大柴胡汤加减联合硫酸氢氯吡格雷片对冠心病心绞痛患者临床疗效及LL-37、ILT3水平的影响

Theraputic effects of modified Dachaihu Decoction combined with Clopidogrel Bisulfate Tablets and effects on LL-37,ILT3 level in patients with angina pectoris of coronary heart disease

目的探究大柴胡汤加减联合硫酸氢氯吡格雷片治疗冠心病心绞痛的临床疗效及对患者抗菌肽(LL-37)、免疫球蛋白样转录子(ILT3)水平的影响。方法前瞻性选取2019年3月—2020年5月于北京核工业医院治疗的冠心病心绞痛患者150例为研究对象,随机分为对照组和试验组,每组各75例。对照组患者采用硫酸氢氯吡格雷片治疗,每次75 mg,每日1次,口服。试验组在对照组基础上加服大柴胡汤(组方:柴胡、枳实、黄芩各15 g,白芍、丹参、茯苓、陈皮各20 g,大黄、半夏、甘草各10 g),组方药材煎煮后取汁400 mL,分早晚2次服用,另随症加减。分别于治疗前及治疗后对两组患者行心脏超声检查,评价患者左室间隔厚度(IST)、左室后壁厚度(LVPWT)、左室等容舒张时间(IVRT)、左室射血分数(LVEF)。分别于治疗前后采集两组患者血清,检测可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素-6(IL-6)、骨保护素(OPG)等炎症因子水平以及LL-37、ILT3水平。治疗前后对两组患者进行中医证候积分评价,同时评价患者的中医及西医疗效。结果治疗后两组患者心功能指标IST、LVPWT、IVRT、LVEF较治疗前明显改善(P<0.05),且试验组好于对照组(P<0.05);治疗后两组患者血清sICAM-1、CRP、OPG、IL-6、LL-37、ILT3水平较治疗前明显下降(P<0.05),且试验组显著低于对照组(P<0.05);治疗后两组中医证候积分均较治疗前显著降低(P<0.05),且试验组显著低于对照组(P<0.05);与对照组比较,治疗后试验组中医及西医总有效率均显著增加(P<0.05);治疗过程中两组不良反应发生率差异无统计学意义(P>0.05)。结论大柴胡汤加减联合硫酸氢氯吡格雷片治疗冠心病心绞痛,可明显改善患者心功能指标,抑制患者炎症反应,改善LL-37、ILT3水平,提高疗效。

Objective To investigate the clinical efficacy of Dachaihu Decoction combined with Clopidogrel Bisulfate Tablets in the treatment of angina pectoris of coronary heart disease and its effect on the levels of antimicrobial peptide(LL-37)and immunoglobulin like transcript(ILT3).Methods A total of 150 patients with angina pectoris of coronary heart disease treated in Beijing Nuclear Industry Hospital from March 2019 to may 2020 were prospectively divided into control group and experimental group,with 75 cases in each group.The patients in the control group were treated with Clopidogrel Bisulfate Tablets,75 mg each time,once a day,orally.On the basis of the control group,the patients in the experimental group were added with Dachaihu Decoction(the formula:Bupleuri Radix,Aurantii Fructus Immaturus and Scutellariae Radix 15 g each,Paeoniae Radix Alba,Salviae Miltiorrhizae Radix et Rhizoma,Poria and Citri Reticulatae Pericarpium 20 g each,Rhei Radix et Rhizoma,Pinelliae Rhizoma and Glycyrrhizae Radix et Rhizoma 10 g each).After decocting,take 400 mL of juice,take it twice in the morning and evening,and add or subtract according to the symptoms.Echocardiography was performed before and after treatment to evaluate the left ventricular septal thickness(IST),left ventricular posterior wall thickness(LVPWT),left ventricular isovolumic relaxation time(IVRT)and left ventricular ejection fraction(LVEF).The serum of the two groups were collected before and after treatment to detect the levels of inflammatory factors such as sICAM-1,CRP,OPG and IL-6,as well as the levels of LL-37 and ILT3.The two groups of patients were evaluated by TCM symptom score before and after treatment,and the curative effects of TCM and Western medicine were evaluated at the same time.Results After treatment,the cardiac function indexes IST,LVPWT,IVRT and LVEF of the two groups were significantly improved(P<0.05),and the experimental group was better than the control group(P<0.05).After treatment,the levels of serum sICAM-1,CRP,OPG,IL-6,LL-37 and ILT3 in the two groups were significantly lower than those before treatment(P<0.05),and the levels in the experimental group were significantly lower than those in the control group(P<0.05).After treatment,the TCM syndrome volume of the two groups was significantly lower than that before treatment(P<0.05),and the experimental group was significantly lower than that of the control group(P<0.05).Compared with the control group,the total effective rates of traditional Chinese medicine and Western medicine in the experimental group increased significantly after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Dachaihu Decoction combined with Clopidogrel Bisulfate Tablets in the treatment of angina pectoris of coronary heart disease can significantly improve the indexes of cardiac function,inhibit the inflammatory response,improve LL-37 and ILT3,and improve the curative effect.