活血通脉片对颈动脉易损斑块的干预作用  

Intervention of Huoxue Tongmai Tablets on Carotid Vulnerable Plaques

作　　者：黄群莲 向淑利 胡运春 陈永钧 

机构地区：[1]西南医科大学附属医院,四川泸州646000

出　　处：《中国实验方剂学杂志》2017年第8期184-189,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：四川省卫生厅科学研究项目(120593)

摘　　要：目的:探讨活血通脉片对颈动脉易损斑块硬化斑块厚度、稳定性的影响,并从抗血小板活化和抗炎反应方面探讨其作用机制。方法:将150例患者随机按数字表法分为对照组和观察组。对照组口服拜阿司匹林肠溶片,100 mg/次,1次/d;阿托伐他汀钙片,10 mg/次,1次/d。观察组在对照组治疗的基础上加服活血通脉片,5片/次,3次/d。两组疗程均为4个月。采用彩色多普勒超声测量治疗前后颈动脉内膜中层厚度(IMT),采用Crouse斑块积分法计算双侧颈动脉斑块积分、测量颈总动脉收缩期最大血流速度(Vmax),舒张期最小血流速度(Vmin),阻力指数(RI)和搏动指数(PI);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;检测治疗前后血小板表面活性标志蛋白CD62 p,CD63和糖蛋白(GP)Ⅱb/Ⅲa受体复合物水平;检测治疗前后高敏C-反应蛋白(hs-CRP),白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),基质金属蛋白酶-9(MMP-9)水平;进行两组患者治疗前后血瘀证评分和安全性评价。结果:治疗后观察组IMT厚度低于对照组,斑块个数少于对照组,Crouse评分低于对照组(P<0.01);观察组Vmax,Vmin快于对照组,PI低于对照组(P<0.01);观察组TG,TC,LDL-C水平均低于对照组,HDL-C高于对照组(P<0.01);观察组CD62p,CD63和GPⅡb/Ⅲa受体复合物均低于对照组(P<0.01);观察组血瘀证评分低于对照组(P<0.01);观察组患者血清hs-CRP,IL-6,TNF-α和MMP-9水平均低于对照组(P<0.01)。结论:加服活血通脉片干预颈动脉易损斑块,能缩小斑块,使斑块厚度变薄,改善颈动脉血流,降低血小板活化程度和抗炎症反应,起到稳定斑块的作用,还能调节脂代谢,降低血瘀证积分,这些都有利于防止动脉粥样硬化性心血管疾病的发生。Objective： To discuss the effects of Huoxue Tongmai tablets on thickness and stability of vulnerable plaques in carotid artery, and investigate their action mechanism from anti-platelet activation and anti- inflammatory response. Method： One hundred and fifty patients were randomly divided into control group and observation group by random number table. Patients in control group received Bayaspirin enteric-coated tablets, 100 mg/time, 1 time/day, Atorvastatin calcium tablets, 10 mg/time, 1 time/day. Based on the treatment in control group, the patients in observation group added Huoxue Tongmai tablets, 5 tablets/time, 3 times/day. The treatment course was 4 months in both groups. Before and after treatment, thickness of carotid intima of the carotid artery （IMT） was detected by color Doppler ultrasound; bilateral carotid plaque score was calculated by Crouse plaque integration method. The maximum blood flow velocity （ Vmax ） of common carotid artery systolic stage, the minimum blood flow velocity （ Vmin ） of diastolic stage, resistance index （RI） and pulsatility index （PI） were detected. Levels of triglycerides （TG）, total cholesterol （TC）, high density lipoprotein-C （HDL-C） and low density lipoprotein-C （LDL-C） were detected. Levels of activity marker protein of platelet surface CD62 p, CD63 and receptor complex of glycoprotein （GP） Ⅱb/Ⅲa, high-sensitivity C-reactive protein （hs-CRP）, interleukin-6 （IL-6） , tumor necrosis factor-α （TNF-α） , and matrix metalloproteinases-9 （MMP-9） were detected. In addition, the scores of blood stasis syndrome were graded and safety evaluation was evaluated both before and after treatment. Result ： After treatment, thickness of IMT, numbers of plaques and scores of Crouse in observation group were less than those in control group （P 〈 0.01 ）. Vmax and gmin were faster than those in control group, and PI was lower than that in control group （P 〈 0.01 ）. Levels of TG, TC and LDL-C and CD62 p, CD63 and r

关 键 词：颈动脉易损斑块 活血通脉片 血小板活化 炎症反应 

分 类 号：R287[医药卫生—中药学]