血府逐瘀汤加减对痰瘀痹阻型冠心病稳定型心绞痛患者SOD、ET-1、sICAM-1及Th1/Th2平衡的影响

Effects of Xuefu Zhuyu Decoction on SOD,ET-1,sICAM-1 and Th1/Th2 Balance in Patients with Stable Angina Pectoris of Coronary Heart Disease Differentiated as Phlegm and Blood Stasis Obstruction Type

【目的】探讨血府逐瘀汤加减在痰瘀痹阻型冠心病稳定型心绞痛患者治疗中的应用价值。【方法】将126例痰瘀痹阻型冠心病稳定型心绞痛患者随机分为观察组和对照组,每组各63例。对照组给予西医常规治疗,观察组在对照组基础上联合血府逐瘀汤加减治疗,疗程为8周。观察2组患者治疗前后心绞痛发作持续时间、每周心绞痛发作次数、中医症状总积分、血液流变学指标及血清可溶性细胞间黏附分子1(sICAM-1)、内皮素1(ET-1)、白细胞介素6(IL-6)、超氧化物歧化酶(SOD)、白细胞介素10(IL-10)水平的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗8周后,观察组的总有效率为95.24%(60/63),对照组为77.78%(49/63),组间比较,观察组的疗效明显优于对照组(P<0.05)。(2)治疗后,2组患者的心绞痛发作持续时间、每周心绞痛发作次数、中医症状总积分均较治疗前改善(P<0.05),且观察组对心绞痛发作持续时间、每周心绞痛发作次数、中医总症状积分的改善幅度均明显优于对照组(P<0.05)。(3)治疗后,2组患者血清sICAM-1、ET-1、IL-6水平均较治疗前降低(P<0.05),血清SOD、IL-10水平均较治疗前升高(P<0.05),且观察组对血清sICAM-1、ET-1、IL-6水平的降低幅度及对血清SOD、IL-10水平升高幅度均明显优于对照组(P<0.05)。(4)治疗后,2组患者血浆血细胞比容、全血黏度高切、血浆黏度等血液流变学指标均较治疗前降低(P<0.05),且观察组对血浆血细胞比容、全血黏度高切、血浆黏度的降低幅度均明显优于对照组(P<0.05)。【结论】对于痰瘀痹阻型冠心病稳定型心绞痛患者而言,联合血府逐瘀汤加减治疗有助于促进Th1/Th2平衡,减轻炎症反应,调节血液流变学,改善心绞痛发作情况,提高临床疗效。

Objective To investigate the clinical effect of modified Xuefu Zhuyu Decoction for patients with stable angina pectoris of coronary heart disease differentiated as phlegm and blood stasis obstruction type. Methods A total of 126 patients with stable angina pectoris of coronary heart disease differentiated as phlegm and blood stasis obstruction type were randomly divided into the observation group and the control group,with 63 patients in each group. The control group was given conventional western medicine treatment, while the observation group was treated with modified Xuefu Zhuyu Decoction on the basis of treatment for the control group. Both groups were treated for a period of 8 weeks. The duration of angina pectoris,the weekly frequency of angina pectoris attacks,the total traditional Chinese medicine(TCM)syndrome scores,blood rheological indexes and the levels of soluble intercellular adhesion molecule 1(s ICAM-1),endothelin 1(ET-1),interleukin 6(IL-6),superoxide dismutase(SOD)and interleukin 10(IL-10)in the two groups were observed before and after treatment. Meanwhile,the clinical efficacy of the two groups of patients was evaluated. Results(1)After 8 weeks of treatment,the overall effective rate of the observation group was 95.24%(60/63)and that of the control group was 77.78%(49/63),and the intergroup comparison showed that the efficacy of the observation group was significantly superior to that of the control group(P<0.05).(2)After treatment, the duration of angina pectoris, the weekly frequency of angina pectoris attacks,and the total TCM symptom score of patients in the two groups were improved compared with those before treatment(P<0.05), and the improvement of the above indexes in the observation group was significantly superior to that in the control group(P<0.05).(3)After treatment,the levels of serum sICAM-1,ET-1 and IL-6 of patients in both groups were decreased(P<0.05)and the serum SOD and IL-10 levels were increased compared with those before treatment(P<0.05). The intergroup comparison showed that the decrease of serum sICAM-1,ET-1 and IL-6 levels and the increase of serum SOD and IL-10 levels in the observation group were significantly superior to those in the control group(P<0.05).(4)After treatment,the plasma hematocrit,whole blood high-shear viscosity,plasma viscosity and other blood rheological indexes of the two groups were all decreased compared with those before treatment(P<0.05), and the decrease of the above indexes in the observation group was significantly superior to that in the control group(P<0.05). Conclusion For patients with stable angina pectoris of coronary heart disease differentiated as phlegm and blood stasis obstruction type, the combined treatment of modified Xuefu Zhuyu Decoction with conventional western medicine is helpful for adjusting Th1/Th2 balance,reducing inflammatory response,regulating blood rheology,improving angina pectoris attacks and enhancing clinical efficacy.