芪参益气滴丸联合单硝酸异山梨酯和氯吡格雷治疗对冠心病不稳定型心绞痛患者临床疗效、心功能及冠脉血流、血小板功能的影响

Effects of Qishenyiqi dropping pills combined with isosorbide mononitrate and clopidogrel on clinical efficacy,heart function,coronary blood flow and platelet function in patients with unstable angina pectoris of coronary heart disease

目的:探讨芪参益气滴丸联合单硝酸异山梨酯和氯吡格雷治疗冠心病不稳定型心绞痛(Unstable angina pectoris,UA)患者临床疗效。方法:选取2022年1月至2023年6月修武县中医医院收治的100例UA患者,随机分为常规西药组和中药联合组,各50例。常规西药组口服单硝酸异山梨酯和氯吡格雷治疗,中药联合组在常规西药治疗基础上联合口服芪参益气滴丸治疗。治疗4 w后,比较两组临床疗效、心功能指标[左室舒张末期的内径(Left ventricular end-diastolic diameter,LVEDD)、左室收缩末期的内径(Left ventricular end systolic diameter,LVESD)、左室等容舒张时间(Left isovolumic relaxation time,IVRT)、左室射血分数(Left ventricular ejection fraction,LVEF)]、冠脉血流参数[收缩期峰值流速(Peak systolic velocity,PSV)、舒张期峰值流速(Peak diastolic velocity,PDV)]、血小板功能指标[P选择素(Platelet P-selectin,CD62P)、血小板最大聚集率(Maximum platelet aggregation rate,MPAR)、血小板特异性糖蛋白(Platelet glycoprotein,GP)Ⅱb/Ⅲa、溶酶体膜糖蛋白(Lysosomal membrane protein,CD63)]、心肌酶指标[肌钙蛋白Ⅰ(Cardiac troponinⅠ,cTnⅠ)、肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、氨基末端脑钠尿肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)]及不良反应。结果:治疗后,中药联合组总有效率明显高于常规西药组(P<0.05);中药联合组LVEF明显高于常规西药组,LVESD、LVEDD、IVRT明显低于常规西药组(P<0.05);中药联合组PSV、PDV明显高于常规西药组,CD62P、MPAR、GPⅡb/Ⅲa、CD63、NT-proBNP、cTnⅠ、CK-MB明显低于常规西药组(P<0.05);两组不良反应发生率无明显差异(P>0.05)。结论:芪参益气滴丸联合单硝酸异山梨酯和氯吡格雷治疗可提高冠心病UA患者临床疗效,并改善心功能、冠脉血流量、血小板功能,有助于患者病情恢复。

Objective:To investigate the clinical efficacy of Qishenyiqi dropping pills combined with isosorbide mononitrate and clopidogrel in the treatment of patients with unstable angina pectoris(UA)of coronary heart disease.Methods:All 100 patients with UA admitted to Xiuwu Hospital of Traditional Chinese Medicine from January 2022 to June 2023 were collected and randomly divided into conventional western medicine group and traditional Chinese medicine(TCM)combined group.The conventional western medicine group was treated with isosorbide mononitrate and clopidogrel orally,and the TCM combined group was treated with Qishenyiqi dropping pills orally on the basis of conventional Western medicine.After 4 weeks of treatment,the clinical curative effect,heart function indexes left ventricular end-diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left isovolumic relaxation time(IVRT),left ventricular ejection fraction(LVEF),coronary blood flow parameters peak systolic velocity(PSV),peak diastolic velocity(PDV),platelet function indicators platelet P-selectin(CD62P),maximum platelet aggregation rate(MPAR),platelet glycoprotein(GP)Ⅱb/Ⅲa,lysosomal membrane protein(CD63),cardiac enzyme indexes cardiac troponin Ⅰ(cTnⅠ),creatine kinase isoenzyme(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)and adverse reactions were compared between two groups.Results:After treatment,the total effective rate of TCM combined group was obviously higher than that of conventional western medicine group(P<0.05).LVEF in TCM combined group was obviously higher than that in conventional western medicine group,LVESD,LVEDD and IVRT were obviously lower than those in conventional Western medicine group(P<0.05).PSV and PDV in TCM combined group were obviously higher than those in conventional western medicine group,CD62P,MPAR,GPⅡb/Ⅲa,CD63,NT-proBNP,cTnⅠ,CK-MB were obviously lower than those in conventional Western medicine group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Qishenyiqi dropping pills combined with isosorbide mononitrate and clopidogrel can improve the clinical efficacy of UA patients with coronary heart disease,improve cardiac function,coronary blood flow and platelet function,and help patients recover from the disease.