麝香保心丸联合尼可地尔对心绞痛后冠脉微循环障碍患者的疗效及一氧化氮、血管紧张素Ⅱ、内皮素-1、C-反应蛋白的变化研究

Effect of Shexiang Baoxin Pill Combined with Nicorandil on Coronary Microcirculation Disturbance after Angina Pectoris and Changes of NO,Angiotensin Ⅱ,Endothelin-1 and CRP in Patients with Coronary Microcirculation Disturbance after Angina Pectoris

目的研究麝香保心丸联合尼可地尔对心绞痛后冠脉微循环障碍患者的疗效及一氧化氮(NO)、血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1)、C-反应蛋白(CRP)的变化。方法选取该院心血管内科(2016年5月—2018年5月)收治的心绞痛后冠脉微循环障碍患者200例,采用随机数字法分为两组,每组各100例。对照组接受常规硝酸酯、β-受体阻滞剂、钙离子拮抗剂等药物治疗,研究组接受麝香保心丸联合尼可地尔口服药物治疗,分析两组患者治疗后的临床疗效。结果两组治疗前心绞痛每周发作次数及每次持续时间组间比较,差异不具有统计学意义(P>0.05)。研究组治疗后心绞痛每周发作次数(2.05±0.81)次少于对照组,每次持续时间(2.74±0.68) min短于对照组(P<0.05)。两组治疗前NO、AngⅡ、ET-1、CRP及肱动脉内皮依赖性血管舒张功能(FMD)水平组间比较,差异不具有统计学意义(P>0.05)。研究组治疗后NO、肱动脉FMD水平高于对照组,AngⅡ、ET-1、CRP水平低于对照组(P<0.05)。随访1年,研究组不良心脏事件发生率(5.00%,5/100)与对照组(8.00%,8/100)组间比较,差异不具有统计学意义(P>0.05)。结论麝香保心丸联合尼可地尔治疗心绞痛后冠脉微循环障碍可缓解患者的心绞痛症状降低血清血管内皮活性因子水平,但对主要不良心脏事件影响不大。

Objective To study the therapeutic effect of Shexiang Baoxin Pill combined with nicorandil on patients with coronary microcirculation disturbance after angina pectoris and the changes of nitric oxide(NO),angiotensin Ⅱ(Ang Ⅱ),endothelin-1(ET-1) and C-reactive protein(CRP).Methods A total of 200 patients with coronary microcirculation disorder after angina pectoris were selected from the Department of Cardiovascular Medicine(May 2016 to May 2018) in our hospital.They were randomly divided into two groups with 100 cases in each group.The patients in the control group were treated with conventional nitrates,blockers,calcium antagonists and so on.The patients in the study group were treated with Shexiang Baoxin Pill combined with nicorandil orally.The clinical effects of the two groups were analyzed after treatment.Results There was no significant difference in the frequency and duration of angina pectoris between the two groups before treatment(P>0.05).The frequency of angina pectoris in the study group was lower than that in the control group [(2.05 0.81) per week],and the duration of each time [(2.74 ± 0.68) min]was shorter than that in the control group [(2.74 ± 0.68) per week].Before treatment,NO,AngⅡand ET-1 in the two groups were shorter.There was no significant difference between CRP and FMD of brachial artery endothelium-dependent vasodilation function(P>0.05).The level of FMD in brachial artery in study group after treatment was higher than that in control group.The levels of AngⅡand ET-1 and CRP were lower than those of the control group(P<0.05).After1-year follow-up,the incidence of adverse cardiac events in the study group(5.00%,5/100) was not significantly different from that in the control group(8.00%,8/100)(P>0.05).Conclusion Shexiang Baoxin Pills combined with nicorandil can relieve angina pectoris symptoms and decrease the level of serum vascular endothelial activity factor(VEGF),but it has little effect on major adverse cardiac events.