天丹通络片联合阿托伐他汀治疗颈动脉粥样硬化风痰阻络证的疗效

Curative effect of Tiandan Tongluo tablets combined with atorvastatin on carotid atherosclerosis with wind-phlegm-blocked collaterals syndrome

目的探讨天丹通络片联合阿托伐他汀治疗颈动脉粥样硬化(CAS)风痰阻络证患者的效果。方法选取2019年3月至2022年12月神木市医院收治的92例CAS风痰阻络证患者,以随机数字表法分为研究组、对照组各46例。对照组男26例,女20例,年龄(52.36±7.09)岁,软斑块21例,混合斑块25例,给予阿托伐他汀钙片治疗(20 mg/次,1次/d);研究组男24例,女22例,年龄(51.48±7.23)岁,软斑块17例,混合斑块29例,给予天丹通络片(2.075 g/次,3次/d)联合阿托伐他汀钙片治疗。两组均治疗3个月。比较两组中医症状评分、斑块情况、临床疗效、血脂、血管内皮功能、血小板功能指标及不良反应情况。采用t检验、χ^(2)检验。结果治疗后,研究组主症评分、次症评分均低于对照组[(3.74±0.72)分比(4.53±0.81)分、(3.47±0.51)分比(3.91±0.58)分],差异均有统计学意义(均P<0.05)。治疗后,研究组颈动脉内膜中层厚度、斑块数量、斑块面积均低于对照组[(1.32±0.22)mm比(1.54±0.26)mm、(1.41±0.23)个比(1.76±0.29)个、(0.65±0.12)cm2比(0.89±0.16)cm2],差异均有统计学意义(均P<0.05)。研究组总有效率高于对照组[93.48%(43/46)比78.26%(36/46)],差异有统计学意义(P<0.05)。治疗后,研究组的甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平均低于对照组[(1.61±0.28)mmol/L比(1.84±0.31)mmol/L、(4.51±0.86)mmol/L比(5.02±0.93)mmol/L、(3.69±0.51)mmol/L比(4.03±0.59)mmol/L],高密度脂蛋白胆固醇水平高于对照组[(1.36±0.24)mmol/L比(1.24±0.21)mmol/L],差异均有统计学意义(均P<0.05)。治疗后,研究组血管内皮生长因子、一氧化氮水平均高于对照组[(18.12±2.59)ng/L比(16.03±2.38)ng/L、(6.98±1.02)μg/L比(6.01±0.98)μg/L],内皮素-1水平低于对照组[(40.35±5.04)ng/L比(43.61±5.91)ng/L],差异均有统计学意义(均P<0.05)。治疗后,研究组的血小板活化因子、血管性血友病因子、血栓素B2水平均低于对照组[(8.46±1.38)ng/L比(9.14±1.62)ng/L、(85.14±10.83)IU/ml比(91.42±12.67)IU/ml、(118.34±17.92)ng/L比(132.16±20.34)ng/L],差异均有统计学意义(均P<0.05)。两组治疗期间均未出现明显不良反应。结论天丹通络片联合阿托伐他汀治疗CAS风痰阻络证疗效显著,可明显改善患者临床症状、缩小斑块、调节血脂,改善血管内皮功能,调控外周血炎症因子分泌,安全可靠。

Objective To investigate the curative effect of Tiandan Tongluo tablets combined with atorvastatin in the treatment of carotid atherosclerosis(CAS)with wind-phlegm-blocked collaterals syndrome.Methods A total of 92 CAS patients with wind-phlegm-blocked collaterals syndrome were selected from Shenmu Hospital from March 2019 to December 2022,and were divided into a study group and a control group with 46 cases in each group by the random number table method.In the control group,there were 26 males and 20 females,aged(52.36±7.09)years,21 cases of soft plaque and 25 cases of mixed plaque,who were treated with atorvastatin calcium tablets(20 mg/time,once a day).In the study group,there were 24 males and 22 females,aged(51.48±7.23)years,17 cases of soft plaque and 29 cases of mixed plaque,who were treated with Tiandan Tongluo tablets(2.075 g/time,3 times each day)combined with atorvastatin calcium tablets.Both groups were treated for 3 months.The traditional Chinese medicine(TCM)symptom score,plaque status,clinical efficacy,blood lipids,vascular endothelial function,platelet function indexes,and adverse reactions were compared between the two groups.t test andχ^(2)test were used.Results After treatment,the main symptom score and secondary symptom score of the study group were lower than those of the control group[(3.74±0.72)points vs.(4.53±0.81)points,(3.47±0.51)points vs.(3.91±0.58)points],with statistically significant differences(both P<0.05).After treatment,the carotid intima-media thickness,plaque number,and plaque area in the study group were lower than those in the control group[(1.32±0.22)mm vs.(1.54±0.26)mm,(1.41±0.23)vs.(1.76±0.29),(0.65±0.12)cm2 vs.(0.89±0.16)cm2],with statistically significant differences(all P<0.05).The total effective rate of the study group was higher than that of the control group[93.48%(43/46)vs.78.26%(36/46)],with a statistically significant difference(P<0.05).After treatment,the levels of triglyceride,total cholesterol,and low density lipoprotein cholesterol in the study group were lower than those in the control group[(1.61±0.28)mmol/L vs.(1.84±0.31)mmol/L,(4.51±0.86)mmol/L vs.(5.02±0.93)mmol/L,(3.69±0.51)mmol/L vs.(4.03±0.59)mmol/L],but the level of high-density lipoprotein cholesterol was higher than that in the control group[(1.36±0.24)mmol/L vs.(1.24±0.21)mmol/L],with statistically significant differences(all P<0.05).After treatment,the levels of vascular endothelial growth factor and nitric oxide in the study group were higher than those in the control group[(18.12±2.59)ng/L vs.(16.03±2.38)ng/L,(6.98±1.02)μg/L vs.(6.01±0.98)μg/L],but the endothelin-1 level was lower than that in the control group[(40.35±5.04)ng/L vs.(43.61±5.91)ng/L],with statistically significant differences(all P<0.05).After treatment,the levels of platelet activating factor,von Willeilia factor,and thromboxen B2 in the study group were lower than those in the control group[(8.46±1.38)ng/L vs.(9.14±1.62)ng/L,(85.14±10.83)IU/ml vs.(91.42±12.67)IU/ml,(118.34±17.92)ng/L vs.(132.16±20.34)ng/L],with statistically significant differences(all P<0.05).There were no obvious adverse reactions during treatment in both groups.Conclusion Tiantan Tongluo tablets combined with atorvastatin has significant efficacy in the treatment of wind-phlegm-blocked collaterals syndrome of CAS,which can significantly improve the clinical symptoms,reduce the plaques,regulate the blood lipids,improve the vascular endothelial function,regulate the secretion of peripheral blood inflammatory factors,and is safe and reliable.