丹参饮合二陈汤加减对颈动脉粥样硬化血管内膜损伤的保护作用

Protective Effect of Modified Danshenyin and Erchentang on Intimal Injury Caused by Carotid Atherosclerosis

目的:探讨丹参饮合二陈汤加减治疗颈动脉粥样硬化(CAS)痰瘀互结证的临床疗效及对血管内膜损伤的影响效果。方法:将151例患者随机按数字表法分为对照组75例(脱失4例,剔除2例,完成69例)和观察组76例(脱失3例,剔除4例,完成69例)。两组患者均口服阿托伐他汀钙片,10 mg/次,1次/d,阿司匹林肠溶片,100 mg/次,1次/d。对照组口服荷丹片,2片/次,3次/d;观察组口服丹参饮合二陈汤加减,1剂/d。两组均为连续治疗4个月。进行治疗前后颈动脉彩色超声检测,记录颈动脉内-中膜厚度(IMT),斑块数量、斑块面积、斑块厚度和血流动力学;检测治疗前后一氧化氮(NO),内皮素-1(ET-1),血管性血友病因子(vWF),可溶性细胞间黏附分子-1(s ICAMs-1),血管内皮生长因子(VEGF),基质金属蛋白酶-9(MMP-9)水平;检测治疗前后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C),全血低切黏度(LBV),全血高切黏度(HBV),血浆黏度(PV),血小板聚集率(PAR),纤维蛋白原(FIB),同型半胱氨酸(Hcy),白细胞介素-6(IL-6),IL-10,肿瘤坏死因子-α(TNF-α),血清超氧化物歧化酶(SOD),丙二醛(MDA),氧化低密度脂蛋白(ox-LDL)和循环谷胱甘肽过氧化物酶(GSH-Px)水平;进行安全性评价。结果:治疗后观察组IMT,斑块数量、斑块面积和斑块厚度均低于对照组(P<0.01);观察组收缩期峰值血流速度和舒张期末血流速度均高于对照组(P<0.01),搏动指数和阻力指数均低于对照组(P<0.01);观察组ET-1,vWF,sICAM-1,VEGF,MMP-9均低于对照组(P<0.01),NO水平高于对照组(P<0.01);观察组TG,TC,和LDL-C水平均低于对照组,HDL-C水平高于对照组(P<0.01);观察组LBV,HBV,PV,PAR和FIB均低于对照组(P<0.01);观察组Hcy,IL-6和TNF-α水平均低于对照组(P<0.01);观察组IL-10,SOD和GSH-Px均高于对照组(P<0.01),MDA和ox-LDL均低于对照组(P<0.01)。未观察到与服用中药相关不良反应。结论:丹参饮合二陈汤加减治疗CAS痰瘀互结患者能缩小斑块,改善血流动力学和血液流变学,调节血脂代谢和血管内皮因子,并具有抗炎和抗氧化损伤,保护血管内膜,抑制CAS发生、发展的效果,且临床使用安全。

Objective: To discuss the clinical efficacy of modified Danshenyin and Erchentang in treating carotid atherosclerosis(CAS),and the effect on intimal injury. Method: Patients(151 cases)were divided into control group(75 cases)and observation group(76 cases). Specifically,69 cases in control finished the treatment(4 cases fell off in follow-up,and 2 cases were eliminated),and 69 cases in observation group finished the treatment(3 cases fell off in follow-up,and 4 cases were eliminated). Patients in both group got atorvastatin calcium tablets,10 mg/time,1 time/day,and aspirin enteric-coated tablets,100 mg/time,1 time/day. Patients in control group got Hedan tablets,2 tablets/time,3 times/day. Patients in observation group got modified Danshenyin and Erchentang,1 dose/day. The treatment lasted for 4 months. Before and after treatment,color Doppler ultrasound of carotid artery was detected,and carotid intima-media thickness(IMT),plaque number,plaque area,plaque thickness and hemodynamics were recorded. Levels of nitric oxide(NO),endothelin-1(ET-1),von Willebrand factor(vWF),soluble intercellular adhesion molecule-1(sICAM-1),vascular endothelial growth factor(VEGF),matrix metalloproteinase-9(MMP-9),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),whole-blood low-shear viscosity(LBV),whole-blood high-shear viscosity(HBV),plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB),homocysteine(Hcy),interleukin-6(IL-6),IL-10,tumor necrosis factor-α(TNF-α),serum superoxide dismutase(SOD),malondialdehyde(MDA),oxidized low density lipoprotein(ox LDL)and circulating glutathione peroxidase(GSH-Px)were detected before and after treatment. And the safety was evaluated. Result: After treatment,IMT,number,area and thickness of plaque in observation group were less than those in control group(P<0.01). Peak systolic velocity and end diastolic velocity in observation group were higher than those in control group(P<0.01),while pulsatility index and resistance index were lower than those in control group(P<0.01). And levels of ET-1,vWF,sICAM-1,VEGF,MMP-9,TG,TC,LDL-C,LBV,HBV,PV,PAR,FIB,Hcy,IL-6,TNF-α,MDA and ox-LDL were lower than those in control group(P<0.01),whereas levels of NO,HDL-C,IL-10,SOD and GSH-Px were higher than those in control group(P<0.01). And there was no adverse reaction caused by traditional Chinese medicine. Conclusion: Modified Danshenyin and Erchentang can reduce plaque,improve hemodynamics and hemorheology,and regulate blood lipid metabolism and vascular endothelial factor,with anti-inflammatory and anti-oxidation damages. It can protect vascular intima,and inhibit the occurrence and development of CAS,with a safety in clinical use.