活血化瘀中药干预冠心病患者经皮冠状动脉介入术后一年主要心血管事件风险的前瞻性队列研究  

A Prospective Cohort Study on the Risk of Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease after Percutaneous Coronary Intervention with Blood-invigorating and Stasis-dissolving Medicinals

作　　者：于林童 陶诗怡 马晓娟[2] 高洁[2] 曲华 杨玉 陈炳畅 史大卓[2] YU Lintong;TAO Shiyi;MA Xiaojuan;GAO Jie;QYU Hua;YANG Yu;CHEN Bingchang;SHI Dazhuo(Graduate School of Beijing University of Chinese Medicine,Beijing,100029;Xiyuan Hospital,China Academy of Chinese Medical Sciences;China-Japan Friendship Hospital)

机构地区：[1]北京中医药大学研究生院,北京市100029 [2]中国中医科学院西苑医院 [3]中日友好医院

出　　处：《中医杂志》2024年第18期1895-1902,共8页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82374433)。

摘　　要：目的观察常规西药治疗基础上联用活血化瘀中药对冠心病行经皮冠状动脉介入术(PCI)后患者主要心血管事件(MACE)发生率的影响。方法采用前瞻性队列研究设计,收集冠心病PCI术后的连续病例资料,依据是否应用活血化瘀中药干预分为中药组和对照组。主要结局指标为患者PCI术后一年MACE发生率;次要结局指标包括中医证候积分、超声心动图左室射血分数(LVEF);并采用逻辑回归分析探索MACE发生的影响因素。结果共纳入符合标准的患者844例,中药组617例,对照组227例,活血化瘀药以丹参(46.35%)、川芎(45.87%)、赤芍(42.30%)为主。在中位随访12.73个月后,中药组MACE发生率(142/617,23.01%)显著低于对照组(68/227,29.96%),中药组MACE发生风险低于对照组[OR=0.70(95%CI,0.50~0.98),P=0.04]。中药组LVEF[(60.06±6.13)%]高于对照组[(58.27±7.36)%],差异具有统计学意义(t=0.356,P<0.01)。中药组患者中医证候积分降至(12.66±4.47)分,对照组患者升高至(13.81±3.88)分,中药组优于对照组(t=2.78,P<0.01)。单因素分析结果显示PCI术后MACE发生率与活血化瘀中药治疗、LVEF、应用肾素-血管紧张素-醛固酮系统(RAAS)抑制剂、中医证候积分、应用β受体阻滞剂因素有关(P<0.05);多因素分析显示,联合活血化瘀类中药可显著减少MACE发生率(P<0.01);基线LVEF降低、中医证候积分升高、未应用RAAS抑制剂或β受体阻滞剂为PCI术后MACE的危险因素(P<0.05)。结论PCI术后患者在常规治疗基础上联用活血化瘀中药可减少术后一年MACE风险,同时可改善患者中医证候积分、保护心功能。Objective To explore the impact of blood-invigorating and stasis-dissolving medicinals combined with conventional western medicine on the major adverse cardiovascular events(MACE)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A prospective cohort study was conducted to collect data on consecutive cases of CHD after PCI.According to whether blood-invigorating and stasis-dissolving medicinals were used,the cases were divided into a Chinese herbal medicinals(CHM)group and control group.The primary outcome was the incidence of MACE one year after PCI,while the secondary outcomes included TCM syndrome score and echocardiography left ventricular ejection fraction(LVEF).Logistic regression analysis was performed to explore the influencing factors of MACE.Results A total of 844 patients who met the criteria were included,with 617 in the CHM group and 227 in the control group.The main blood-invigorating and stasis-dissolving medicinals being used were Danshen(Radix et Rhizoma Salviae Miltiorrhizae,46.35%),Chuanxiong(Rhizoma Chuanxiong,45.87%),and Chishao(Radix Paeoniae Rubra,42.30%).After a median follow-up of 12.73 months,the incidence of MACE in the CHM group(142/617,23.01%)was significantly lower than that in the control group(68/227,29.96%)with significant difference(OR=0.70,95%CI 0.50 to 0.98,P=0.04).The LVEF of the CHM group[(60.06±6.13)%]was higher than that of the control group[(58.27±7.36)%]with significant difference(t=0.356,P<0.01).The TCM syndrome score in the CHM group decreased to 12.66±4.47,while that in the control group increased to 13.81±3.88,with the results favoring the CHM group(t=2.78,P<0.01).Univariate analysis showed correlations between the incidence of MACE after PCI and the use of blood-invigorating and stasis-dissolving medicinals,LVEF,usage of renin-angiotensin-aldosterone system(RAAS)inhibitors,TCM syndrome score,and usage ofβblockers(P<0.05).Multivariate analysis showed that the use of blood-invigorating and stasis-dissolving medicinals

关 键 词：冠心病 活血化瘀中药 经皮冠状动脉介入术后 主要心血管事件 

分 类 号：R259[医药卫生—中西医结合]