血府逐瘀汤治疗原发性稳定型微血管心绞痛不同中医证型患者的疗效观察

The effect of Xuefu Zhuyu decoction on primary stable microvascular angina in patients with different TCM syndromes

目的观察血府逐瘀汤治疗原发性稳定型微血管心绞痛不同中医证型患者的疗效。方法2018年9月至2020年9月浙江省立同德医院收治原发性稳定型微血管心绞痛患者50例,根据中医辨证分型分为血瘀证组26例和非血瘀证组24例,两组患者均在常规治疗的基础上给予血府逐瘀汤剂(1剂/d,分2次服用),以28 d为一个治疗周期。测定并比较两组患者治疗前后血脂指标、血液流变学指标、血栓弹力图参数、血小板活性及超敏C反应蛋白(hs-CRP)水平变化,评价临床疗效。结果治疗前,两组患者各项血脂指标、血液流变学指标、血栓弹力图参数、血小板活性及hs-CRP水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者低密度脂蛋白胆固醇(LDL-C)、甘油三酯、总胆固醇(TC)、全血黏度、血浆黏度、血细胞比容、纤维蛋白原、凝固角(α角)、最大振幅(MA)、血小板活性单位(PRU)、hs-CRP均明显下降(均P<0.05),凝血反应时间(R)、凝血形成时间、30 min血凝块将要溶解的百分比、30 min血凝块减少速率、血小板抑制率均明显升高(均P<0.05);血瘀证组LDL-C、TC、全血黏度、血浆黏度、血细胞比容、纤维蛋白原、α角、MA、凝血指数、PRU、hs-CRP均明显低于非血瘀证组(均P<0.05);R、血小板抑制率均高于非血瘀证组(均P<0.05)。血瘀证组存在血小板抵抗的比例为53.8%,明显低于非血瘀证组的83.3%(P<0.05);总有效率为88.5%,明显高于非血瘀证组的58.3%(P<0.05)。结论血府逐瘀汤治疗原发性稳定型微血管心绞痛血瘀证患者的疗效优于非血瘀证患者。

Objective To observe the effect of Xuefu Zhuyu decoction on primary microvascular angina(PMA)in patients with different TCM syndromes.Methods Fifty patients with PMA were enrolled from September 2018 to September 2020 in Tongde Hospital of Zhejiang Province,and divided into blood stasis syndrome group(26 cases)and non-blood stasis syndrome group(24 cases)according to TCM syndrome differentiation.All patients in the two groups were treated with Xuefu Zhuyu decoction(1 dose/d,divided into 2 times)for 28 days on the basis of conventional therapy.Blood lipid,hemorheology,thromboelastogram,platelet activity and high sensitivity C-reactive protein(hs-CRP)were measured before and after treatment and compared between the two groups.The clinical efficacy was evaluated.Results Before treatment,there were no significant differences in blood lipid,hemorheology,thromboelastogram,platelet activity and hs-CRP between the two groups(all P>0.05).After treatment,low density lipoprotein cholesterol(LDL-C),triglyceride,total cholesterol(TC),whole blood viscosity,plasma viscosity,hematocrit,fibrinogen,alpha angle,maximum amplitude(MA),platelet reaction unit(PRU)and hs-CRP were significantly decreased,while the clotting reaction time(R time),kinetics time,estimated percent lysis at 30 min,30-minute percent lysis after MA and platelet inhibition rate(PIR)were significantly increased(all P<0.05)in both groups.LDL-C,TC,whole blood viscosity,plasma viscosity,hematocrit,fibrinogen,alpha angle,MA,coagulation index,PRU and hs-CRP were significantly lower in blood stasis syndrome group than in non-blood stasis syndrome group(all P<0.05).The R-time and PIR were significantly higher in blood stasis syndrome than in non-blood stasis syndrome group(all P<0.05).The proportion of platelet resistance was significantly lower and the total efficacy was significantly higher in blood stasis syndrome group than in non-blood stasis syndrome group(53.8%vs.83.3%,88.5%vs.58.3%,respectively,all P<0.05).Conclusion Xuefu Zhuyu decoction is more effective in relieving primary stable microvascular angina in patients with blood stasis syndrome than with non-blood stasis syndrome.