温阳通络方对急性心肌梗死经皮冠状动脉介入治疗术后患者心室重构和血管内皮功能的影响

Effect of Wenyang Tongluo recipe on ventricular remodeling and vascular endothelial function in patients with acute myocardial infarction after percutaneous coronary intrerration

目的观察温阳通络方对急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后患者心室重构和血管内皮功能的影响。方法将118例PCI术后的AMI患者按照随机数字表法分为2组。对照组59例予芪苈强心胶囊口服;治疗组59例在对照组治疗基础上加用温阳通络方口服。2组均治疗12周。比较2组疗效;观察2组治疗前后中医证候积分、心功能指标、T淋巴细胞亚群水平变化;观察2组治疗前后基质金属蛋白酶9(MMP-9)、肿瘤坏死因子α(TNF-α)及一氧化氮(NO)水平变化;对2组患者随访6个月,比较2组心血管并发症发生情况。结果治疗组总有效率89.83%,对照组总有效率74.58%,治疗组疗效优于对照组(P<0.05)。2组治疗后胸闷、心悸、气短积分及总积分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后左室射血分数(LVEF)、室间隔厚度(IVSd)均较本组治疗前增加(P<0.05),左室舒张末内径(LVEDD)缩小(P<0.05),且治疗组治疗后LVEF、IVSd增加更明显(P<0.05),LVEDD缩小更明显(P<0.05)。2组治疗后CD3^+、CD4^+水平及CD4^+/CD8^+均较本组治疗前升高(P<0.05),CD8^+水平降低(P<0.05),且治疗组治疗后CD3^+、CD4^+水平及CD4^+/CD8^+均高于对照组(P<0.05),CD8^+水平低于对照组(P<0.05)。2组治疗后MMP-9、TNF-α水平均较本组治疗前降低(P<0.05),NO水平升高(P<0.05),且治疗组治疗后MMP-9、TNF-α水平均低于对照组(P<0.05),NO水平高于对照组(P<0.05)。治疗组心血管疾病并发症发生率(18.64%)低于对照组(35.59%,P<0.05)。结论温阳通络方联合芪苈强心胶囊治疗AMI,能有效提高患者心肌功能和免疫功能,降低心室重构的风险,改善血管内皮功能,改善预后。

Objective To observe the effect of Wenyang Tongluo recipe on ventricular remodeling and vascular endothelial function(AMI) in patients with acute myocardial infarction after percutaneous coronary intrerration(PCI) with acute myocardial infarction(AMI). Methods 118 patients with AMI were divided into two groups according to the random number table method. 59 cases in control group were treated by Qili Qiangxin capsule. 59 cases in treatment group were treated by Wenyang Tongluo recipe. Both groups were treated for 12 weeks. The therapeutic effects of the two groups were compared. The TCM syndrome score, cardiac function index and T-lymphocyte subsets were observed before and after treatment. The levels of matrix metalloproteinase-9(MMP-9), tumor necrosis factorα(TNF-α) and nitric oxide(No) were observed before and after treatment in the two groups. The cardiovascular complications of the two groups were compared after 6 months of follow-up. Results The total effective rate was 89.83 % in treatment group and 74.58 % in control group. The clinical curative effect of the treatment group was better than that of the control group(P<0.05). After treatment, the scores of chest distress, palpitation, shortness of breath and total scores in the two groups were lower than those in the group before treatment(P<0.05), and the scores in the treatment group were significantly lower(P<0.05). The left ventricular ejection fraction(LVEF) and interventricular septal thickness(IVSd) in the two groups were increased(P<0.05), the left ventricular end diastolic diameter(LVEDd) were reduced(P<0.05), and the LVEF and IVSD were increased more significantly in the treatment group(P<0.05), the LVEDd was reduced more significantly in the treatment group(P<0.05). After treatment, the levels of CD3^+, CD4^+ and CD4^+/CD8^+ in the two groups were higher than those in the group before treatment(P<0.05), and the level of CD8^+ was decreased(P<0.05). and CD3^+, CD4^+ and CD4^+/CD8^+ in the treatment group were higher than those in the control group(P<0.05), and the level of CD8^+ was lower than the control group(P<0.05). The levels of MMP-9 and TNF-α in the two groups were lower than those in the group before treatment(P<0.05), and No in the two groups were higher than those in the group before treatment(P<0.05). After treatment, the levels of MMP-9 and TNF-α in the treatment group were lower than those in the control group(P<0.05), and No in the treatment group were higher than that in the control group(P<0.05). The incidence of cardiovascular complications in the treatment group(18.64%) was lower than that in the control group(35.59%, P<0.05). Conclusion Wenyang Tongluo recipe combined with Qili Qiangxin capsule can effectively improve the myocardial function and immune function, improve the vascular endothelial function, and improve the prognosis of AMI.