活血化瘀类中成药与阿司匹林联合治疗慢性稳定性心绞痛的合理性用药  

Clinical study of rational drug use of blood-circulation-activating traditional Chinese drugs combined with aspirin in patients with stable angina pectoris

作　　者：闫晓霞[1] 王建昌[2] 刘丽芳[2] 李忠东[3] 马建伟[4] 魏璇[2] 盖亚男[2] 张伟江[5] 靳英[2] 张婧[2] 朱贤关[6] 

机构地区：[1]第四军医大学西京医院老年病科,陕西西安710032 [2]解放军空军总医院空军老年医学研究所 [3]空军总医院药剂科 [4]空军总医院中医科 [5]空军西郊干休所 [6]安徽医科大学

出　　处：《中国老年学杂志》2011年第5期739-741,共3页Chinese Journal of Gerontology

基　　金：首都医学发展科研基金(SF-2007-II-06)

摘　　要：目的研究活血化瘀类中成药与阿司匹林联合治疗慢性稳定性心绞痛(SAP)的规范化方案。方法选择SAP患者76例,随机分为单用阿司匹林治疗组(阿司匹林组)25例,中医辨证用药联合阿司匹林治疗组(标准治疗组)17例,中医不辨证用药联合阿司匹林治疗组(习惯治疗组)34例,疗程3个月,比较三组治疗前后的血小板聚集率(PAG)、P选择素(CD62P)、血小板糖蛋白Ⅱb/Ⅲa复合物(GPⅡb/Ⅲa)、血液流变学变化及临床疗效。结果与治疗前相比,标准治疗组PAG、CD62P、GPⅡb/Ⅲa、血流变、中医证候总积分明显下降(P<0.05),其GPⅡb/Ⅲa、中医证候总积分下降幅度显著大于阿司匹林组及习惯治疗组(P<0.05),PAG、低切全血黏度、红细胞刚性指数、红细胞聚集指数下降幅度显著高于习惯治疗组。虽然阿司匹林组红细胞聚集指数、红细胞变形指数及习惯治疗组血浆黏度较治疗前下降(均P<0.05),但2组患者治疗后PAG、CD62P、GPⅡb/Ⅲa以及中医证候总积分均较前无显著变化。三组患者心绞痛总积分治疗前后无明显变化(P>0.05)。结论在应用阿司匹林基础上辨证使用活血化瘀类中成药可有效改善SAP患者中医症状,且有明显的抗血小板活化、抑制血小板聚集及改善血液流变的作用。Objective To investigate the standard program of blood-circulation-activating traditional Chinese drugs combined with aspirin in patients with stable angina pectoris（SAP）.Methods Seventy-six patients with SAP were randomly divided into aspirin（25 cases）,aspirin combined with Chinese patent drugs according to TCM syndrome differentiation（standard treatment,17 cases）,not according to syndrome differentiation groups（customary treatment,34 cases）.The levels of platelet aggregation（PAG）,P-selection（CD62P）,platelet glycoprotein Ⅱb/Ⅲa（GPⅡb/Ⅲa）,blood rheology and clinical efficacy were evaluated after 3 months.Results The levels of PAG,CD62P,GPⅡb/Ⅲa,hemorrheology,TCM total symptom scores were significantly decreased in standard treatment group after treatment（P0.05）.In standard treatment group,the decreases of GPⅡb/Ⅲa and TCM total symptom scores were significantly greater than those of aspirin and customary treatment groups,and PAG,low-shear whole blood viscosity,erythrocyte rigidity index,erythrocyte aggregation index decrease were obviously lower than those of customary treatment group（P0.05）.Although erythrocyte aggregation index and erythrocyte deformation index in aspirin group and plasma viscosity in customary treatment group were reduced after treatment,but the TCM total symptom scores had no change.There was no significant decrease in total symptom scores in 3 groups（P0.05）.Conclusions Treated with blood-circulation-activating Chinese patent medicines by syndrome differentiation at the found of aspirin can effectively improve TCM symptoms in patients with SAP,and have significant anti-platelet activity,platelet aggregation and improved blood rheology.These effects are superior to aspirin alone and customary treatment group.In the treatment of SAP,TCM syndrome differentiation drugs combined with aspirin can get better clinical effects.

关 键 词：慢性稳定性心绞痛 辨证论治 血小板聚集率 P选择素 血小板糖蛋白Ⅱb/Ⅲ复合物 血液流变学 

分 类 号：R541.4[医药卫生—心血管疾病]