柴苓汤加减治疗微血管性心绞痛(气滞湿阻证)临床观察

Clinical Observation on Modified Chailing Decoction in Treating Microvascular Angina Pectoris(Syndrome of Blockade of Dampness due to Qi Stagnation)

目的评价柴苓汤加减治疗微血管性心绞痛(MVA)(气滞湿阻证)的临床疗效及对心肌微循环、炎症因子及心功能的影响。方法将80例MVA患者随机分为对照组与观察组各40例。对照组采用西医常规治疗,包括口服阿司匹林肠溶片、美托洛尔缓释片、阿托伐他汀钙片及尼可地尔片等。观察组在对照组治疗的基础上口服柴苓汤加减治疗。两组均连续治疗2周。比较心绞痛疗效和心电图疗效;比较治疗前后心绞痛症状积分、DuKe评分、左室射血分数(LVEF)、每搏心输出量(SV)、西雅图心绞痛调查量表(SAQ)、中医证候评分和冠状动脉血流储备功能(CFR);检测治疗前后炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hsCRP)、白细胞介素-6(IL-6)]水平。结果治疗后,两组心绞痛症状评分、气滞湿阻证积分均下降,生活质量各维度评分、DuKe评分均升高,LVEF、SV和CFR均增加,TNF-α、hs-CRP和IL-6均降低;观察组的改善优于对照组(P<0.05)。观察组心电图疗效和心绞痛疗效的总有效率均高于对照组(P<0.05)。结论柴苓汤加减联合西医常规疗法治疗MVA(气滞湿阻证)患者,可减轻炎症反应、改善心肌微循环,提高冠状动脉血流储备功能,改善心功能,缓解心绞痛的临床症状,提高临床治疗效果和生活质量。

Objective:To evaluate the clinical efficacy of Modified Chailing Decoction on microvascular angina pectoris(MVA)with syndrome of blockade of dampness due to qi stagnation and its influence on myocardial microcirculation,inflammatory factors and cardiac function.Methods:A total of 80 cases of MVA were randomly divided into the control group and observation group,40 cases in each group.The control group was given western medicine treatment measures,including oral aspirin enteric-coated tablets,metoprolol sustained-release tablets,atorvastatin calcium tablets and nicorandil tablets.In the observation group,the western medicine treatment measures were the same as those in the control group,and oral Modified Chailing Decoction was added.Both groups were continuously treated for 2 weeks.The efficacy of angina pectoris and ECG was compared;the angina pectoris symptom score,DuKe score,left ventricular ejection fraction(LVEF),stroke volume(SV),Seattle Angina Questionnaire(SAQ),TCM syndrome score and coronary flow reserve(CFR)before and after treatment were compared;inflammatory factors(TNF-α,hs-CRP,and IL-6)levels were measured before and after treatment.Results:After treatment,the angina pectoris symptom score and qi stagnation and dampness syndrome score decreased in the two groups(P<0.05),and the observation group was lower than the control group(P<0.05);the quality of life dimension score and DuKe score increased in the two group(P<0.05),and the observation group was higher than the control group(P<0.05).After treatment,the levels of LVEF,SV and CFR were significantly increased in both groups(P<0.05),and the observation group was higher than the control group(P<0.05).After treatment,the levels of TNF-α,hs-CRP and IL-6 decreased in both groups(P<0.05),and were lower in the observation group than in the control group(P<0.05).After treatment,the total effective rates of ECG and angina pectoris in the observation group were higher than those in the control group(P<0.05).Conclusion:Modified Chailing Decoction combined with conventional western medicine can reduce inflammatory reaction,improve myocardial microcirculation,improve coronary blood flow reserve function,improve cardiac function,relieve clinical symptoms of angina pectoris,improve clinical therapeutic effect and quality of life in patients with MVA with syndrome of blockade of dampness due to qi stagnation.