银杏酮酯滴丸对稳定型心绞痛患者心绞痛发作及外周血miR-29a、ICAM-1水平的影响

Effects of ginkgolides drops on anginal attacks and peripheral blood miR⁃29a and ICAM⁃1 levels in patients with stable angina pectoris

目的观察银杏酮酯滴丸对稳定型心绞痛患者心绞痛发作及外周血microRNA-29a(miR-29a)、细胞间黏附分子-1(ICAM-1)水平的影响。方法研究选取2022年1月至2023年12月,就诊于长沙市第四医院心内科的78例稳定型心绞痛患者,将患者采用随机数字表法随机分为常规组和中成药组各39例。常规组给予常规西药治疗,中成药组在常规组基础上联合银杏酮酯滴丸治疗。观察两组心绞痛发作情况、心电图平板运动试验指标、血液流变学、6 min步行试验距离、中医症状评分及外周血miR-29a、ICAM-1变化,统计两组硝酸甘油停减率和不良反应发生率。结果两组治疗前心绞痛发作情况比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后每周发作次数、每周硝酸甘油用量、单次持续时间降低,中成药组较常规组更低(P<0.05)。两组治疗前心电图平板运动试验指标比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后诱发阳性时间、运动终止时间、最大ST下降时间增加,中成药组诱发阳性时间、最大ST下降时间较常规组更高,运动终止时间与治疗前比较,差异无统计学意义(P>0.05);两组治疗后最大ST下降幅度、ST恢复时间降低,中成药组较常规组更低(P<0.05)。两组治疗前miR-29a、ICAM-1、血液流变学比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后ICAM-1及全血高/低切黏度、FIB、血小板凝聚率、血浆黏度降低,中成药组较常规组更低(P<0.05);两组治疗后miR-29a与治疗前比较,差异无统计学意义(P>0.05)。两组治疗前6 min步行试验距离、中医症状评分比较,差异无统计学意义(P>0.05)。治疗前后比较,两组治疗后6min步行试验距离增加,中成药组较常规组更高(P<0.05);两组治疗后中医症状评分降低,中成药组较常规组更低(P<0.05)。中成药组硝酸甘油停减率(79.49%,31/39)高于常规组(56.41%,22/39),不良反应发生率(7.69%,3/39)与常规组(5.13%,2/39)比较,差异无统计学意义(P>0.05)。结论银杏酮酯滴丸治疗稳定型心绞痛患者可改善心肌缺血程度和血液流变学,减少心绞痛发作,降低ICAM-1水平,提高硝酸甘油停减率。

Objective To observe the effects of ginkgolides drops on anginal attacks and peripheral blood levels of microRNA⁃29 a(miR⁃29a)and intercellular adhesion molecule⁃1(ICAM⁃1)in patients with stable angina pectoris.Methods 78 patients with stable angina pectoris patients,who had visited the cardiology department of our hospital during the period of January 2022 to December 2023,were selected.The patients were divided in a Chinese medicine group or a conventional group by using the random number table method,39 in each group.The conventional group received conventional Western medicine treatment,while the Chinese medicine received ginkgo ketone ester drip pills on the basis of conventional Western medicine therapies.Occurrence of angina attack,treadmill electrocardiogram test indexes,blood rheology,6⁃minute walking distance,TCM symptom scores and changes in peripheral blood miR⁃29a and ICAM⁃1 were observed in the two groups.The rate of nitroglycerin discontinuation or reduction and the incidence of adverse reactions were counted.Results Before treatment,there was no statistically significant difference in occurrence of angina attacks between the two groups(P>0.05).After treatment,the number of attacks per week,weekly glyceryl trinitrate uses,and duration of each attack decreased in both groups,with a greater decline in the Chinese medicine group than in the conventional group(P<0.05).Before treatment,there was no statistically significant difference in the indicators of treadmill electrocardiogram test between the two groups(P>0.05).After treatment,induction positive time,exercise termination time,and maximum ST depression time increased in both groups,with longer induction positive time and maximum ST depression time in the Chinese medi⁃cine group than in the conventional group,while exercise termination time,as compared with the baseline,did not differ statistically(P>0.05).Maximum ST depression amplitude and ST recovery time decreased in both groups,with a greater decrease in the Chinese medicine group than in the conventional group(P<0.05).Before treatment,there were no statistically significant differences in miR⁃29a,ICAM⁃1,and rheology between the two groups(P>0.05).After treatment,ICAM⁃1 and whole blood high/low shear viscosity,FIB,platelet aggregation rate,and plasma viscosity decreased in both groups,with a bigger drop in the Chinese medicine group than in the conventional group(P<0.05).As compared with the baseline,miR⁃29a did not differ statistically between the two groups(P>0.05).Before treatment,there were no statistically significant differences in 6min walking distance and Chinese medicine symptom scores between the two groups.After treatment,6 min walking distance increased in both groups,with a greater increase in the Chinese medicine group than in the conventional group(P<0.05);Chinese medicine symptom scores decreased in both groups,with a greater decrease in the Chinese medicine group than in the conven⁃tional group(P<0.05).The glyceryl trinitrate reduction rate was higher in the Chinese medicine group(79.49%,31/39 cases)than in the conventional group(56.41%,22/39 cases),and the incidence of adverse reactions did not differ statistically between the Chinese medicine group and the conventional group(7.69%vs.5.13%,3/39 vs.2/39 cases;P>0.05).Conclusions Ginkgolides drops for stable angina improve the degree of myocardial ischaemia and blood rheology,reduce angina attacks,lower ICAM⁃1 levels,and increase the rate of nitroglycerin discontinua⁃tion or reduction.