参附汤合桂枝甘草汤联合西医常规治疗不稳定型心绞痛气虚血瘀证79例临床观察

Clinical observation on 79 cases of unstable angina pectoris with qi asthenia and blood stasis syndrome treated by Shenfu Tang(参附汤) conjunct Guizhi Gancao Tang( 桂枝甘草汤) combined with Western medicine routine treatment

目的 观察参附汤合桂枝甘草汤联合西医常规治疗不稳定型心绞痛(UAP)气虚血瘀证的临床疗效。方法 将158例UAP气虚血瘀证患者采用随机数字表法分为对照组和治疗组,各79例。对照组采用常规西医治疗,治疗组在对照组治疗方法的基础上给予参附汤合桂枝甘草汤治疗。连续治疗8周后比较2组的临床疗效、不良反应发生率,以及治疗前后中医证候积分、西雅图心绞痛量表(SAQ)评分、心功能[左心射血分数(LVEF)、左心室舒张末期内径(LVEDD)]指标、心肌损伤指标[血清1型组织纤溶酶原激活物抑制剂(t PAI-1)、可溶性细胞间黏附分子(s ICAM-l)、金属基质蛋白酶(MMP-9)水平]。结果 治疗组总有效率为96.20%(76/79),对照组为87.34%(69/79),2组比较差异有统计学意义(P<0.05);治疗后2组中医证候积分,LVEDD,血清t PAI-1、s ICAM-l、MMP-9水平均明显降低,SAQ评分、LVEF均明显升高,与同组治疗前比较差异有统计学意义(P<0.01),且治疗组对各项指标的改善作用更明显,与对照组治疗后比较差异均有统计学意义(P<0.01)。治疗组不良反应发生率为2.53%(2/79),对照组为11.39%(9/79),2组比较差异有统计学意义(P<0.05)。结论 参附汤合桂枝甘草汤联合西医常规治疗UAP气虚血瘀证疗效显著,能明显降低中医证候积分,改善机体功能状态及心功能,减轻心肌损伤,降低不良反应发生率,值得临床推广应用。

Objective To observe the clinical efficacy of Shenfu Tang(参附汤)conjunct Guizhi Gancao Tang(桂枝甘草汤)combined with Western medicine routine treatment for unstable angina pectoris(UAP)with qi asthenia and blood stasis syndrome.Methods A total of 158 UAP patients with qi asthenia and blood stasis syndrome were divided into control group and treatment group by random number table method,with 79 cases in each group.The control group was given Western medicine routine treatment,on this basis,the treatment group was given Shenfu Tang conjunct Guizhi Gancao Tang.After 8 weeks of continuous treatment,the clinical efficacy,incidence of adverse reactions,TCM syndrome score,Seattle angina questionnaire(SAQ)score,cardiac function[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)]indicators,myocardial injury indicators[the levels of serum type 1 tissue plasminogen activator inhibitor(t PAI-1),soluble intercellular adhesion molecule(s ICAM-l),and matrix metalloproteinase-9(MMP-9)]before and after treatment were compared between the 2groups.Results The total effective rate was 96.20%(76/79)in the treatment group and 87.34%(69/79)in the control group,and the difference between the 2 groups was statistically significant(P<0.05);After treatment,the TCM syndrome score,LVEDD,serum levels of t PAI-1,s ICAM-l and MMP-9 in the 2 groups decreased significantly,and the SAQ score and LVEF increased significantly as compared with those in the same group before treatment(P<0.01),and the improvement effect of the treatment group on each index was more significant,which was statistically significant as compared with that in the control group after treatment(P<0.01).The incidence of adverse reactions was 2.53%(2/79)in the treatment group and 11.39%(9/79)in the control group,and the difference was statistically significant between the 2 groups(P<0.05).Conclusion It has marked efficacy,can markedly reduce the TCM syndrome score,improve the body functional status and cardiac function,reduce myocardial injury,and reduce the incidence of adverse reactions to use Shenfu Tang conjunct Guizhi Gancao Tang combined with Western medicine routine treatment for UAP with qi asthenia and blood stasis syndrome,which deserves clinical promotion and application.