加味温胆汤联合黛力新治疗冠心病PCI术后焦虑抑郁患者的临床疗效及对Lp-PLA2的影响研究

Clinical Efficacy of Modified Wendan Decoction Combined with Flupentixoland Melitracen Tablets for the Treatment of Anxiety and Depression inPatients with Coronary Artery Disease After Percutaneous CoronaryIntervention and Its Effect on Lp-PLA2

【目的】观察加味温胆汤治疗冠心病冠状动脉支架植入术(PCI)后并发焦虑抑郁患者的临床疗效及其对血清脂蛋白磷脂酶A2(Lp-PLA2)的影响。【方法】将60例冠心病PCI术后伴有焦虑抑郁状态,中医证型为痰浊闭阻证的患者随机分为对照组和观察组,每组各30例。所有患者均给予冠心病PCI术后常规西药治疗,对照组同时给予黛力新(氟派噻吨美利曲辛片)口服及心理干预治疗(包括健康教育、语言安慰及运动疗法等),治疗组在对照组的基础上联合加味温胆汤治疗,2周为1个疗程,共治疗4个疗程。观察2组患者治疗前后汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、中医证候积分及血清Lp-PLA2水平的变化情况,并评价2组患者的中医证候疗效和焦虑抑郁症状改善疗效。【结果】(1)中医证候疗效方面,治疗后,观察组的总有效率为93.33%(28/30),对照组为76.67%(23/30),组间比较,观察组的中医证候疗效明显优于对照组(P<0.05)。(2)焦虑抑郁症状改善疗效方面,治疗后,观察组焦虑、抑郁症状改善疗效的总有效率分别为93.33%(28/30)、96.67%(29/30),对照组均为76.67%(23/30),组间比较,观察组的焦虑、抑郁症状改善疗效均优于对照组(P<0.05)。(3)量表评分方面,治疗后,2组患者的HAMA评分、HAMD评分和中医证候积分均较治疗前明显下降(P<0.01),且观察组的下降幅度均明显优于对照组(P<0.05或P<0.01)。(4)血清Lp-PLA2水平方面,治疗后,2组患者的血清Lp-PLA2水平均较治疗前明显下降(P<0.01),且观察组的下降幅度明显优于对照组(P<0.01)。【结论】加味温胆汤有助于缓解冠心病PCI术后患者焦虑抑郁状态,减轻中医临床症状,改善患者预后,提高患者生活质量,其机制可能与降低血清Lp-PLA2水平,减轻炎性细胞浸润有关。

Objective To observe the clinical efficacy of modified Wendan Decoction combined with Flupentixol and Melitracen Tablets for the treatment of anxiety and depression in patients with coronary heart disease after percutaneous coronary intervention(PCI)by coronary artery stent implantation and to investigate its effect on the serum lipoprotein phospholipase A2(Lp-PLA2).Methods Sixty patients with anxiety and depression after PCI by coronary artery stent implantation for coronary heart disease and with the traditional Chinese medicine(TCM)syndrome of turbid phlegm obstruction were randomly divided into the control group and the observation group,with 30 patients in each group.All of the patients were given conventional western medicine treatment for coronary heart disease after PCI.Additionally,the control group was given oral use of Deanxit(Flupentixol and Melitracen Tablets)and psychological intervention(including health education,consoling words,exercise therapy,etc.).The treatment group was given the modified Wendan Decoction based on the treatment for the control group.Patients in both groups were treated for 2 weeks as a course of treatment and for a total of 4 courses of treatment.Before and after treatment,the changes in Hamilton anxiety scale(HAMA)scores,Hamilton depression scale(HAMD)scores,TCM syndrome scores and serum Lp-PLA2 levels in the two groups were observed.After treatment,the efficacy for TCM syndrome and the efficacy for improving anxiety and depression in the two groups were evaluated.Results(1)After treatment,the total effective rate for TCM syndrome in the observation group was 93.33%(28/30)and that in the control group was 76.67%(23/30).The intergroup comparison showed that the efficacy for TCM syndrome in the observation group was significantly superior to that in the control group(P<0.05).(2)After treatment,the overall effective rates for improving anxiety and depression in the observation group were 93.33%(28/30)and 96.67%(29/30)respectively,and those in the control group were all 76.67%(23/30).The intergroup comparison showed that the efficacy for improving anxiety and depression in the observation group was superior to that in the control group(P<0.05).(3)After treatment,the HAMA scores,HAMD scores and TCM syndrome scores in the two groups were all significantly decreased compared with those before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01)(.4)After treatment,the serum Lp-PLA2 level in both groups was significantly decreased compared with that before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).Conclusion The modified Wendan Decoction is effective on relieving the anxiety and depression symptoms of patients with coronary heart disease after PCI,alleviating the TCM symptoms,improving the prognosis of patients and enhancing their quality of life.Its mechanism may be related to the decrease of serum Lp-PLA2 level and the alleviation of the infiltration of inflammatory cells.