黄芪桂枝五物汤加味治疗气虚血瘀证冠心病的临床疗效观察(1)
摘要 目的：观察黄芪桂枝五物汤加味治疗气虚血瘀证冠心病的临床疗效，着重探讨其对患者颈动脉粥样硬化斑块、心肌功能、血管内皮功能的影响。方法：选取2017年6月至2018年6月日照市中医医院收治的气虚血瘀证冠心病患者132例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组66例。对照组患者给予阿托伐他汀钙片口服;观察组患者则在对照组基础上加用黄芪桂枝五物汤加味方内服。比较2组患者的临床疗效，检测颈动脉内膜中层厚度(IMT)、斑块面积，观察心功能，监测血管内皮功能指标一氧化氮(Nitric Oxide，NO)、内皮素-1(Endothelin-1，ET-1)、血栓素2(Thromboxane 2，TXB2)、血管紧张素Ⅱ(AngiotensinⅡ，AngⅡ)含量。结果：与对照组的有效率78.79%比较，观察组的有效率90.91%明显升高(P<0.05);与对照组组间比较，观察组患者治疗后的心绞痛发作情况明显减轻，每周心绞痛平均发作次数明显减少，发作持续时间明显缩短，心肌缺血总负荷明显降低(P<0.05);颈动脉粥样硬化斑块IMT厚度、斑块面积明显缩小(P<0.05);心肌功能指标心肌耗氧量、LVESD、LVEDD水平明显降低，LVEF水平明显升高(P<0.05);血管内皮功能指标NO水平明显上升，ET-1、TXB2、AngⅡ水平则明显降低(P<0.05)。结论：黄芪桂枝五物汤加味利于缓解心绞痛症状，降低心肌缺血总负荷，缩小和稳定动脉粥样硬化斑块，改善心肌功能，其机制可能在于通过良性调控血清ET/NO的平衡、TXB2、AngⅡ水平以发挥血管内皮保护作用。
关键词 冠心病;氣虚血瘀证;黄芪桂枝五物汤;颈动脉粥样硬化斑块;心肌功能;血管内皮功能
Clinical Observation on Therapeutic Effects of Huangqi Guizhi Wuwu Decoction in Treatment of Coronary Heart Disease with Syndrome of Qi Deficiency and Blood Stasis
Yu Ning，Zhang Xianzhong，Xu Dongcheng
(Second Department of Cardiovascular Diseases，Rizhao Hospital of Traditional Chinese Medicine，Rizhao 276800，China)
Abstract Objective：To observe the therapeutic effect of Huangqi Guizhi Wuwu Decoction in the treatment of coronary heart disease with syndrome of qi deficiency and blood stasis，and to focus on discussing the effect of the decoction on carotid atherosclerotic plaque，myocardial function and vascular endothelial function.Methods：From June 2017 to June 2018，132 cases of coronary heart disease patients with syndrome of qi deficiency and blood stasis admitted to Rizhao Hospital of Traditional Chinese Medicine were selected and randomly divided into a control group(n=66)and an observation group(n=66)according to the random number table method.Patients in the control group were given atorvastatin calcium tablets orally.Patients in the treatment were given Huangqi Guizhi Wuwu Decoction on the basis of the control group for oral administration.The therapeutic effects of the 2 groups were compared.The carotid intima-media thickness(IMT)，plaque area was detected.The myocardial function，monitor the function indexes endothelial nitric oxide(NO)，Endothelin-1(ET-1)，thromboxane2(TXB2)and angiotensin Ⅱ(AngⅡ)were observed.Results：Compared with the effective rate of 78.79% in the control group，the effective rate of 90.91% in the treatment group significantly increased(P<0.05).Compared with the control group，the angina attack in the observation group significantly reduced after treatment，the average number of angina attack per week was significantly reduced，the duration of angina attack was significantly shortened，and the total myocardial ischemia load was significantly reduced(P<0.05).The IMT thickness and plaque area of carotid atherosclerotic plaque significantly decreased(P<0.05).Myocardial function indexes，such as myocardial oxygen consumption，LVESD and LVEDD，significantly decreased，and LVEF significantly increased(P<0.05).Endothelial function index of the NO level increased obviously，while the ET-1，TXB2 and AngⅡ levels significantly decreased(P<0.05).Conclusion：Modified Huangqi Guizhi Wuwu Decoction is beneficial to relieve angina symptoms，reduce myocardial ischemia total load，narrow and stabilize atherosclerotic plaque and improve cardiac function.Its mechanism may be through regulating the balance of serum ET/NO，TXB2 and AngⅡ levels to play a role of vascular endothelial protection., 百拇医药(于宁 张宪忠 徐东成)
关键词 冠心病;氣虚血瘀证;黄芪桂枝五物汤;颈动脉粥样硬化斑块;心肌功能;血管内皮功能
Clinical Observation on Therapeutic Effects of Huangqi Guizhi Wuwu Decoction in Treatment of Coronary Heart Disease with Syndrome of Qi Deficiency and Blood Stasis
Yu Ning，Zhang Xianzhong，Xu Dongcheng
(Second Department of Cardiovascular Diseases，Rizhao Hospital of Traditional Chinese Medicine，Rizhao 276800，China)
Abstract Objective：To observe the therapeutic effect of Huangqi Guizhi Wuwu Decoction in the treatment of coronary heart disease with syndrome of qi deficiency and blood stasis，and to focus on discussing the effect of the decoction on carotid atherosclerotic plaque，myocardial function and vascular endothelial function.Methods：From June 2017 to June 2018，132 cases of coronary heart disease patients with syndrome of qi deficiency and blood stasis admitted to Rizhao Hospital of Traditional Chinese Medicine were selected and randomly divided into a control group(n=66)and an observation group(n=66)according to the random number table method.Patients in the control group were given atorvastatin calcium tablets orally.Patients in the treatment were given Huangqi Guizhi Wuwu Decoction on the basis of the control group for oral administration.The therapeutic effects of the 2 groups were compared.The carotid intima-media thickness(IMT)，plaque area was detected.The myocardial function，monitor the function indexes endothelial nitric oxide(NO)，Endothelin-1(ET-1)，thromboxane2(TXB2)and angiotensin Ⅱ(AngⅡ)were observed.Results：Compared with the effective rate of 78.79% in the control group，the effective rate of 90.91% in the treatment group significantly increased(P<0.05).Compared with the control group，the angina attack in the observation group significantly reduced after treatment，the average number of angina attack per week was significantly reduced，the duration of angina attack was significantly shortened，and the total myocardial ischemia load was significantly reduced(P<0.05).The IMT thickness and plaque area of carotid atherosclerotic plaque significantly decreased(P<0.05).Myocardial function indexes，such as myocardial oxygen consumption，LVESD and LVEDD，significantly decreased，and LVEF significantly increased(P<0.05).Endothelial function index of the NO level increased obviously，while the ET-1，TXB2 and AngⅡ levels significantly decreased(P<0.05).Conclusion：Modified Huangqi Guizhi Wuwu Decoction is beneficial to relieve angina symptoms，reduce myocardial ischemia total load，narrow and stabilize atherosclerotic plaque and improve cardiac function.Its mechanism may be through regulating the balance of serum ET/NO，TXB2 and AngⅡ levels to play a role of vascular endothelial protection., 百拇医药(于宁 张宪忠 徐东成)
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