开郁祛痰活血汤合加味丹参饮治疗冠心病心绞痛痰瘀气滞证合并抑郁临床研究

Clinical efficacy of Kaiyu Qutan Huoxue Decoction combined with modified Danshen Decoction for patients with coronary heart disease angina pectoris and depression of phlegm and blood stasis syndrome

目的观察开郁祛痰活血汤合加味丹参饮治疗冠心病心绞痛痰瘀气滞证合并抑郁的临床疗效。方法将110例冠心病心绞痛痰瘀气滞证合并抑郁患者按照随机数字表法分为2组,对照组55例予西医常规治疗,治疗组55例在对照组基础上联合开郁祛痰活血汤合加味丹参饮治疗。2组均治疗2个月,比较2组心电图疗效和中医症状疗效,比较2组治疗前后心绞痛发作次数、每次持续时间、每次硝酸甘油用量及疼痛视觉模拟评分(VAS)变化情况,比较2组治疗前后血液指标能量平衡相关蛋白(Adropin)、胶质纤维酸性蛋白(GFAP)、血小板活化因子(PAF)及糖类抗原153(CA153)水平变化情况,比较2组治疗前后颈动脉内膜中层厚度(CIMT)及颈动脉硬化斑块形成情况,比较2组治疗前后抑郁程度变化情况。结果治疗组心电图疗效总有效率94.55%(52/55),中医症状疗效总有效率96.36%(53/55),对照组分别为76.36%(42/55)、78.18%(43/55),治疗组心电图疗效和中医症状疗效总有效率均高于对照组(P<0.05)。与本组治疗前比较,2组治疗后心绞痛发作次数、每次持续时间及每次硝酸甘油用量均减少(P<0.05),疼痛VAS均降低(P<0.05),且治疗组治疗后心绞痛发作次数、每次持续时间、每次硝酸甘油用量及疼痛VAS均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后GFAP、PAF及CA153水平均降低(P<0.05),Adropin水平均升高(P<0.05),且治疗组治疗后GFAP、PAF及CA153水平均低于对照组(P<0.05),Adropin水平高于对照组(P<0.05)。与本组治疗前比较,2组治疗后CIMT减小(P<0.05),颈动脉硬化斑块形成率降低(P<0.05),且治疗组治疗后CIMT及颈动脉硬化斑块形成率均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后抑郁程度均有减轻(P<0.05),且治疗组治疗后抑郁程度轻于对照组(P<0.05)。结论开郁祛痰活血汤合加味丹参饮治疗冠心病心绞痛痰瘀气滞证合并抑郁疗效确切,可有效控制冠心病病情,减少和减轻心绞痛发作,改善患者抑郁程度,其作用机制可能与调节血清Adropin、GFAP、PAF及CA153水平,改善CIMT及颈动脉硬化斑块形成有关。

Objective To observe the clinical efficacy of Kaiyu Qutan Huoxue Decoction combined with modified Danshen Decoction for coronary heart disease angina pectoris(CHD-AP)patients with depression(phlegm and blood stasis syndrome).Methods Totally 110 CHD-AP patients with depression(phlegm and blood stasis syndrome)were randomized 1∶1 to receive conventional Western medicine(the control group)or conventional Western medicine+Kaiyu Qutan Huoxue Decoction+modified Danshen Decoction(the treatment group)for 2 months.The aim was to compare electrocardiogram(ECG)efficacy,curative effect of traditional chinese medicine(TCM),the frequency and duration of AP,nitroglycerin dosage,visual analogue scale(VAS),blood indexesAdropin,Glial Fibrillary Acidic Protein[GFAP],Platelet-Activating Factor[PAF],Carbohydrate (Antigen 153[CA153]),carotid intima-media thickness(CIMT),carotid plaque formation(CPF),degree of depression.Results The overall effective rate of ECG and TCM in the treatment group were better than those in the control group(94.55%[52/55]vs 76.36%[42/55];96.36%[53/55]vs 78.18%[43/55][P<0.05],respectively).After treatment,the frequency and duration of AP,nitroglycerin dosage,VAS in the both groups were decreased(all P<0.05),the treatment group was more common with respect to the control group(P<0.05).GFAP,PAF and CA153 in the both groups were decreased(P<0.05),while serum adropin level in the both groups was increased(P<0.05);which in the treatment group was superior to the control group(all P<0.05).CIMT and CPF in the both groups were decreased(all P<0.05),the reduction in the treatment group was more prevalent relative to the control group(P<0.05).The degree of depression in the both groups was decreased(all P<0.05),which was decreased in the treatment group than in the control group(P<0.05).Conclusion For CHD-AP patients with depression(phlegm and blood stasis syndrome),the two combinations have definite curative effect,which can reduce AP and alleviate depressive symptoms.Its effects may be related to the regulation of serum adropin level,GFAP,PAF,CA153 levels and improve CIMT and prevent CPT.