中医辨证论治对不稳定型心绞痛PCI术后心肌损伤的影响  

Effect of Traditional Chinese Medicine Treatment Based on Syndrome Differentiation on Myocardial Injury in Patients with Unstable Angina Pectoris after PCI

作　　者：高占义[1] 魏月娟[1] 张玲慧[2] GAO Zhan-yi;WEI Yue-juan;ZHANG Ling-hui(Department of Cardiology,Cangzhou Hospital of Integrated TCM-WM,Cangzhou,Hebei 061000,China;Department of Internal Medicine,Shijiazhuang Medical College,Shijiazhuang 050071,China)

机构地区：[1]河北省沧州中西医结合医院心内科,河北沧州061000 [2]石家庄医学高等专科学校内科教研室,石家庄050071

出　　处：《临床误诊误治》2022年第3期22-26,63,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局项目(2019269)。

摘　　要：目的探讨中医辨证论治对不稳定型心绞痛经皮冠状动脉介入(PCI)术后心肌细胞损伤的影响。方法选取2018年4月—2020年4月收治的诊断为不稳定型心绞痛行PCI术者180例,按治疗方法分为观察组和对照组各90例,对照组采用西药治疗,观察组在此基础上加用中医辨证论治。比较两组中医证候改善及术后3个月心脏不良事件发生情况,比较两组手术前后心肌肌钙蛋白I(cTnI)、肌钙蛋白T(cTnT)、血栓烷A_(2)(TXA_(2))、前列环素(PGI_(2))及超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平变化情况。结果两组中医证候总有效率高于对照组(P<0.05)。两组术后7 d心肌cTnI、cTnT、血清TXA_(2)水平均低于术后1 d,且观察组低于对照组(P<0.05)。两组术后7 d血清PGI_(2)高于术后1 d,且观察组高于对照组(P<0.05)。观察组术后3个月心脏不良事件总发生率低于对照组(P<0.05)。两组均未发生不良反应。结论中医辨证论治可减轻不稳定型心绞痛PCI术后患者的心肌损伤,其作用机制可能与改善血管内皮功能及降低炎性因子水平有关。Objective To investigate the effect of traditional Chinese medicine(TCM)treatment based on syndrome differentiation on injury of myocardial cell in patients with unstable angina pectoris after percutaneous coronary intervention(PCI).Methods A total of 180 patients diagnosed as unstable angina pectoris who had undergone PCI between April 2018 and April 2020 were selected and divided into observation group(n=90)and control group(n=90)according to different therapeutic methods.Control group was treated with western medicine,while observation group was supplemented with TCM treatment based on syndrome differentiation.In two groups,improved conditions of TCM syndromes and incidence rate of adverse cardiac events after operation for 3 months were compared,and level changes of cardiac troponin I(cTnI),cardiac troponin T(cTnT),thromboxane A_(2)(TXA_(2)),prostacyclin 2(PGI_(2)),high-sensitivity C-reactive protein(hs CRP)and tumor necrosis factor-α(TNF-α)before and after operation were also compared.Results The total effective rate of TCM syndromes in observation group was significantly higher than that in control group(P<0.05).Levels of cTnI,cTnT and serum TXA_(2) after operation for 7 d were significantly lower than those after operation for 1 d in two groups,and the levels in observation group were significantly lower than those in control group(P<0.05).Serum PGI_(2) levels after operation for 7 d were significantly higher than those after operation for 1 d in two groups,and the level in observation group was significantly higher than that in control group(P<0.05).The total incidence rate of adverse cardiac events after operation for 3 months in observation group was significantly lower than that in control group(P<0.05).No adverse reaction occurred in both groups.Conclusion TCM treatment based on syndrome differentiation may reduce myocardial injury in patients with unstable angina pectoris after PCI,and its mechanism may be related to the improvement of vascular endothelial function and reduction of inflammatory fac

关 键 词：心绞痛 不稳定型 辨证论治 经皮冠状动脉介入 肌钙蛋白I 肌钙蛋白T 血栓烷A_(2) 肿瘤坏死因子-α 

分 类 号：R256.22[医药卫生—中医内科学]