枳实薤白桂枝汤合理中汤加减辅助治疗稳定型心绞痛及对炎症因子和血管内皮功能的影响  

Addition and Subtraction Therapy of Zhishi Xiebai Guizhitang and Lizhongtang for Stable Angina and Effect on Inflammatory Factors and Endothelial Function

作　　者：闫红 余洪 潘小丹 范良 刘利涛 YAN Hong;YU Hong;PAN Xiao-dan;FAN Liang;LIU Li-tao(Haikou Hospital of Traditional Chinese Medicine(TCM),Haikou 570216,China;Hainan TCM,Haikou 570100,China)

机构地区：[1]海口市中医医院,海口570216 [2]海南省中医院,海口570100

出　　处：《中国实验方剂学杂志》2020年第17期83-88,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：海南省卫生计生行业科研项目(15A200059)。

摘　　要：目的:观察枳实薤白桂枝汤合理中汤加减治疗稳定型心绞痛(SAP)阴寒凝滞证的疗效及对炎症因子和血管内皮功能的影响。方法:将138例患者随机按数字表法分为对照组和观察组各69例;对照组研究期间脱落、失访3例,剔除3例,完成63例;观察组脱落、失访3例,剔除1例,完成65例。两组患者基础治疗,口服酒石酸美托洛尔片,50 mg/次,2次/d;和阿司匹林肠溶片,100 mg/次,1次/d;和盐酸曲美他嗪片,1片/次,3次/d;心绞痛发作时,舌下含服硝酸甘油片,0.25~0.5 mg,每5 min可重复l次,直到心绞痛缓解;并给予控制血糖、血脂和血压处理措施。对照组采用冠心苏合丸,嚼碎服,1丸/次,2次/d。观察组采用枳实薤白桂枝汤合理中汤加减,1剂/d。两组疗程均为12周。记录治疗前1周和治疗后1周的心绞痛发作次数、每次发作的持续时间和硝酸甘油用量;评价治疗前后心电图;进行治疗前后西雅图心绞痛量表(SAQ)和阴寒凝滞证评分;检测治疗前后超敏C反应蛋白(hs-CRP),血清磷脂酶A2(Lp-PLA2),肿瘤坏死因子-α(TNF-α),同型半胱氨酸(Hcy),D-二聚体(D-D),白细胞介素-6(IL-6),一氧化氮(NO)和内皮素-1(ET-1)水平。结果:治疗后观察组心绞痛发作次数和硝酸甘油用量少于对照组(P<0.01),心绞痛发作持续时间短于对照组(P<0.01);观察组阴寒凝滞证评分低于对照组(P<0.01),SAQ评分高于对照组(P<0.01);观察组Lp-PLA2,D-D和Hcy水平均低于对照组(P<0.01);IL-6,hs-CRP和TNF-α均低于对照组(P<0.01);观察组NO水平高于对照组(P<0.01),ET-1水平低于对照组(P<0.01);观察组心电图疗效优于对照组(Z=2.043,P<0.05);观察组疾病疗效优于对照组(Z=2.003,P<0.05)。结论:在西医综合治疗的基础上,采用枳实薤白桂枝汤合理中汤加减治疗SAP阴寒凝滞证患者,可进一步减轻症状,减少缺血发作,提高生活质量,并具有抗炎、改善血管内皮功能和稳定斑块作用,有着较好的临床效果和心电图疗�Objective:To discuss the efficacy of addition and subtraction therapy of Zhishi Xiebai Guizhitang and Lizhongtang for stable angina(SAP)with syndrome of Yin-cold stagnation and investigate its effects on inflammatory factors and endothelial function.Method:One hundred and thirty-eight patients were randomly divided into control group(69 cases)and observation group(69 cases)by random number table.During the study period,there were 3 drop-out cases,3 excluded cases,and 63 completed cases in the control group.There were 3 drop-out cases,1 excluded case,and 65 completed cases in the observation group.Basic therapy was given in both groups.Patients in both groups got metoprolol tartrate tablets,50 mg/time,2 times/days.Aspirin enteric-coated tablets,100 mg/time,1 time/day.Trimetazidine dihydrochloride tablets,1 tablet/time,3 times/days In case of angina pectoris attacks,nitroglycerin tablets under the tongue,0.25-0.5 mg,for every 5 minutes until the angina is relieved.And they also got treatment to control blood glucose,lipids and blood pressure.Based on the above treatment,the patients in control group additionally received Guanxin Suhe pills,chewed for administration,1 pill/time,twice a day.The patients in observation group additionally received addition and subtraction therapy of Zhishi Xiebai Guizhitang and Lizhongtang,1 dose/day.The course of treatment was 12 weeks in both groups.One week before treatment and one week after treatment,the number of times and duration of anginal attacks and dosage of nitroglycerin were recorded.Before treatment and after treatment,electrocardiogram was checked,and scores of Seattle Angina Questionnaire(SAQ)and syndrome of Yin-cold stagnation were graded;levels of serum phospholipase A2(Lp-PLA2),homocysteine(Hcy),D-dimer(D-D),hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),nitric oxide(NO)and endothelin(ET-1)were detected.Result:The number of times of angina attacks and Nitroglycerin consumption in observation group were less than those

关 键 词：稳定型心绞痛 阴寒凝滞证 枳实薤白桂枝汤 理中汤 炎症因子 血管内功能 稳定斑块 

分 类 号：R289[医药卫生—方剂学] R24[医药卫生—中药学]