清热解毒法对热毒证急性心肌梗死介入术后患者巨噬细胞极化的影响

Effect of clearing heat and detoxification method on macrophages polarization in patients with acute myocardial infarction and heat toxin syndrome after intervention

目的:评价清热解毒法对介入术后的热毒证急性心肌梗死患者巨噬细胞极化的影响。方法:将60例接受经皮冠状动脉介入术的急性心肌梗死热毒证患者,随机分为对照组和试验组各30例。对照组予一般常规治疗,在对照组的基础上,试验组加上清热解毒法的代表方黄连解毒汤口服。两组干预时间均为2周。比较两组治疗前后西雅图心绞痛量表(Seattle Angina Questionnaire,SAQ),肌酸激酶(creatine kinase,CK),肌酸激酶MB同工酶(creatine kinase MB isoenzyme,CK-MB)、超敏肌钙蛋白I(high-sensitivity troponin I,hs-TnI)、血清磷脂酶A_(2)(lipoprotein-associated phospholipase A_(2),LP-PLA_(2))及巨噬细胞M1、M2表型比例,并观察不良反应。结果:两组患者在治疗后,SAQ各项评分均得到改善,CK、CK-MB、hs-TnI、LPPLA_(2)水平均明显下降,试验组SAQ中AS、AF、TS、DP评分高于对照组,hs-TnI、LP-PLA_(2)水平显著低于对照组(P<0.05或0.01)。治疗后两组患者巨噬细胞中M1型巨噬细胞比例下降(P<0.05或0.01),M2型巨噬细胞比例上升(P<0.05或0.01),M1/M2比值下降(P<0.05或0.01)。试验组M1/M2比值比对照组低(P<0.01)。所有患者无明显的不良反应。结论:清热解毒法对热毒证急性心肌梗死介入术后患者疗效确切,可减少心肌损伤,改善心肌功能,降低炎症反应,安全性较好。

Objective:To evaluate the effect of heat-clearing and detoxification method on the macrophages polarization in patients with acute myocardial infarction and heat toxin syndrome after intervention.Methods:Sixty patients with acute myocardial infarction andheat toxin syndrome who underwent percutaneous coronary intervention were randomly divided into the control group and the experimental group with 30 patients each.The control group was given conventional treatment,while the experimental group was given Huanglian Jiedu Decoction,the representative of the method of clearing heat and detoxification,orally,on the basis of treatment of the control group.The intervention time of both groups was 2 weeks.The Seattle Angina Questionnaire(SAQ),creatine kinase(CK),creatine kinase MB isoenzyme(CK-MB),high-sensitivity troponin I(hs-TnI),and lipoproteinassociated phospholipase A_(2)(LP-PLA_(2)),the phenotype ratio of M1 and M2 macrophages were compared in both groups before and after treatment,and the adverse reactions were observed.Results:After treatment,the SAQ scores of the two groups of patients were improved,and the levels of CK,CK-MB,hs-TnI,and LP-PLA_(2) were decreased significantly.The scores of AS,AF,TS,and DP in the SAQ of the experimental group were all higher than those of the control group,and the levels of hs-TnI and LP-PLA_(2) were significantly lower than those of the control group(P<0.05 or 0.01).After treatment,the proportion of M1 type macrophages in the two groups of patients was decreased significantly(P<0.05 or 0.01),the ratio of M2 type macrophages increased(P<0.05 or 0.01),and the M1/M2 ratio decreased(P<0.05 or 0.01).The ratio of M1/M2 in the experimental group was significantly lower than that of the control group(P<0.01).There were no obvious adverse reactions in both groups.Conclusion:The method of clearing heat and detoxifying has a significant effect on patients with acute myocardial infarction and heat toxin syndrome after interventional operation.It can reduce myocardial damage,improve myocardial function,and reduce inflammation,which is safe for clinical treatment without any increasing risk of bleeding or other risk of cardiovascular events.