七味三芎汤治疗冠状动脉临界病变瘀阻心脉证

Qiwei Sanxiong Decoction in Treating Coronary Artery Disease with Stasis and Heart Vessel Syndrome

目的:观察七味三芎汤对冠状动脉临界病变(瘀阻心脉证)患者的临床疗效及对血清脂蛋白相关磷脂酶A2(lipoprotein associated phospholipase A2,LP-PLA2)的影响。方法:采用随机数字表法抽取69个数随机分给69例冠状动脉临界病变患者,将每位患者所得到的数码除以2,得到余数为0的为对照组(34例),余数为1的为试验组(35例)。对照组给予冠状动脉粥样硬化性心脏病(以下简称“冠心病”)二级预防治疗(瑞舒伐他汀钙片、阿司匹林肠溶片);试验组在上述基础上服用七味三芎汤(中药颗粒剂),每日1剂,开水冲400 mL,每次200 mL,早晚温服。两组均治疗18个月。治疗后,评估两组患者的临床疗效,采用免疫荧光法测定治疗前及治疗6、12、18个月血清LP-PLA2的水平,观察两组治疗前后冠状动脉造影术(coronary angiography,CAG)测定的冠状动脉狭窄情况,运动平板试验变化情况、西雅图心绞痛量表各项目评分。结果:治疗后,试验组的有效率为100%,对照组为91.2%,两组有效率比较,差异有统计学意义(P<0.05)。两组患者治疗前血清LP-PLA2比较,差异无统计学意义(P>0.05);治疗后两组患者LP-PLA2均呈下降趋势;治疗6、12、18个月时,试验组和对照组LP-PLA2比较,差异有统计学意义(P<0.05);试验组治疗前与治疗6、12、18个月及6个月与18个月的LP-PLA2比较,差异有统计学意义(P<0.05);对照组治疗前与治疗12、18个月的LP-PLA2比较,差异有统计学意义(P<0.05)。时间和分组因素存在交互效应,提示随着时间的增加,不同分组对LP-PLA2的影响比较,差异有统计学意义(P<0.05)。对照组治疗前后CAG测定的冠状动脉狭窄情况比较,差异无统计学意义(χ^2=7.702,P>0.05);试验组治疗前后CAG测定的冠状动脉狭窄情况比较,差异有统计学意义(χ^2=8.814,P<0.05)。两组治疗后运动平板试验阳性结果比较,差异有统计学意义(χ^2=5.226,P<0.05)。治疗前,两组患者西雅图心绞痛量表各项目评分比较,差异无统计学意义(P>0.05);对照组治疗18个月后心绞痛稳定状态、躯体活动受限程度、心绞痛发作情况评分均高于本组治疗前,差异有统计学意义(P<0.05);试验组治疗18个月后疾病认知程度、心绞痛稳定状态、躯体活动受限程度、心绞痛发作情况、治疗满意程度评分均高于本组治疗前,差异有统计学意义(P<0.05)。与对照组比较,试验组治疗18个月后的以上评分均高于对照组,差异有统计学意义(P<0.05)。两组患者治疗前左心室射血分数(left ventricular ejection fraction,LVEF)、每搏心输出量(cardiac output per stroke,CO)、左心室收缩末期内经(left ventricular end systolic dimension,LVSD)比较,差异无统计学意义(P>0.05);治疗18个月后,试验组的LVEF、CO高于对照组,LVESD低于对照组,差异均有统计学意义(P<0.05)。结论:七味三芎汤能够提高冠状动脉临界病变患者的临床疗效,降低血清LP-PLA2水平,改善患者心肌缺血状况及心功能,提高心绞痛患者生活质量。

Objective:To observe the clinical effect of Qiwei Sanxiong Decoction on patients with critical coronary artery disease(stasis of heart stasis syndrome)and its effect on serum lipoprotein associated phospholipase A2(LP-PLA2).Methods:69 patients with critical coronary artery disease were randomly assigned to 69 patients by random number table method,and the number obtained by each patient was divided by 2 to obtain the remainder as the control group(34 cases),The remainder is 1 for the experimental group(35 cases).The control group was given secondary preventive treatment of coronary atherosclerotic heart disease(coronary heart disease)(rosuvastatin calcium tablets,aspirin enteric-coated tablets);the test group took Qiwei Sanxiong Decoction(Chinese medicine granules)on the above basis,1 dose per day,boiled water 400ml,200ml each time,warm in the morning and evening.Both groups were treated for 18 months.After treatment,the clinical efficacy of the two groups of patients was evaluated,and the changes of serum LP-PLA2 before and at 6,12,and 18 months after treatment were measured by immunofluorescence,and coronary angiography(CAG)was observed before and after treatment in the two groups.Coronary artery stenosis changes,exercise plate test changes,and Seattle Angina Scale scores.Results:After treatment,the effective rate was 100%in the test group and 91.2%in the control group.There was a statistically significant difference between the two groups(P<0.05).The difference of serum LP-PLA2 at different time points before and after treatment was statistically significant(P<0.05),that is,there was a time effect.There was no significant difference in serum LP-PLA2 between the two groups before treatment(P>0.05);after treatment,the LP-PLA2 of both groups showed a downward trend;at 6,12,and 18 months of treatment,the test group and the control group Compared with LP-PLA2,the difference was statistically significant(P<0.05);compared with LP-PLA2 in the experimental group before treatment and at 6,12,18 months,and 6 months and 18 months,the difference was statistically significant(P<0.05);The difference between the control group before treatment and the LP-PLA2 at 12 and 18 months of treatment was statistically significant(P<0.05).There is an interactive effect between time and grouping factors,suggesting that with the increase of time,the effect of different groupings on LP-PLA2 is statistically significant(P<0.05).Comparison of coronary artery stenosis measured by CAG before and after treatment in the control group showed no statistically significant difference(χ^2=7.702,P>0.05);comparison of coronary artery stenosis measured by CAG before and after treatment in the experimental group was statistically significant(χ^2=8.814,P<0.05).The positive results of exercise treadmill test between the two groups before and after treatment were statistically significant(χ^2=5.226,P<0.05).Before treatment,there was no significant difference in the scores of the items on the Seattle Angina Scale between the two groups(P>0.05);the control group had stable angina(AS),physical activity limitation(PL),and angina after 18 months of treatment The scores of seizures(AF)were higher than that of this group before treatment,and the difference was statistically significant(P<0.05);the disease cognition(DS),AS,PL,AF,treatment satisfaction of the experimental group after 18 months of treatment(TS)scores were higher than before treatment in this group,the difference was statistically significant(P<0.05).Compared with the control group,the scores of DS,AS,PL,AF,and TS of the experimental group after 18 months of treatment were higher than the control group,and the difference was statistically significant(P<0.05).Before treatment,LVEF,CO,LVESD left ventricular ejection fraction(LVEF),cardiac output per stroke(CO),left ventricular end systolic dimension,LVSD comparison,the difference was not statistically significant(P>0.05);after 18 months of treatment,LVEF and CO in the experimental group were higher than the control group,and LVESD was lower than the control group,the differences were statistically significant(P<0.05).Conclusion:Qiwei Sanxiong Decoction can improve the clinical efficacy of patients with critical coronary artery disease,reduce serum LP-PLA2 level,improve myocardial ischemia and cardiac function,and improve the quality of life of patients with angina pectoris.