涤痰逐瘀法联合西药治疗脑血管狭窄

目的 探讨涤痰逐瘀法联合西药治疗脑血管狭窄患者的效果。方法 将入选的70例患者随机分为西药组（21例）、中药组(23例）、联合用药组（26例）。西药组采用阿司匹林、波力维、他汀类药物等西药治疗；中药组根据证候特点分为痰湿型、痰火型、气虚型及阳亢型，以中成药大黄虫丸和天麻杜仲胶囊为基础方，并加用相应的院内自制中药汤剂（痰湿方、痰火方、气虚方、阳亢方）口服；联合用药组用药为上述两组中西药总和；疗程为3个月，连续用药2个疗程。观察治疗前后临床症状及中医证候变化，测定C反应蛋白(CRP)、血小板聚集率（PAR）及纤维蛋白原（Fib），并行医学影像检查颅内血管狭窄程度。结果 治疗后3组患者血CRP、PAR及Fib水平与治疗前比较均呈不同程度下降，有统计学意义（P＜0.05），但组间比较差异无统计学意义。治疗后3组患者中度及重度脑血管狭窄支数较治疗前均明显减少（P＜0.05），但组间比较无统计学意义。西药组、中药组及联合用药组脑血管狭窄总有效率分别为42.9%（9/21例）、39.1%（9/23例）和61.5%（16/26例），3组间比较无统计学意义。结论 中西医结合治疗脑血管狭窄在临床疗效及实验室指标改善方面较单纯西医或中医治疗疗效有提高趋势。

Removing Phlegm and Dispelling Stasis Method Combined with Western Medicine for Treatment of Cere-brovascular Stenosis

OBJECTIVE: To investigate the effect of removing phlegm and dispelling stasis method (RPDSM) combined with Western medicine for treatment of cerebrovascular stenosis. METHODS: Seventy enrolled patients were randomly assigned to 3 groups: the Western medicine (WM) group, the integrative medicine (IM) group, and the traditional Chinese medicine (TCM) group. The 21 patients in the WM group were treated with Western medicine as aspirin, Clopidogrel, statins, etc.; the 23 patients in the TCM group were treated with Chinese drugs using the patent preparation Dahuang Zhechong Pill and Tianma Duzhong Capsule as the basic drugs, and supplemented by self-formulated decoctions, selected according to their syndrome types (Tanshi Recipe for dampness-phlegm syndrome, Tanhuo Recipe for fire-phlegm syndrome, Qixu Recipe for qi-deficiency syndrome, and Yang-kang Recipe for yang-excess syndrome); and the 26 patients in the IM group were treated by both TCM and WM with the same drugs and doses mentioned above. The course of treatment was 3 months, and all patients received at least 2 courses in succession. Changes in clinical symptoms and TCM syndrome, levels of C-reactive protein (CRP), platelet aggregation rate (PAR) and fibrinogen (Fib), as well as pictures of medical imaging were observed to evaluate cerebrovascular stenosis. RESULTS: After 6-month treatment, the blood levels of CRP, PAR and Fib were lowered and the number of moderate and severe stenosed vessel lessened in all the three groups (all P < 0.05). The respective total effective rate in the WM, TCM and IM group was 42.9% (9/21 cases), 39.1% (9/23 cases) and 61.5% (16/26 cases), no significant difference was shown among them. CONCLUSION: The integrative Chinese traditional and Western medical treatment for cerebrovascular stenosis shows an increasing trend in improving clinical efficacy and laboratory indexes, combared with pure Western or Chinese medical treatment.