双降汤联合阿托伐他汀对颈动脉粥样硬化患者斑块的影响及其机制研究  

Effect of Shuangjiang Decoction on Carotid Atherosclerotic Plaque

作　　者：郑晓丹[1,2] 解金洪 蔡娟[1] 朱建华[2] 姜卫东 倪卫兵[1] 陶志强[1] 高想[1] ZHENG Xiao-dan;XIE Jin-hong;CAI Juan;ZHU Jian-hua;JIANG Wei-dong;NI Wei-bing;TAO Zhi-qiang;GAO Xiang(Department of Cardiology,Nantong Hospital of Traditional Chinese Medicine,Nantong,226001,China;ZHU Jianhua Inheritance Studio of Famous Chinese Medicine Expert in Jiangsu Province,Nantong,226001,China)

机构地区：[1]南通市中医院心血管内科,江苏南通226001 [2]江苏省名老中医药专家朱建华传承工作室,江苏南通226001

出　　处：《南京中医药大学学报》2018年第5期456-460,共5页Journal of Nanjing University of Traditional Chinese Medicine

基　　金：南通市科技局前沿与关键技术创新(KS22015066)

摘　　要：目的观察双降汤联合阿托伐他汀对颈动脉粥样硬化患者的临床疗效及作用机制。方法 107例颈动脉粥样硬化斑块气虚痰瘀证患者随机分成4组。基础治疗为受试者均采用低盐低脂饮食,硬斑块1组及软斑块1组每日口服阿托伐他汀20mg,硬斑块2组及软斑块2组在每天口服阿托伐他汀20mg的基础上,加双降汤,每日1剂口服,各组均连续服用12周。观察各组患者治疗前后血清单核细胞趋化蛋白-1(MCP-1)、巨噬细胞移动抑制因子(MIF)、基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-9(MMP-9)、核转录因子κBp65(NF-κBp65)、转化生长因子β1(TGF-β1)水平,斑块面积及中医证候积分。结果各组患者血清中均见较高水平的细胞炎症因子MCP-1、MIF、NF-κBp65、TGF-β1及蛋白酶MMP-1、MMP-9表达。与治疗前硬斑块1组及硬斑块2组加双降汤比较,软斑块1组及软斑块2组加双降汤患者血清中MCP-1、MIF、NF-κBp65、MMP-1、MMP-9水平升高,而TGF-β1水平降低(P<0.01)。与本组治疗前比较,硬斑块1组及软斑块1组患者血清中MCP-1、MIF、NF-κBp65、MMP-1、MMP-9水平升高,而TGF-β1水平降低(P<0.05),硬斑块2组加双降汤及软斑块2组加双降汤变化尤为显著(P<0.01)。与治疗后硬斑块2组加双降汤比较,软斑块2组加双降汤MCP-1、MIF、NF-κBp65、MMP-1、MMP-9水平升高,而TGF-β1水平降低(P<0.05)。与治疗前比较,硬斑块1组及软斑块1组颈动脉斑块面积缩小(P<0.05),硬斑块2组加双降汤及软斑块2组加双降汤颈动脉斑块面积缩小(P<0.01),且软斑块2组加双降汤颈动脉斑块面积缩小优于硬斑块2组加双降汤(P<0.05)。治疗后各组均能降低中医证候积分,与硬斑块1组及软斑块1组比较,硬斑块2组加双降汤及软斑块2组加双降汤能明显降低颈动脉粥样硬化患者中医证候积分(P<0.05)。结论细胞炎症因子MCP-1、MIF、NF-κBp65、TGF-β1及蛋白酶MMP-1、MMP-9参与颈动脉粥样硬化的形成的调控,�OBJECTIVE To observe effect of Shuangjiang Decoction combined with atorvastatin on carotid atherosclerotic plaque.METHODS 107 patients with carotid atherosclerotic plaque were randomly divided into four groups.The basic treatment was based on low salt and low fat diet.The hard plaque group 1 and soft plaque group 1 were treated with oral atorvastation daily 20 mg,while hard plaque group 2 and soft plaque group 2 were given Shuangjiang Decoction on the basis of 20 mg of atorvastation.One dose per day orally,each group was continuously taken for 12 weeks.The serum monocyte chemoattractant protein 1(MCP 1),macrophage migration inhibitory factor(MIF),matrix metalloproteinase 1(MMP 1),matrix metalloproteinase 9(MMP 9),nuclear factorκBp65(NFκBp65),transforming growth factorβ1(TGFβ1)levels,plaque area and TCM syndrome scores of two groups were observed before and after treatment.RESULTS High levels of cellular inflammatory factors MCP 1,MIF,NFκBp65,TGFβ1 and proteases MMP 1 and MMP 9 were observed in the serum of each group.Compared with hard plaque group 1 and 2 with Shuangjiang Decoction before treatment,the level of MCP 1,MIF,NFκBp65,MMP 1,MMP 9 in soft plaque group 1 and 2 with Shuangjiang Decoction were higher,while TGFβ1 levels were decreased(P<0.01).Compared with the pre treatment group,the level of MCP 1,MIF,NFκBp65,MMP 1,MMP 9 in the serum of hard plaque group 1 and soft plaque group 1 were increased,while the level of TGFβ1 was decreased(P<0.05).The changes of hard plaque group 2 and soft plaque group 2 with Shuangjiang Decoction were especially significant(P<0.01).Compared with hard plaque group 2 with Shuangjiang Decoction after treatment,the levels of MCP 1,MIF,NFκBp65,MMP 1 and MMP 9 in soft plaque group 2 with Shuangjiang Decoction were increased,while the level of TGFβ1 was decreased(P<0.05).Compared with pre treatment,the area of carotid plaque in group 1 of hard plaque and soft plaque group 1 was reduced(P<0.05),and in group 2 of hard plaque and soft plaque with Shuangjiang Decoction was al

关 键 词：双降汤 颈动脉粥样硬化斑块 MCP-1 临床研究 

分 类 号：R256[医药卫生—中医内科学]