脑心通胶囊对2型糖尿病亚临床血管病变患者血管重构的影响  

Effect of Naoxintong Capsule on Vascular Remodeling in Type 2 Diabetic Patients with Subclinical Vascular Disease

作　　者：程森华 王俊 徐更华 孙国香 陶晓剑 杨晓翠 朱月娇 陈银伟 

机构地区：[1]浙江省绍兴市上虞中医医院内分泌科,浙江312300

出　　处：《中国中西医结合杂志》2016年第12期1439-1444,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：浙江省中医药科技计划(No.2014ZA117);浙江省绍兴市上虞区社会发展科技计划立项资助项目

摘　　要：目的观察脑心通胶囊对2型糖尿病(type 2diabetes mellitus,T2DM)亚临床血管病变患者颈动脉血管重构(vascular remodeling,VR)的影响。方法将180例T2DM亚临床动脉粥样硬化(atherosclerosis,AS)患者按1∶1随机分为对照组和观察组,每组90例,所有患者均采取常规口服降糖药治疗,治疗用药及剂量根据患者病情选择,在此基础上观察组加服脑心通胶囊干预治疗,每次3粒,每日3次;对照组不干预用药。疗程为6个月。治疗前后分别应用彩色多普勒超声诊断仪对患者进行双侧颈动脉斑块大小及性质探查,测量双侧颈总动脉内膜中层厚度(intimal-medial thickness,IMT)、斑块面积(plaque area,PA)、血管总面积(total vascular area,TVA)、管腔面积(lumen area,LA)、收缩期峰值血流速度(peak systolic velocity,PSV)、舒张末期流速(end diastolic velocity,EDV)、血管阻力指数(vascular resistance index,VRI)及脉动指数(pulsatility index,PI),计算斑块总积分、不稳定斑块检出率、狭窄率(stenosis,S)、重构指数(refactoring index,RI);检测空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycated hemoglobin A1c,HbA1c)、TG、TC、HDL-C及LDL-C水平。结果与本组治疗前比较,两组患者治疗后颈动脉IMT及斑块积分下降,TC、TG、LDL-C、FPG及HbA1c降低,PSV、EDV及PI增加,VRI降低,差异均有统计学意义(P<0.05);且观察组在减少颈动脉IMT、斑块积分、PA、不稳定斑块检出率,降低TC、LDL-C、VRI,升高HDL-C、PSV、EDV作用较对照组更为明显,差异有统计学意义(P<0.05)。与本组治疗前比较,对照组治疗后的重构发生率及负性重构升高(P<0.05);与对照组治疗后比较,观察组负性重构升高明显(χ2=6.4615,P<0.05)。结论脑心通胶囊治疗2型糖尿病亚临床血管病变患者,能够减轻颈动脉内膜中层厚度,缩小和稳定斑块,改善血流参数,延缓血管重构,具有较好的作用。Objective To observe the effect of Naoxintong Capsule（NC）on carotid artery vascular remodeling（VR）in type 2 diabetes mellitus（T2DM）patients with subclinical vascular disease.Methods A total of 180T2 DM patients with subclinical atherosclerosis（AS）were randomly assigned to the observation group and the control group in the ratio of 1∶1,90 in each group.All patients took conventional hypoglycemic therapy,and the choices of therapeutic drugs and doses were selected according to patients′conditions.Patients in the observation group additionally took NC（3 pills each time,three times per day）,while those in the control group took no interventional drug.The therapeutic course for all was 6 months.The size and nature of bilateral carotid artery plaque were measured before and after treatment using color Doppler ultrasound diagnostic instrument.Bilateral carotid artery intimal-medial thickness（IMT）,plaque area（PA）,total vascular area（TVA）,lumen area（LA）,peak systolic velocity（PSV）,end diastolic velocity（EDV）,vascular resistance index（VRI）,and pulsatility index（PI）were measured.The totalplaque score,unstable plaque detection rate,stenosis rate（S）,and refactoring index（RI）were calculated.Levels of fasting plasma glucose（FPG）,glycated hemoglobin A1c（HbA1c）,triglyceride（TG）,total cholesterol（TC）,high density lipoprotein cholesterol（HDL-C）,and low density lipoprotein cholesterol（LDL-C）were detected.ResultsCompared with before treatment in the same group,carotid artery IMT and plaque score decreased,levels of TC,TG,LDL-C,FPG,and HbA1 c were reduced,PSV,EDV and PI increased,and VRI decreased in both two groups after treatment,with statistical significance（P〈0.05）.More obvious effects were shown in decreasing carotid artery IMT,plaque score,PA,and unstable plaque detection rate,reducing levels of TC,LDL-C and VRI,and increasing HDL-C,PSV,and EDV in the observation group,with statistical difference as compared with the control group（P�

关 键 词：脑心通胶囊 糖尿病 亚临床 颈动脉 内膜中层厚度 血管重构 

分 类 号：R259[医药卫生—中西医结合]