复方丹参滴丸联合氯吡格雷治疗不稳定型心绞痛的效果及对血清一氧化氮与内皮素-1水平的影响

The effect of compound danshen dropping pills combined with clopidogrel in the treatment of unstable angina pectoris and the effect on serum nitric oxide and endothelin-1 level

目的探讨复方丹参滴丸联合氯吡格雷治疗不稳定型心绞痛的效果及对血清一氧化氮、内皮素-1水平影响。方法选取2016年5月至2018年5月山西大医院(山西医学科学院)心血管内科收治的140例不稳定型心绞痛患者,采用随机数表法随机分为单药组与联合治疗组,每组70例。单药组男39例,女31例,年龄(53.57±5.93)岁,年龄范围为37~72岁。联合治疗组男40例,女30例,年龄(53.71±5.81)岁,年龄范围为37~73岁。单药组患者口服氯吡格雷,联合治疗组患者在单药组基础上口服复方丹参滴丸,两组患者持续治疗4周。比较两组患者治疗后的临床治疗效果、血液流变学相关指标[血细胞比容(HCT)、血浆黏度、血小板聚集率(MPA)、纤维蛋白原(FIB)]、血清一氧化氮、内皮素-1水平、临床症状缓解情况及不良反应发生率。结果治疗后,联合治疗组患者的治疗有效率[92.9%(65/70)]显著高于单药组[77.1%(54/70)];HCT[(24.72±3.86)%]、血浆黏度[(3.14±0.74)mPa.s]、MPA[(45.29±6.48)%]、FIB[(3.27±0.52)g/L]显著低于单药组患者[(34.63±5.15)%、(4.68±1.03)mPa.s、(53.69±7.36)%、(4.71±0.69)g/L];血清一氧化氮[(4.54±0.57)μmol/L]、内皮素-1水平[(57.32±8.69)ng/L]显著低于单药组患者[(5.61±0.68)μmol/L、(65.33±9.85)ng/L];心绞痛持续时间[(4.32±1.34)min]、发作次数[(1.03±0.18)次/d]、硝酸甘油用量[(0.32±0.05)mg/d]显著低于单药组患者[(6.86±1.75)min、(1.46±0.21)次/d、(0.67±0.10)mg/d],差异有统计学意义(P<0.05)。两组患者不良反应发生情况的比较,差异无统计学意义(P>0.05)。结论采用复方丹参滴丸联合氯吡格雷治疗不稳定型心绞痛,取得了较好的治疗效果,且可改善患者血液流变学相关指标水平,值得在临床上推广应用。

Objective To investigate the efficacy of compound danshen dropping pills combined with clopidogrel in the treatment of unstable angina pectoris and the effect on serum nitric oxide and endo-thelin (ET)-1 levels. Methods A total of 140 patients with unstable angina pectoris who were admitted from May 2016 to May 2018 were selected and randomly divided into monotherapy group and combined treatment group by random number table method,70 patients in each group. In the monotherapy group,39 males and 31 females were aged (53.57 ± 5.93) years and ranging from 37 to 72 years. In the combined treatment group,40 males and 30 females were aged (53.71 ± 5.81) years and ranging from 37 to 73 years. Patients in the monotherapy group received oral clopidogrel,and patients in the combination therapy group received compound danshen dripping pills on the basis of the monotherapy group. Patients in the two groups received continuous treatment for 4 weeks. After treatment,clinical efficacy,hemorheology related in-dicators [hematocrit (HCT),plasma viscosity,platelet aggregation rate (MPA),fibrinogen (FIB)],serum nitric oxide,ET-1 level,clinical symptom relief and incidence of adverse reactions were compared between the two groups. Results After treatment,the effective rate of the combined treatment group [92.9% (65/70)] was significantly higher than that of the monotherapy group [77.1% (54/70)]. HCT [(24.72 ± 3.86) % ],plasma viscosity [(3.14 ± 0.74) mPa.s],MPA [(45.29 ± 6.48) % ],FIB[(3.27 ± 0.52) g/L] were significantly lower than that of the monotherapy group [(34.63 ± 5.15) % ,(4.68 ± 1.03) mPa.s,(53.69 ± 7.36) % ,(4.71 ± 0.69) g/L]. The levels of nitric oxide [(5.04 ± 057) μmol/L] and ET-1 [(57.32 ± 8.69) ng/L] were significantly lower than those in the monotherapy group [(5.01 ± 0.59) μmol/L, (65.33 ± 9.85 ) ng/L].The duration of angina pectoris [( 4.32 ± 1.34 ) min],the frequency of angina pectoris [( 1.03 ± 0.18 ) times/d ], and the dosage of nitroglycerin [(0.32 ± 0.05) mg/d] were significantly lower than those in the monotherapy group [(6.86 ± 1.75) min,(1.46 ± 0.21) times/d,(0.67 ± 0.10) mg/d],with statistically significant differences (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P >0.05). Conclusion Compound danshen dropping pills combined with clopidogrel in the treatment of un-stable angina pectoris has achieved good therapeutic effect and can improve the level of hemorheology relat-ed indicators in patients,which is worthy of clinical application.