清热化瘀方对热毒血瘀型急性ST段抬高型心肌梗死病人急诊PCI术后左室重构的影响

Effect of Qingre Huayu Formula on Left Ventricular Remodeling after Emergency PCI in Patients with Heat-toxic Blood-stasis Type with Acute ST-segment Elevation Myocardial Infarction

目的观察清热化瘀方对热毒血瘀型急性ST段抬高型心肌梗死(STEMI)病人急诊经皮冠状动脉介入(PCI)术后左室重构的影响。方法选取2018年5月1日—2019年12月1日在上海中医药大学附属曙光医院心血管科住院诊断为急性STEMI并行急诊PCI术的病人100例,随机分为中药组和对照组,各50例。对照组根据治疗指南给予标准化西医治疗,中药组在标准化西医治疗基础上加用清热化瘀方治疗,治疗时间为1个月。观察两组治疗前、治疗后7 d和治疗后30 d炎性因子、心功能指标变化;观察两组治疗前、治疗后1个月和随访6个月时左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVSd)、左心室射血分数(LVEF)、左心室重量指数(LVMI)、左室舒张末期容积指数(LVEDVI)、左室收缩末期容积指数(LVESVI)水平变化。结果治疗后7 d,中药组白介素-8(IL-8)水平明显低于对照组,差异有统计学意义(P<0.05);治疗后30 d,中药组白介素-6(IL-6)水平明显低于对照组(P<0.05),而血管内皮生长因子(VEGF)水平明显高于对照组(P<0.05);治疗后30 d,中药组B型脑钠肽(BNP)水平低于对照组(P<0.05);随访6个月时,中药组LVEF水平高于对照组(P<0.05);两组治疗后LVEDD、LVESD、LVPWT、IVSd、LVMI、LVEDVI、LVESVI水平比较差异均无统计学意义(P>0.05)。结论清热化瘀方能够明显改善急性STEMI急诊PCI术后病人的炎症反应和心功能。

Objective To observe the effect of Qingre Huayu Formula on left ventricular remodeling after emergency percutaneous coronary intervention(PCI)in patients with heat-toxic blood-stasis type with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 100 acute STEMI patients after emergency PCI in Department of Cardiology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 1,2018 to December 1,2019 were randomly divided into Chinese medicine group and control group,with 50 patients in each group.The patients in control group were given standardized treatment of western medicine according to the treatment guidelines,and the patients in Chinese medicine group were additionally treated with Qingre Huayu Formula for 1 month.The changes of inflammatory factors and cardiac function indexes were observed before treatment,at 7 days after treatment,and 30 days after treatment.Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVSd),left ventricular ejection fraction(LVEF),left ventricular mass fraction(LVMI),left ventricular end-diastolic volume index(LVEDVI),and left ventricular end-systolic volume index(LVESVI)in 2 groups were observed before treatment,at 1 month and 6 months after treatment.Results After 7 days of treatment,interleukin-8(IL-8)level in Chinese medicine group was lower than that in control group(P<0.05).After 30 days of treatment,interleukin6(IL-6)level in Chinese medicine group was lower than that in control group,while vascular endothelial growth factor(VEGF)level in Chinese medicine group was higher than that in control group(P<0.05).After 30 days of treatment,the B-type brain natriuretic peptide(BNP)level in Chinese medicine group was lower than that in control group(P<0.05).After 6 months of follow-up,the LVEF level in Chinese medicine group was higher than that in control group(P<0.05).There were no significant differences in LVEDD,LVESD,LVPWT,IVSd,LVMI,LVEDVI,and LVESVI between two groups after treatment(P>0.05).Conclusion Qingre Huayu Formula can significantly improve inflammatory response and cardiac function in STEMI patients after emergency PCI.