天丹通络胶囊联合普罗布考治疗风痰瘀阻型老年脑梗死合并颈动脉粥样硬化斑块的临床研究

Clinical Study on Tiandan Tongluo Capsules Combined with Probucol in the Treatment of Phlegm-Stagnation Type of Senile Cerebral Infarction Complicated with Carotid Atherosclerotic Plaque

目的:探讨天丹通络胶囊联合普罗布考治疗风痰瘀阻型老年脑梗死合并颈动脉粥样硬化斑块的临床效果。方法:将2018年7月至2020年6月北京市丰台中西医结合医院收治的风痰瘀阻型老年脑梗死合并颈动脉粥样硬化斑块患者102例,按随机数字表法分为对照组和研究组。两组患者均接受常规治疗,在此基础上,对照组51例患者给予普罗布考治疗,研究组51例患者给予天丹通络胶囊联合普罗布考治疗,两组患者均持续治疗3个月。比较两组患者的临床疗效,记录两组患者治疗前后中医证候积分,超声观察高、低回声斑块变化并测量斑块面积;检测两组患者治疗前后颈部总动脉血流动力学,血清超敏C反应蛋白(hs-CRP)、D-二聚体(D-dimer)及基质金属蛋白酶9(MMP-9)水平;统计两组患者治疗期间不良反应发生情况。结果:研究组患者的总有效率为92.16%(47/51),明显高于对照组的74.51%(38/51),差异有统计学意义(P<0.05)。两组患者治疗后中医证候积分均较治疗前明显降低,且研究组患者明显低于对照组,差异均有统计学意义(P<0.05)。与对照组比较,研究组患者治疗后斑块面积明显更小,低回声斑块个数明显更少,高回声斑块个数明显更多,差异均有统计学意义(P<0.05)。两组患者治疗后颈动脉收缩中期内径比较,差异无统计学意义(P>0.05);研究组患者舒张末期流速、收缩期峰值流速均明显高于对照组,阻力指数、搏动指数均明显低于对照组,差异均有统计学意义(P<0.05)。与对照组比较,研究组患者治疗后的血清hs-CRP、D-dimer和MMP-9水平明显更低均显著低于对照组,差异均有统计学意义(P<0.05)。对照组、研究组患者的不良反应发生率分别为7.84%(4/51)、3.92%(2/51),差异无统计学意义(P>0.05)。结论:天丹通络胶囊联合普罗布考治疗风痰瘀阻型老年脑梗死并颈动脉粥样硬化斑块的疗效显著,能明显改善血流动力学,降低血清hs-CRP、D-dimer及MMP-9水平。

OBJECTIVE:To probe into the clinical effect of Tiandan Tongluo capsules combined with probucol in the treatment of phlegm-stagnation type of senile cerebral infarction complicated with carotid atherosclerotic plaque.METHODS:Totally 102 patients with phlegm-stagnation type of senile cerebral infarction complicated with carotid atherosclerotic plaque admitted into Fengtai Hospital of Integrated Chinese and Western Medicine from Jul.2018 to Jun.2020 were divided into control group and research group via random number table.Both groups were given conventional therapy,on that basis,the 51 patients in control group was given probucol,while the other 51 patients in research group was given Tiandan Tongluo capsules combined with probucol,both groups were given continuous treatment for 3 months.The clinical efficacy was compared between two groups,the TCM syndrome scores were recorded before and after treatment,the changes of high and low echogenic plaques were observed by ultrasound and the plaque area was measured;the hemodynamics of common carotid artery,serum hypersensitive C-reactive protein(hs-CRP),D-dimer and matrix metalloproteinase 9(MMP-9)levels of the two groups were measured before and after treatment;the incidences of adverse drug reactions in the two groups during treatment was collected.RESULTS:The total effective rate of research group was 92.16%(47/51),which was significantly higher than that of the control group(74.51%,38/51),with statistically significant difference(P<0.05).After treatment,the TCM symptom scores of both groups were significantly lower than those of before treatment,and that of the research group were significantly lower than the control group,with statistically significant differences(P<0.05).After treatment,the plaque area of patients in the research group was significantly smaller than that of the control group,the number of hypo-echoic plaques of the research group was significantly less than that of the control group,and the number of hyper-echoic plaques of the research group was significantly more than that of the control group,with statistically significant differences(P<0.05).There was no statistical significance in difference in the mid-systolic internal diameter of carotid artery between the two groups after treatment(P>0.05);the end-diastolic flow velocity and peak systolic flow velocity levels of patients in the research group were significantly higher than those in the control group,and the resistance index and pulsatility index of patients in the research group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The serum hs-CRP,D-dimer and MMP-9 levels of patients in the research group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The incidences of adverse drug reactions of patients in the control group and research groups were respectively 7.84%(4/51)and 3.92%(2/51),the difference was not statistically significant(P>0.05).CONCLUSIONS:The efficacy of Tiandan Tongluo capsules combined with probucol in the treatment of phlegm-stagnation type of senile cerebral infarction complicated with carotid atherosclerotic plaque is remarkable,which can significantly improve hemodynamics,reduce serum hs-CRP,D-dimer and MMP-9 levels.