养心汤加减化裁对冠心病PCI术后病人心血管不良事件及氧化应激指标的影响

Effects of Modified Yangxin Decoction on Cardiovascular Adverse Events and Oxidative Stress Indexes in Patients with Coronary Heart Disease after PCI

目的观察养心汤加减化裁对冠心病经皮冠状动脉介入(PCI)术后病人心血管不良事件及氧化应激指标的影响。方法选取2019年2月—2020年7月我院心病科收治的120例冠心病行PCI术后病人为研究对象,采用分层区组随机化分组法分为观察组和对照组,各60例。对照组给予围术期常规治疗,包括阿司匹林肠溶片、硫酸氢氯吡格雷片或替格瑞洛片,观察组在对照组基础上通过辨证给予养心汤加减化裁治疗,两组均连续治疗6个月。比较两组治疗前后气虚血瘀证候评分、心功能指标[包括左室射血分数(LVEF)、每搏输出量(SV)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)]及氧化应激指标[核因子E2相关因子2(Nrf2)、血红素加氧酶-1(HO-1)、醌氧化还原酶-1(NQO-1)、超氧化物歧化酶(SOD)和丙二醛(MDA)]水平。术后每个月进行随访,观察记录6个月内心绞痛复发、严重心律失常、支架内再狭窄等心血管不良事件发生率。结果治疗后,两组心胸阵痛、胸闷、心悸气短、易汗、倦怠懒言、面色晦暗各项气虚血瘀证候评分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组LVEF、SV较治疗前均升高,LVEDD和LVESD较治疗前均降低,且观察组优于对照组,差异有统计学意义(P<0.05)。治疗后,两组Nrf2、HO-1、NQO-1、SOD水平较治疗前均升高,MDA水平较治疗前降低,且观察组优于对照组,差异有统计学意义(P<0.05)。随访期间,观察组心血管不良事件发生率为28.3%,对照组为65.0%,两组比较差异有统计学意义(P<0.05)。结论养心汤加减化裁用于冠心病PCI术后治疗,能改善病人临床症状和心功能,降低心血管不良事件发生率,其作用机制可能是通过调节机体氧化应激水平实现。

Objective To observe the effect of Modified Yangxin Decoction on cardiovascular adverse events and oxidative stress indexes in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods One hundred and twenty patients with coronary heart disease were randomly divided into the observation group and the control group.The patients in the control group were treated with routine perioperative treatment,including aspirin enteric-coated tablets,clopidogrel sulfate(or ticagrelor),bisoprolol fumarate for 6 months,and the patients in the observation group were treated with Modified Yangxin Decoction on the basis of the control group for 6 months.The scores of qi deficiency and blood stasis syndrome,cardiac function indexes[left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular end-diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)],oxidative stress indexes[nuclear factor E2 oxidative stress biomarkers related factor 2(Nrf2),heme oxygenase 1(HO-1),quinone oxidoreductase 1(NQO-1),superoxide dismutase(SOD),and malondialdehyde(MDA)]were compared between the two groups.The cardiovascular adverse events such as recurrence of angina pectoris,severe arrhythmia,and in-stent restenosis were observed and recorded within 6 month.Results After treatment,the scores of qi deficiency and blood stasis syndrome in both groups,such as chest pains,chest tightness,palpitation,shortness of breath,easy to sweat,hypologia,gloomy complexion,were lower significantly than those before treatment(P<0.05),and those in the observation group were lower significantly than those in the control group(P<0.05).After treatment,LVEF,SV,Nrf2,HO-1,NQO-1,and SOD in both groups were increased significantly,LVEDD,LVESD,and MDA were decreased(P<0.05),those in the observation group were significantly better than those in the control group(P<0.05).During the follow-up period,the incidence of adverse cardiovascular events in the observation group(28.3%)was significantly lower than that in the control group(65.0%),and the difference was statistically significant(P<0.05).Conclusion Modified Yangxin Decoction could improve clinical symptoms and cardiac function of patients after PCI,and reduce the incidence of adverse cardiovascular events.Its mechanism might relate regulating the level of oxidative stress.