清脂降浊法对痰瘀互结型冠心病合并血脂异常患者血管内皮功能和氧化应激反应的影响

Effect of Lipid-Clearing and Turbid-Lowering Method on Vascular Endothelial Function and Oxidative Stress Response in Patients(Phlegm-blood stasis Syndrome)with Coronary Heart Disease Complicated with Dyslipidemia

目的探讨清脂降浊法对痰瘀互结型冠心病合并血脂异常患者血管内皮功能和氧化应激反应的影响。方法汇总2019年2月—2020年2月该院诊治的冠心病合并血脂异常患者信息,依照纳、排标准进行筛选,将筛选后入组的114例患者随机分组,其中对照组57例,予血脂康治疗,治疗组57例应用清脂降浊法的代表方剂中药降脂灵治疗,两组疗程均为3个月。观察两组患者中医症状积分改变情况,治疗前后患者血脂水平、血管内皮功能及氧化应激反应指标改善情况,并比较两组临床疗效。结果治疗后两组患者胸痛、胸闷、身重、舌苔白腻有瘀斑等症状均减轻,中医症状积分均明显降低(P<0.05),且治疗组各症状改善更明显,积分降低更显著(P<0.05);治疗后两组血脂指标中甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)均明显降低,治疗组高密度脂蛋白胆固醇(HDL-C)明显升高(P<0.05),对照组HDL-C无变化(P>0.05),且组间比较,治疗组改善程度更明显(P<0.05);治疗组血管内皮素-1(ET-1)明显下降(P<0.05),血管扩张率(FMD)、一氧化氮(NO)明显上升(P<0.05),对照组无变化(P>0.05),且组间比较,治疗组各指标改善更显著(P<0.05);治疗组丙二醛(MDA)明显下降,超氧化物歧化酶(SOD)明显上升(P<0.05),对照组无变化(P>0.05),且组间比较,治疗组改善程度更明显(P<0.05);治疗组临床总有效率为91.23%(52/57),对照组临床总有效率为77.19%(43/57),治疗组的临床疗效优于对照组(P<0.05)。结论清脂降浊法的代表方剂中药降脂灵可化瘀祛痰、清脂降浊,能够有效调节冠心病合并血脂异常患者的血脂水平,其作用机制可能为抑制氧化应激反应、改善血管内皮功能,临床疗效较好,值得推广应用。

Objective The purpose of this study was to explore the effect of lipid-clearing and turbid-lowering method on vascular endothelial function and oxidative stress response in patients(phlegm-blood stasis syndrome)with coronary heart disease complicated with dyslipidemia.Methods The information of patients with coronary heart disease complicated with dyslipidemia diagnosed and treated in our hospital from February 2019 to February 2020 was summarized and screened according to the criteria of sodium and drainage.A total of 114 patients enrolled after screening were randomly divided into different groups.Among them,57 patients in the control group were treated with Xuezhikang(血脂康),while 57 patients in the treatment group were treated with Traditional Chinese medicine Jiangzhiling(降脂灵).Both groups’treatment course was 3 months.The changes of TCM symptom scores,the improvement of blood lipid level,vascular endothelial function and oxidative stress index before and after treatment,and the clinical effects were compared.Results The changes of the two groups after treatment were as follows:the symptoms of chest pain,chest tightness,body weight,slimy white tongue fur and other symptoms of the two groups were relieved.The TCM syndrome scores were significantly reduced(P<0.05).The symptoms of the treatment group were improved more obviously,and the scores were reduced more significantly(P<0.05).The levels of triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and total cholesterol(TC)in the blood lipid indexes of the two groups were significantly reduced,while the high density lipoprotein cholesterol(HDL-C)in the treatment group was significantly increased(P<0.05).The level of HDL-C in the control group did not change(P<0.05).The improvement degree in the treatment group was more obvious(P<0.05).The level of ET-1 in the treatment group decreased significantly(P<0.05),and the FMD and the level of NO increased significantly(P<0.05),while the above indexes in the control group did not change(P<0.05).Compared with the control group,each index in the treatment group improved more significantly(P<0.05).The levels of MDA were significantly decreased,and the levels of SOD in the treatment group were significantly increased(P<0.05),while those in the control group were unchanged(P<0.05).Compared with the control group,the improvement degree of the treatment group was more obvious(P<0.05).The clinical total effective rate of the treatment group(91.23%,52/57)was better than that of the control group(77.19%,43/57)(P<0.05).Conclusion Jiangzhiling,a representative prescription of lipid-clearing and turbid-lowering method,can promote blood circulation eliminating sputum,reduce blood lipid and relieve mental stress,and can effectively regulate the blood lipid level of patients with coronary heart disease complicated with dyslipidemia.The mechanism may be inhibiting oxidative stress response and improving vascular endothelial function.It has good clinical efficacy and is worthy of popularization and application.