微血管性心绞痛与内皮功能的相关性及中西医结合治疗效果

Correlation between microvascular angina and vascular endothelial function and curative effect of integrated traditional Chinese and Western medication

目的观察微血管性心绞痛与血管内皮功能的相关性及中西医结合药物治疗的效果。方法收集106例诊断为“微血管性心绞痛”住院患者,按随机数字表分为试验组(n=54)和对照组(n=52),对照组给予常规冠心病二级预防治疗,试验组在常规治疗基础上加麝香通心滴丸治疗12周。检测治疗前后影响血管内皮的舒缩因子:一氧化氮(NO)、生长分化因子(GDF-15)、内皮素(ET-1)及炎性因子:高敏C反应蛋白(hs-CRP)、尿酸(UA)、白细胞介素(IL-6)的变化。观察各组患者的心绞痛发作频次、西雅图心绞痛调查量表(SAQ)评分、心电图平板试验的运动总时间及ST段压低情况及冠状动脉血流储备(CFR)。结果治疗12周后,血清学指标结果显示:两组治疗后的NO水平均高于治疗前,ET-1、GDF-15均低于治疗前,差异有统计学意义(P<0.05)。试验组治疗后NO高于对照组,ET-1、GDF-15均低于对照组,差异有统计学意义(P<0.05)。治疗后两组hs-CRP、IL-6、UA水平均低于治疗前,差异有统计学意义(P<0.05)。试验组治疗后hs-CRP、IL-6、UA均低于对照组,差异有统计学意义(P<0.05)。试验组总有效率为96.29%,与对照组78.84%相比,差异有统计学意义(P<0.05)。试验组SAQ评分高于对照组(P<0.01)。试验组心电图平板运动试验可疑阳性率及阳性率较治疗前明显下降,差异有统计学意义(P<0.05)。治疗后试验组CFR总有效率显著高于对照组。结论中西医结合治疗可改善患者内皮功能,调整内皮舒血管物质及缩血管物质达到稳态,抗冠状动脉炎症反应,减轻胸痛发作,较单纯西药治疗,疗效显著。

Objective To observe the correlation between microvascular angina(MVA)and vascular endothelial function and curative effect of integrated traditional Chinese and Western medication.Methods MVA patients(n=106)were chosen and divided,according to random digital table,into test group(n=54)and control group(n=52).The control group was given routine secondary preventive treatment of coronary heart disease(CHD),and test group was additionally given Shexiang Tongxin Gutta Pills for 12 weeks.The changes of vasomotor cytokines influencing vascular endothelial function including nitric oxide(NO),growth differentiation factor-15(GDF-15)and endothelin(ET-1),and inflammatory factors including high sensitive C-reactive protein(hs-CRP),uric acid(UA)and interleukin 6(IL-6)were detected before and after treatment.The times of angina pectoris attack,scores of Seattle Angina Questionnaire(SAQ),the total time of electrocardiogram treadmill exercise test(TET),ST-segment depression and coronary flow reserve(CFR)were observed in 2 groups.Results After treatment for 12 weeks,the results of serological index detection showed that NO level was higher,and levels of ET-1 and GDF-15 were lower in 2 groups than those before treatment(P<0.05).NO level was higher and levels of ET-1 and GDF-15 were lower in test group than those in control group(P<0.05).The levels of hs-CRP,IL-6 and UA were lower in 2 groups after treatment than before(P<0.05).The levels of hs-CRP,IL-6 and UA were lower in test group than those in control group(P<0.05).The total effective rate was 96.29%in test group and 78.8%in control group(P<0.05).The scores of SAQ were higher in test group than those in control group(P<0.01).The suspicious positive rate and positive rate of electrocardiogram TET decreased significantly in test group after treatment than before(P<0.05).The total effective rate of CFR was significantly higher in test group than that in control group after treatment(P<0.05).Conclusion The therapy integrated traditional Chinese and Western medication can improve vascular endothelial function,regulate endothelium vasodilator and vasoconstrictor to achieve steady state,resist the inflammatory reactions of coronary artery and relieve chest pain attack,and it has more significant curative effect than simple Western medication.