益气活血法对冠心病不稳定性心绞痛患者PCI后心肌损伤、冠状动脉微循环的影响

Effect of qi-tonifying and blood-activating therapy on myocardial injury and coronary microcirculation in patients with unstable angina pectoris after PCI

目的 探讨参元益气活血胶囊(SYD)对冠心病不稳定性心绞痛患者PCI后心肌损伤、冠状动脉微循环的影响。方法 选择2019年6月—2023年6月首都医科大学附属北京中医医院心血管内科收治的68例冠心病不稳定性心绞痛(UA)患者,采用随机数字表法分成观察组和对照组各34例。观察组在规范化治疗基础上加SYD口服,对照组在规范化治疗基础上加安慰剂(PBO)口服,2组均给予PCI治疗。对比2组治疗前后心肌损伤指标肌酸激酶同工酶MB (CK-MB)、CK-MB峰值、冠状动脉微循环指数(IMR)、IMR的变化率(△IMR)以及安全性。CK-MB峰值与△IMR的相关性采用Spearman相关法进行分析。结果 术后24 h,2组CK-MB水平均高于术前(P<0.05),且观察组CK-MB水平低于对照组(P<0.05),差异有统计学意义;术后72 h,2组CK-MB水平与术前比较,差异均无统计学意义(P>0.05),观察组CK-MB水平低于对照组,但差异无统计学意义(P>0.05)。观察组CK-MB峰值低于对照组(P<0.05)。术后,2组IMR水平均高于术前(P<0.05),观察组IMR水平低于对照组,但差异无统计学意义(P>0.05)。观察组△IMR低于对照组(P<0.05)。PCI术后对照组CK-MB峰值与△IMR无明显相关性(r=-0.158 5,P>0.05),观察组CK-MB峰值与△IMR呈正相关性(r=0.3392,P<0.05)。观察组1例血脂控制不佳,予阿托伐他汀钙片加倍强化治疗后出现丙氨酸氨基转移酶升高,停药后恢复正常。余患者未出现肝肾功能、血尿便常规、凝血指标等异常。2组均未发生药物性皮炎、出血等不良反应。结论 SYD可改善冠心病UA患者PCI后心肌损伤及冠状动脉微循环,且安全性高。

Objective To explore the effect of Shenyuan Yiqi Huoxue Capsules(SYD)on myocardial injury and coronary microcirculation in patients with unstable angina(UA)following percutaneous coronary intervention(PCI).Methods A total of 68 patients with coronary heart disease(CHD)and UA who were treated in the Department of Vasculocardiology at Beijing Hospital of Traditional Chinese Medicine,Capital Medical University from June 2019 to June 2023 were enrolled and randomly divided into an observation group and a control group according to a random number table,with 34 patients in each group.The observation group received SYD orally in addition to standardized treatment,while the control group received placebo(PBO)orally in addition to standardized treatment.Both groups underwent PCI.The myocardial injury markers,including creatine kinase-MB(CK-MB),CK-MB peak values,coronary microcirculation index(IMR),and the change rate of IMR(△IMR)in both groups,were compared before and after treatment,along with safety evaluations.The correlation between CK-MB peak values and△IMR was analyzed using Spearman's correlation method.Results Twenty-four hours after surgery,the CK-MB levels in both groups were higher than those before surgery(P<0.05),and the observation group had lower CK-MB levels than the control group(P<0.05).At 72 hours post-surgery,the CK-MB levels in both groups showed no significant difference compared with pre-treatment values(P>0.05).The CK-MB levels in the observation group were lower than in the control group,but the difference was not statistically significant(P>0.05).The peak CK-MB value in the observation group was lower than in the control group(P<0.05).After surgery,the IMR levels in both groups were higher than those before surgery(P<0.05),but the difference between the two groups was not statistically significant(P>0.05).The△IMR value in the observation group was lower than in the control group(P<0.05).There was no significant correlation between CK-MB peak value and△IMR in the control group(r=-0.1585,P>0.05),while in the observation group,a positive correlation was found between CK-MB peak value and△IMR(r=0.3392,P<0.05).In the observation group,one patient had poor lipid control and developed elevated alanine aminotransferase(ALT)after doubling the dose of atorvastatin,which returned to normal after stopping the medication.No abnormalities in liver or kidney function,routine blood/urine tests,or coagulation indicators were observed in the remaining patients.No drug-related dermatitis,bleeding,or other adverse reactions were observed in either group.Conclusion SYD can improve myocardial injury and coronary microcirculation in patients with UA after PCI,with high safety.