山楂降脂散对高脂血症患者血脂的影响：附484例患者的病例分析

Effect of Hawthorn Jiangzhi powder on blood lipids in patients with hyperlipidemia： a pathological analysis of 484 cases

目的观察山楂降脂散对高脂血症患者血脂的影响。方法选择2011年1月至2016年6月黄淮学院附属医院心内科收治的484例高脂血症患者，按随机数字表法分为观察组和对照组，每组242例。观察组服用山楂降脂散粉剂（山楂6g、丹参18g、黑豆16g、茯苓6g、灵芝9g、葛根6g、砂仁6g、山药9g、薏苡仁16g、决明子6g），每H早晚2次吞服，每次6～9g；对照组服用辛伐他汀，每次20mg，每晚餐时1次顿服；两组治疗周期均为2个月。比较两组治疗前后血脂及血清炎性因子水平的差异，观察两组淋巴细胞亚群变化并与本院同期淋巴细胞亚群正常且年龄在35—80岁的100例健康体检者进行比较，以及观察组和对照组总有效率、不良反应发生隋况和肝肾功能变化。结果观察组和对照组治疗前CD4^＋、CD8^＋、CD4^＋／CD8^＋比值均较健康对照组明显降低，但两组治疗后CD4^＋、CD8^＋、CD4^＋／CD8^＋比值均较治疗前升高，且以观察组的变化较对照组更显著（CD4^＋：0．47±0．11比0．40±0．10，CD8^＋：0．28±0．10比0．26±0．08，CD4^＋／CD8^＋：1．67±0．79比1．53±0．45）；两组治疗后超敏C-反应蛋白（hs—CRP）、白细胞介素-6（IL-6）、血管性血友病因子（vWF）、同型半胱氨酸（Hcy）均较治疗前明显降低，且观察组hs—CRP、IL-6、vWF明显低于对照组[hs—CRP（mg／L）：5．1±1．8比5．8±1．7，IL-6（ng／L）：2．9±1．6比3．7±1．8，vWF：（126．8±12．8）％比（156．5±11.3）％，均P〈0．05]。治疗后观察组Hcy较对照组有所降低，但两组比较差异无统计学意义（μmol／L：5．2±1．8比5．4±2．6，P〉0．05）。观察组治疗后各时间点总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白胆固醇（LDL—C）均治疗前明显降低，高密度脂蛋白胆固醇（HDL—C）和高密度脂蛋白，总胆固醇（HDL／TC）均较治疗前明显升高；对照组治疗后TC、TG和LDL—C较治疗前降低，治疗2个月HDL—C和HDL／TC较治疗前明显升高；观察组治疗2个月TC-TG和LDL—C较对照组显著降低[TC（mmol／L）：1．26±0．57比2．26±0．56，TG（mmol／L）：3．45±0．78比5．45±0．75，LDL—C（mmol／L）：2．40±0．65比2．72±0．85，均P〈0．05]，HDL/TC较对照组显著升高（1．19±0．15比0．62±0．35，P〈0．01）。观察组总有效率显著高于对照组[90．1％（218／242）比73．5％（178／242），P〈0．01]。两组治疗期间不良反应轻微，肝肾功能无明显变化。结论山楂降脂散可有效降低高脂血症患者的血脂和血清炎性因子水平，改善血液流变学，抑制动脉粥样硬化的形成与发展，有效改善患者免疫功能。

Objective To observe the effect of Hawthorn Jiangzhi powder on blood lipids in hyperlipidemia patients. Methods Four hundreds and eighty-four patients with hyperlipidemia were selected from Department of Cardiology in Huanghuai University Affiliated Hospital from January 2011 to June 2016, and they were divided into observation group and control group by random number table, each group 242 cases. The observation group took orally Hawthorn Jiangzhi powder （including ingredients： hawthorn 6 g, salvia mihiorrhiza 18 g, black soybean 16 g, hoelen 6 g, ganoderma lucidum 9 g, kudzuvine root 6 g, Chinese yam 6 g, frnctus amomum 9 g, coix seed 16 g, cassia seed 6 g） once 6 - 9 g powder, twice a day, once in the morning and another in the evening; the control group was given simvastatin, 20 mg each day during taking dinner; the therapeutic period lasted 2 months in both groups. The differences in serum lipid and serum inflammatory factor levels were compared before and after treatment in the two groups; the changes of lymphocyte subsets of the two groups were observed and compared with the changes of the subset results of 100 normal heahhy subjects aged 35 - 80 years old in the same period in our hospital, and the total efficiency, the situations of adverse reactions and liver and kidney functions of two groups were observed. Results In the observation group and the control group, before treatment the levels of CD4^＋, CD8^＋, CD4^＋/CD8^＋ were lower than those of healthy control group, but after treatment the levels of CD4^＋, CD8^＋ and CD4^＋/CD8^＋ were higher than those before treatment, and the changes of the observation group were more significant than those of the control group（CD4^＋： 0.47 ± 0.11 vs. 0.40 ± 0.10, CD8^＋： 0.28 ± 0.10 vs. 0.26 ± 0.08, CD4^＋/CD8^＋： 1.67 ± 0.79 vs. 1.53 ± 0.45）; After treatment, the levels of hypersensitiveC-reactive protein （hs-CRP）, interleukin-6 （IL-6）, yon Willebrand factor （vWF） and homocysteine （Hey） in the two groups were significantly lower than those before treatment, and the levels of hs-CRP, IL-6 and vWF in the observation group were obviously lower than those in the control group [hs-CRP （mg/L）： 5.1 ± 1.8 vs. 5.8 ± 1.7, 1L-6 （ng/L）： 2.9 ± 1.6 vs. 3.7 ± 1.8, vWF： （126.8 ± 12.8）% vs. （156.5 ± 11.3）%, all P 〈 0.05]. After treatment, Hey in the observation group was lower than that in the control group, but there was no significant difference between the two groups （μmol/L： 5.2 ± 1.8 vs. 5.4 ± 2.6, P 〉 0.05）. In the observation group after treatment at each time point, the levels of total cholesterol （TC）, triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） were lower than those before treatment, while the levels of high density lipoprotein cholesterol （HDL-C） and high density lipoprotein cholesterol/total cholesterol （HDL/TC） were higher than those before treatment; after treatment in the control group, the levels of TC, TG and LDL-C were decreased, and the levels of HDL-C and HDL/TC were obviously increased compared with those before treatment; The levels of TC, TG and LDL-C in the observation group after treatment for 2 months were significantly lower than those in the control group [TC （mmol/L）： 1.26 ±0.57 vs. 2.26 ±0.56; TG （mmol/L）： 3.45 ± 0.78 vs. 5.45 ± 0.75, LDL-C （mmol/L）： 2.40±0.65 vs. 2.72±0.85; all P 〈 0.05）, and HDL/TC was obviously inereascd （1.19±0.15 vs. 0.62±0.35, P 〈 0.01）. The total therapeutic effective rate of the observation group was significantly higher than that of the control group [90.1% （218/242） vs. 73.4% （178/242）, P 〈 0.01 ]. Adverse reactions and changes of liver and kidney functions during the period of treatment in the two groups were minimal. Conclusions Hawthorn Jiangzhi powder can effectively reduce the blood lipids and serum inflammation cytokines in patients with hyperlipidemia, improve blood theological situation, reduce serum levels of inflammatory factors, inhibit the formation and development of atherosclerosis and enhance the immune function obviously in patients with high lipid abnormalities.