大株红景天胶囊对颈动脉不稳定斑块气虚血瘀证的干预分析

Effect of Dazhu Hongjingtian Capsule on Unstable Carotid Plaque with Qi Deficiency and Blood Stasis Syndrome

目的:探讨大株红景天胶囊对颈动脉不稳定斑块气虚血瘀证的干预及抗氧化、抗炎和抗血栓形成的作用机制。方法:将符合要求的123例患者,随机按数字表法分为对照组61例和观察组62例。对照组给予抗血小板和调节血脂药物治疗,口服阿司匹林肠溶片,0.1 g/次,1次/d;瑞舒伐他汀钙胶囊,10 mg/次,1次/d。观察组西药使用同对照组,并给予大株红景天胶囊,4粒/次,3次/d。两组疗程均为患者每2周门诊随访1次,连续观察16周。采用彩色多普勒超声测量颈动脉内膜中层厚度(IMT),斑块数量和斑块大小;检测治疗前后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;进行气虚血瘀证评分;检测治疗前后超氧化物歧化酶(SOD),丙二醛(MDA),超敏C反应蛋白(hs-CRP),同型半胱氨酸(Hcy),基质金属蛋白酶-2(MMP-2),MMP-9,基质金属蛋白酶组织抑制剂-2(TIMP-2),血小板α-颗粒膜蛋白-140(GMP-140),血小板表面P-选择素(CD62 p),溶酶体颗粒糖蛋白(CD63)和血管性假血友病因子(v WF)水平。结果:治疗后,观察组患者IMT薄于对照组、斑块数量少于对照组、斑块大小积分小于对照组(P<0.01);治疗后,观察组患者LDL-C低于对照组(P<0.01),HDL-C高于对照组(P<0.01),气虚血瘀证评分低于对照组(P<0.01);观察组患者血清hs-CRP,Hcy,MMP-2,MMP-9均低于对照组,TIMP-2水平高于对照组(P<0.01);观察组患者SOD水平高于对照组,MDA水平低于对照组(P<0.01);观察组患者GMP-140,v WF,CD62 p和CD63水平均低于对照组(P<0.01)。结论:在抗血小板和调节血脂药物治疗的基础上,加服大株红景天胶囊,对治疗气虚血瘀型颈动脉不稳定斑块,具有缩小或减少颈动脉斑块的作用,能调节脂代谢,改善中医证候症状,并具有抗氧化、抗炎和抗血栓形成的作用。

Objective: To discuss the effect of Dazhu Hongjingtian capsule to unstable carotid plaque ( Qi deficiency and blood stasis syndrome) ,and its mechanisms in resisting oxidation,inflammation and thrombosis. Method: One hundred and twenty-three patients were randomly divided into control group ( 61 cases) and observation group ( 62 cases) by random number table. Patients in control group got aspirin enteric-coated tablets, 0. 1 g /time,1 time /day,and rosuvastatin calcium capsules,10 mg /time,1 time /day. In addition to the therapy of control group,patients in observation group were also given Dazhu Hongjingtian capsule,4 grains /days,3 times / days. And the outpatient follow-up was made once every 2 weeks for continued 16 weeks. Intima-media wall thickness ( IMT) ,and number and size of plaque were detected by color Doppler ultrasound. And levels of triglyceride ( TG) ,total cholesterol ( TC) ,high-density lipoprotein ( HDL-C) ,low-density lipoprotein ( LDL-C) , superoxide dismutase ( SOD ) , malondialdehyde ( MDA ) , hypersensitive C reactive protein ( hs-CRP ) , homocysteine ( Hcy) ,matrix metalloproteinase-2 ( MMP-2) ,MMP-9,tissue inhibitor of matrix metalloproteinase-2 ( TIMP-2) ,platelet alpha granular membrane protein ( GMP-140) ,P-selectin on surface of platelets ( CD62 p) , lysosome glycoprotein ( CD63) ,and vascular pseudotumor factor ( VWF) were detected. Qi deficiency and blood stasis syndrome were graded. Result: After treatment,IMT in observation group was thinner than that in control group,number of plaque was less than that in control group,and size of plaque was smaller than those in control group ( P < 0. 01) . After treatment,levels of LDL-C,hs-CRP,Hcy,MMP-2,MMP-9,MDA,GMP-140,vWF, CD62 p and CD63 were lower than those in control group ( P < 0. 01) ,whereas levels of HDL-C and TIMP-2 were higher than those in control group ( P < 0. 01) . And scores of Qi deficiency and blood stasis syndrome were lower than those in control group ( P < 0. 01 ) . Conclusion: In addition to the treatment for resisting platelet and regulating blood lipid, Dazhu Hongjingtian capsule can lessen and reduce arterial speckle regulate lipid metabolism,ameliorate symptoms of traditional Chinese medical ( TCM) syndrome,with effects in resisting oxidation,inflammation and thrombotic formation.