通心络胶囊联合替格瑞洛治疗非ST段抬高型急性冠脉综合征的临床研究

Clinical study on Tongxinluo Capsules combined with ticagrelor in treatment of non-ST segment elevation acute coronary syndrome

目的探讨通心络胶囊联合替格瑞洛片治疗非ST段抬高型急性冠脉综合征的临床疗效。方法选择2016年1月—2017年1月在青海省心脑血管病专科医院收治的非ST段抬高型急性冠脉综合征患者106例作为研究对象,采用随机数字表法将所有患者分为对照组和治疗组,每组各53例。对照组口服替格瑞洛片,首次剂量2片,此后1片/次,2次/d。治疗组在此基础上口服通心络胶囊,4粒/次,3次/d。两组患者均连续治疗2个月。观察两组的临床疗效,比较两组的症状缓解情况、炎性因子、心肌酶谱指标、左心功能参数、主要不良心血管事件(MACE)。结果治疗后,对照组和治疗组的总有效率分别为75.5%、92.5%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组硝酸甘油用量、心绞痛发作频率、心绞痛发作持续时间均显著下降,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组超敏C反应蛋白(hs-CRP)、肿瘤抑制因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组肌酸激酶(CK)、氨基末端脑钠肽前体(NT-proBNP)、肌酸磷酸激酶同工酶(CK-MB)和肌钙蛋白T(cTnT)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组左心房内径(LADD)、左心室舒张末内径(LVEDD)、左心室收缩末内径(LVESD)明显降低,左心室射血分数(LVEF)明显增高,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,对照组和治疗组的MACE发生率分别为13.2%、3.8%,两组比较差异具有统计学意义(P<0.05)。结论通心络胶囊联合替格瑞洛片治疗非ST段抬高型急性冠脉综合征具有较好的临床疗效,可改善临床症状,调节炎性因子和心肌酶谱指标水平,降低MACE发生率,具有一定的临床推广应用价值。

Objective To explore the clinical efficacy of Tongxinluo Capsules combined with Ticagrelor Tablets in treatment of non-ST segment elevation acute coronary syndrome. Methods Patients（106 cases） with non-ST segment elevation acute coronary syndrome in Qinghai Cardio Cerebrovascular Disease Specialist Hospital from January 2016 to February 2017 were randomly divided into control and treatment groups, and each group had 53 cases. Patients in the control group were po administered with Ticagrelor Tablets, 2 tablets for the first time, then 1 tablet/time, twice daily. Patients in the treatment group were po administered with Tongxinluo Capsules on the basis of the control group, 4 grains/time, three times daily. Patients in two groups were treated for 2 months. After treatment, the clinical efficacies were evaluated, and symptomatic remission, inflammatory factors, myocardial enzyme spectrum indexes, left ventricular function parameters, and MACE in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 75.5% and 92.5%, respectively, and there was difference between two groups（P＜0.05）. After treatment, the levels of hs-CRP, TNF-α, IL-6, and IL-8 in two groups were significantly decreased, and the difference was statistically significant in the same group（P＜0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P＜0.05）. After treatment, the levels of CK, NT-pro BNP, CK-MB, and cTnT in two groups were significantly decreased, and the difference was statistically significant in the same group（P＜0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P＜0.05）. After treatment, LADD, LVEDD, and LVESD in two groups were significantly decreased, but the LVEF in two groups were significantly increased, and the difference was statistically significant in the same group（P＜0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups（P＜0.05）. After treatment, the incidence of MACE in the control and treatment groups were 13.2% and 3.8%, respectively, and there was difference between two groups（P＜0.05）. Conclusion Tongxinluo Capsules combined with Ticagrelor Tablets has clinical curative effect in treatment of non-ST segment elevation acute coronary syndrome, can improve clinical symptoms, regulate the levels of inflammatory factor and myocardial enzyme spectrum index, decrease the incidence of MACE, which has a certain clinical application value.