雪莲通脉丸对冠心病心绞痛患者血管内皮影响的临床研究

Clinical Study on the Effects of Xuelian Tongmai Pills on Vascular Endothelium of Patients with Coronary Heart Disease Angina

目的:通过观察雪莲通脉丸治疗冠心病心绞痛患者前后,血浆一氧化氮(NO)、抗氧化应激指标超氧化物歧化酶(SOD)、血栓素B2(TXB2)、P-选择素(P-selectin)等血管内皮功能指标的变化,评估雪莲通脉丸对血管内皮功能的影响。方法:选取2014年5月至2017年5月新疆乌鲁木齐市中医医院冠心病心绞痛患者60例,按随机数字表分成观察组和对照组,每组30例。对照组给予西医常规治疗,根据患者病情选用阿司匹林肠溶片100 mg,1次/d;他汀类(口服辛伐他汀片20 mg,1次/d);β-受体阻滞剂(口服比索洛尔5 mg,1次/d,或美托洛尔25 mg,2次/d),硝酸酯类(口服欣康40 mg,1次/d);疗程8周。观察组:在对照组的基础上,同时给予雪莲通脉丸,9 g/次,2次/d,疗程8周。治疗8周后观察2组患者中医症候积分、NO、SOD、TXB2、P-selectin的变化。结果:1)中医证候:治疗后2组中医证候积分均有明显改善,差异有统计学意义(P<0.05),且观察组改善程度明显优于对照组,差异有统计学意义(P<0.05)。医证候临床疗效方面:观察组显效率60.00%,明显优于对照组的33.33%,差异有统计学意义(P<0.05),观察组总有效率96.7%,明显优于对照组的80%,差异有统计学意义(P<0.05)。2)血浆一氧化氮(NO)水平:治疗后2组患者血浆NO水平升高,且观察组前后比较差异有统计学意义(P<0.05),对照组前后比较差异无统计学意义(P>0.05),治疗后2组患者血浆NO比较差异有统计学意义(P<0.05)。3)血浆SOD水平:治疗后2组患者SOD水平均有所升高,差异有统计学意义(P<0.05),且观察组前后比较差异有统计学意义(P<0.05),对照组前后比较差异无统计学意义(P>0.05),治疗后2组患者血浆SOD比较差异有统计学意义(P<0.05)。4)血浆TXB_2、P-selectin水平:治疗后2组患者TXB2、P-selectin水平均有所下降,且观察组与治疗前比较明显下降,差异有统计学意义(P<0.05);对照组前后比较差异无统计学意义(P>0.05)。治疗后组间比较,观察组TXB_2、P-selectin水平较对照組均明显下降,差异有统计学意义(P<0.05)。结论:雪莲通脉丸可以有效改善冠心病稳定性心绞痛患者的临床症状,同时升高NO和SOD水平,增强抗氧化能力;降低TXB_2和P-selectin水平,减轻血管内皮细胞的损伤,使血管内皮功能部分恢复。由此推断雪莲通脉丸对血管内皮功能有保护作用。

Objective： To observe the changes of vascular endothelial function indexes of plasma-nitric oxide（ NO）,superoxide dismutase（ SOD）,thromboxane B2（ TXB2） and P-selectin of patients with coronary heart disease（ CHD） angina by treating with Xuelian Tongmai Pills,and to evaluate the effects of Xuelian Tongmai Pills on vascular endothelial function. Methods： A total of 60 patients with CHD angina in accordance from May 2014 to May 2017 with diagnosis criteria were divided into control group（ conventional western medicine treatment group） and treatment group（ Xuelian Tongmai Pills ＋ conventional western medicine treatment）,30 cases in each group. The control group was treated with conventional western medicine treatment. The patients were given Aspirin Enteric-coated Tablets 100 mg,qd,Statins（ oral administration of Simvastatin Tablets 20 mg,qd）,β-receptor blocker（ oral administration of bisoprolol 5 mg,qd or metoprolol 25 mg,bid）,Nitrates（ oral administration of xinkang 40 mg,qd）. The treatment course was 8 weeks. The treatment group was added Xuelian Tongmai Pills 9 g per time,bid for 8 weeks. The changes of TCM pattern scores,NO,SOD,TXB2 and P-selectin of patients in two groups after 8 weeks’ treatment were observed. Results： 1） For TCM pattern,TCM pattern scores of two groups were significantly improved after treatment（ P 〈 0. 05）,and the improvement of treatment group was significantly better than that of control group（ P 〈 0. 05）. For clinical efficacy,the effective rate of treatment group was60. 00%,which was significantly better than 33. 33% in control group（ P 〈 0. 05）. The total effective rate of treatment group was96. 7%,which was significantly better than 80% of control group（ P 〈 0. 05）. 2） For plasma NO level,plasma NO levels of two groups were increased after treatment,and there was significant difference in treatment group before and after treatment（ P 〈0. 05）,while the difference was not significant in control group（ P 〉 0. 05）. The difference in plasma NO level of two groups was significant after treatment（ P 〈 0. 05）. 3） For plasma SOD level,the plasma SOD levels were increased in both groups after treatment（ P 〈 0. 05）,and the difference in treatment group was significant before and after treatment（ P 〈 0. 05）,while no significant different in control group（ P 〉 0. 05）. The difference in plasma SOD of two groups after treatment was significant（ P 〈 0. 05）. 4）For plasma TXB2 and P-selectin levels,the plasma TXB2 and P-selectin levels of two groups were decreased after treatment,and the decrease of treatment group was significant before and after treatment（ P 〈 0. 05）,while no significant difference in control group（ P 〉 0. 05）. When compared between two groups after treatment,the plasma TXB2 and P-selectin levels of treatment group were significantly decreased when compared with that in control group（ P 〈 0. 05）. Conclusion： Xuelian Tongmai Pills can significantly improve the symptoms of patients with CHD stable angina,increase NO and SOD level,strengthen oxidation resistance,decrease TXB2 and P-selectin levels,alleviate vascular endothelium damage,and partially restore the functions of vascular endothelium,which can be inferred that Xuelian Tongmai Pills has protective effect on vascular endothelial function.