铜砭刮痧联合疏肝逐瘀汤加减干预气滞血瘀型冠心病的临床疗效及对患者血液流变学、心绞痛症状的影响

Clinical effect of Tongbian Guasha combined with Shugan Zhuyu Decoction on coronary heart disease of qi stagnation and blood stasis type and its influence on hemorheology and angina pectoris

目的观察铜砭刮痧联合疏肝逐瘀汤加减干预气滞血瘀型冠心病的临床疗效及对患者血液流变学、心绞痛症状的影响。方法前瞻性选取2020年12月至2022年10月湖南中医药大学第二附属医院收治的80例中医辨证属于气滞血瘀型的冠心病患者为研究对象,采用随机数字表法分为观察组和对照组,每组40例。两组均给予抗凝、调脂等常规治疗,对照组加用疏肝逐瘀汤加减治疗,观察组在对照组基础上联合铜砭刮痧治疗,两组均连续治疗2周。比较两组治疗前和治疗2周后血液流变学指标、同型半胱氨酸(Hcy)、缺氧诱导因子-1α(HIF-1α)、内皮素-1(ET-1)、左心室射血分数(LVEF)、心绞痛症状评分的差异,统计两组心绞痛疗效。结果治疗2周后,两组全血低切和血浆黏度、血细胞比容、血小板凝聚率、Fib较治疗前下降,且观察组分别为(9.23±2.01)mPs·s、(1.34±0.36)mPs·s、(37.44±4.27)%、(32.71±3.23)%、(2.67±0.38)g/L,均低于对照组[(11.42±2.16)mPs·s、(1.72±0.42)mPs·s、(46.22±4.07)%、(38.25±3.23)%、(3.44±0.41)g/L],差异均有统计学意义(P<0.05)。治疗2周后,两组Hcy、HIF-1α、ET-1水平较治疗前均下降,且LVEF较治疗前升高,且观察组Hcy、HIF-1α、ET-1水平分别为(10.14±2.23)μmol/L、(5.12±0.64)μg/L、(47.32±5.11)ng/L,均低于对照组[(13.46±2.78)μmol/L、(5.93±0.78)μg/L、(55.06±6.23)ng/L],LVEF为(64.02±6.77)%,高于对照组[(55.96±5.23)%],差异均有统计学意义(P<0.05)。治疗2周后,两组疾病程度、持续时间、发作次数、硝酸甘油用量均较治疗前下降,且观察组分别为(1.68±0.32)、(1.57±0.34)、(1.42±0.29)、(1.21±0.35)分,均低于对照组[(2.14±0.42)、(2.03±0.38)、(1.91±0.33)、(1.76±0.46)分],差异均有统计学意义(P<0.05)。观察组总有效率为92.50%,与对照组(82.50%)比较,差异无统计学意义(P>0.05)。结论铜砭刮痧联合疏肝逐瘀汤加减干预气滞血瘀型冠心病可改善血液流变学,减轻心绞痛症状,降低Hcy、HIF-1α、ET-1的表达。

Objective To observe the clinical effect of Tongbian Guasha combined with Shugan Zhuyu Decoction on coronary heart disease of qi stagnation and blood stasis type,and its influence on hemorheology and angina pectoris.Methods Prospectively selected 80 patients with coronary heart disease of qi stagnation and blood stasis type treated in Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine from December 2020 to October 2022,and they were divided into observation group and control group,40 case in each group.Both groups were given routine treatment such as anticoagulation and lipid regulation.The control group was treated with modified Shugan Zhuyu Decoction.The observation group was treated with copper needle scraping on the basis of the control group for two consecutive weeks.The hemorheology indexes,homocysteine(Hcy)and hypoxia inducible factor-1α(HIF-1α)were compared between the two groups before and after treatment for 2 weeks,the difference of endothelin-1(ET-1),left ventricular ejection fraction(LVEF)and angina symptom score was calculated.Two groups of angina pectoris efficacy were statistically analyzed.Results After 2 weeks of treatment,the whole blood low shear rate,plasma viscosity,hematocrit,platelet aggregation rate,and FIB in both groups decreased compared to before treatment,and those in the observation group were(9.23±2.01)mPs·s,(1.34±0.36)mPs·s,(37.44±4.27)%,(32.71±3.23)%,(2.67±0.38)g/L,respectively,which were lower than those in the control group[(11.42±2.16)mPs·s,(1.72±0.42)mPs·s,(46.22±4.07)%,(38.25±3.23)%,(3.44±0.41)g/L],the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of Hcy,HIF-1α,ET-1 in both groups decreased compared to before treatment,and LVEF increased compared to before treatment,and the levels of Hcy,HIF-1α,ET-1 in the observation group were(10.14±2.23)μmol/L,(5.12±0.64)μg/L,(47.32±5.11)ng/L,respectively,which were lower than those in the control group[(13.46±2.78)μmol/L,(5.93±0.78)μg/L,(55.06±6.23)ng/L],LVEF was(64.02±6.77)%,which was higher than that in the control group[(55.96±5.23)%],and the differences were statistically significant(P<0.05).After 2 weeks of treatment,the degree of disease,duration,frequency of attacks,and dosage of nitroglycerin in both groups decreased compared to before treatment,and the observation group were(1.68±0.32),(1.57±0.34),(1.42±0.29),and(1.21±0.35)scores,respectively,which were lower than those in the control group[(2.14±0.42),(2.03±0.38),(1.91±0.33),and(1.76±0.46)scores],and the differences were statistically significant(P<0.05).The total effective rate of the observation group was 92.50%,and there was no statistically significant difference compared to the control group(82.50%)(P>0.05).Conclusion Tongbian Guasha combined with Shugan Zhuyu Decoction can improve hemorheology,relieve angina symptoms,and reduce expression of Hcy and HIF-1α,ET-1 in patients with coronary heart disease of qi stagnation and blood stasis type.