桃红四物汤合柴胡疏肝散加减治疗不稳定型心绞痛A型行为的临床观察

Clinical Observation of Addition and Subtraction Therapy of Taohong Siwutang Combined with Chaihu Shugansan to Unstable Angina Pectoris with Type A Behavior Pattern

目的:观察桃红四物汤合柴胡疏肝散加减治疗不稳定型心绞痛A型行为(气滞血瘀证)的疗效及对促炎因子和5-羟色胺(5-HT)表达的影响。方法:将124例患者随机分为对照组60例和观察组64例。对照组口服拜阿司匹林肠溶片,100 mg/次,1次/d;替格瑞洛片,90 mg/次,2次/d;酒石酸美托洛尔片,50 mg/次,2次/d;辛伐他汀片,10 mg/次,1次/d;心绞痛发作时舌下含服硝酸甘油片0. 5 mg。观察组西医治疗同对照组,并给予桃红四物汤合柴胡疏肝散加减内服,1剂/d。两组疗程均为连续治疗8周。记录每周心绞痛发作次数、持续时间、疼痛程度和硝酸甘油使用情况;进行治疗前后心电图检测;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;进行治疗前后西雅图心绞痛量表(SAQ)和气滞血瘀证评分;检测治疗前后白细胞介素-6 (IL-6),肿瘤坏死因子-α(TNF-α),超敏C反应蛋白(hs-CRP)和5-HT水平。结果:经秩和检验;观察组心电图疗效优于对照组(Z=1. 965,P <0. 05);观察组心绞痛发作次数少于对照组,持续时间缩短于对照组,疼痛程度轻于对照组,硝酸甘油用量少于对照组(P <0. 01);观察组SAQ量表各维度评分和SAQ总分均高于对照组(P <0. 01);观察组气滞血瘀证各症状评分和总积分均低于对照组(P <0. 01);观察组LDL-C低于照组(P <0. 01),HDL-C高于对照组(P <0. 01);观察组IL-6,hs-CRP,TNF-α和5-HT水平均低于对照组(P <0. 01)。结论:在常规西医治疗的基础上,采用桃红四物汤合柴胡疏肝散加减治疗不稳定型心绞痛(UAP) A型行为(气滞血瘀证)患者,可进一步控制心绞痛发作情况,减轻临床症状,提高生活质量,调节脂代谢,并可抑制促炎因子和5-HT表达,起到稳定病情的作用。

Objective:To observe the clinical efficacy of addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan to unstable angina pectoris with type A behavior pattern(Qi stagnation and blood stasis syndrome),and investigate its effects on proinflammatory factors and serotonin(5-HT).Method:One hundred twenty-four patients were randomly divided into control group(60 cases)and observation group(64 cases)by random number table.Patients in control group got Aspirin enteric-coated tablets,100 mg/time,1 time/day.Tigrillo tablets,90 mg/time,2 times/days.Metoprolol tartrate tablets,50 mg/time,2 times/days.Simvastatin tablets,10 mg/time,1 time/day.Nitroglycerin tablets,0.5 mg/time.Based on the treatment in control group,patients in observation group also received addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan,1 dose/day.The treatment course was 8 weeks in both groups.Number of attacks,duration,degree of pain and usage of nitroglycerin were recorded for every week.Before and after treatment,electrocardiogram was also recorded.And levels of triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),hypersensitive C-reactive protein and 5-HT were detected.In addition,scores of Seattle Angina Scale(SAQ)and Qi stagnation and blood stasis syndrome were graded.Result:In the rank sum test,the curative effect in electrocardiogram of observation group was better than that of control group(Z=1.965,P<0.05).Number of attacks,duration,degree of pain and usage of nitroglycerin were all less than those in control group(P<0.01).Scores of various dimensions in SAQ and the total scores of SAQ were all higher than those in control group(P<0.01).Scores of various symptoms for Qi stagnation and blood stasis syndrome and the total scores were lower than those in control group(P<0.01).Levels of LDL-C,IL-6,hs-CRP,TNF-αand 5-HT in observation group were lower than those in control group(P<0.01),while level of HDL-C was higher than that in control group(P<0.01).Conclusion:On the basis of conventional western medicine,addition and subtraction therapy of Taohong Siwutang combined with Chaihu Shugansan can further control angina attack,relieve clinical symptoms,improve quality of life,regulate lipid metabolism,and can inhibit expression of proinflammatory factors and 5-HT,so it can play a role in stabilizing the disease.