减轻心肌损伤和血管内皮损伤。

Objective To observe the prevention of Fangshuan Capsule （FC） on percutaneous coronary intervention （PCI） induced myocardial damage and vascular endothelial injury in patients with un- stable angina pectoris （UAP）. Methods Totally 100 UAP patients undergoing PCI were assigned to the control group and the treatment group by random digit table, 50 in each group. All patients received routine Western medicine therapy. Those in the treatment group additionally took FC, 6 pills each time, three times per day for at least 2 days before PCI operation. The therapeutic course for each group was 2 weeks. The clinical therapeutic effect was observed in the two groups. Heart rate （HR）, systolic blood pressure （SBP）, changes of myocardial oxygen consumption （HR x SBP, kPa/min） were compared. The levels of serum troponin I （cTn I）, creatinine kinase-MB （CK-MB）, myoglobin （MYO）, endothelin （ET）, and nitric oxide （NO） were measured before PCI, and 6, 12,24 h, 3 and 7 days after PCI. Results The markedly ef- fective rate of Chinese medical syndromes was 54% （17/50） and the total effective rate was 94% （4＂/＇/50） in the treatment group, obviously higher than those of the control group [26% （13/50） and 88% （44/50） P 〈0.01 1. Compared with before treatment in the same group, HR, SBP, myocardial oxygen consumption, and plasma ET level were reduced, plasma NO level was elevated in two groups after treatment （P 〈0.05, P 〈0.01）. cTnl concentration increased at 6, 12, 24 h, and day 3 （P 〈0.05, P 〈0.01） ; CK-MB concentra- tion was elevated at 6, 12, and 24 h （P 〈0.05, P 〈0.01）; MYO concentration increased at 6 and 12 h （P 〈 0.01 ） in the control group after treatment, cTnl concentration increased at 12 and 24 h （P 〈0.05, P 〈0.01 ） CK-MB concentration was elevated at 6 and 12 h （P 〈0.05）; MYO concentration increased at 6 h （P 〈0.01 ） in the treatment group after treatment. Compared with the control group at the same time point, HR, myo- cardial oxygen consumption, and plasma ET level decreased （P 〈0.05）; cTnl decreased at 6, 12, and 24 h （P〈0.05）; CK-MB concentration decreased at 12 h （P 〈0.05）; MYO concentration decreased at 6 and 12 h （P 〈0.05） in the treatment group after treatment. Conclusion FC could effectively improve scores of Chinese medical syndromes after PCI surgery, reduce myocardial oxygen consumption, attenuate myocar- dial damage and vascular endothelial injury in UAP patients after PCI.