冠心颗粒对稳定性心绞痛炎症反应的影响

目的:观察冠心颗粒治疗稳定性心绞痛心血瘀阻证的临床疗效及对炎症反应和血小板功能的影响。方法:将154例患者按就诊先后,依据分层,随机分为对照组和观察组各77例。对照组给予拜阿司匹林肠溶片0.1 g,1次/d;盐酸曲美他嗪片20 mg,3次/d;对高血脂、高血压和糖尿病患者给予对症处理(冠心病二级预防药物)。观察组在对照组治疗的基础上加用冠心颗粒,1剂/d,早晚分2次冲服。两组疗程均为20周。记录心绞痛发作次数、发作持续时间、疼痛程度、诱发因素及与体力活动的关系;测量治疗前后心电图和血脂变化,进行治疗前后西雅图心绞痛量表(SAQ)和心血瘀阻证评分;检测治疗前后超敏C反应蛋白(hs-CRP),同型半胱氨酸(HCY),血清胱抑素C(Cys-C),血小板膜糖蛋白CD63,CD42 b和基质金属蛋白酶-9(MMP-9)水平。结果:观察组疾病疗效总有效率为92.21%,高于对照组的77.92%(P0.05);观察组中医证候疗效总有效率为93.51%,高于对照组的72.73%(P0.01);治疗后观察组心绞痛发作次数少于对照组,持续时间缩短于对照组,硝酸甘油用量少于对照组(P0.01);治疗后观察组ST段下移导联数,T波低平导联数,和T波倒置导联数均少于对照组(P0.01);治疗后观察组TG异常率为10.39%,低于对照组的22.08%(P0.05),TC异常率为9.09%,低于对照组的25.97%(P0.01),HDL-C异常率为12.99%,低于对照组的28.57%(P0.05);治疗后观察组SAQ量表评分均高于对照组,心血瘀阻证评分低于对照组(P0.01);治疗后观察组hs-CRP,HCY,Cys C,CD63和MMP-9水平均低于对照组,CD42 b水平高于对照组(P0.01)。结论:冠心颗粒治疗心血瘀阻型稳定性心绞痛能减少心绞痛发作程度,能调节脂代谢,还抑制炎症反应和血小板的活化功能,从而改善心肌缺血,提高临床疗效。

Effect of Guanxin Granule on Inflammatory Response in Patients with Stable Angina Pectoris

Objective: To observe the clinical efficacy of Guanxin granules on stable angina pectoris with heart-blood stasis syndrome and investigate its effect on platelet activation. Method: One hundred and fifty-four patients were randomly divided into control group (77 cases) and observation group (77 cases) by random number table. In observation group, the patients took aspirin enteric-coated tablets 0.1 g, 1 time/day, trimetazidine dihydrochloride tablets, 20 mg, 3 times/day. In addition, the patients with high blood fat, high blood pressure, or diabetes got symptomatic treatment (secondary prevention of coronary heart disease). Based on the treatment of control group, patients in observation group got Guanxin granules, 1 dose/day in both morning and evening. The treatment course was 20 weeks in both groups. Attack times of angina pectoris, duration of attack, degree of pain, inducing factors and the relationship with physical activity were recorded. Before and after treatment, changes of electrocardiogram and blood lipid were measured. Scores of seattle angina scale (SAQ) and heart-blood stasis syndrome were graded; levels of high sensitive C reactive protein (hs-CRP), homocysteine (HCY), serum cystatin-C (Cys-C), platelet membrane glycoprotein CD63 and CD42 b, and matrix metalloproteinases-9 (MMP-9) were detected. Result: The total effective rate for the disease was 92.21% in observation group, higher than 77.92% in control group (P<0.05). The total effective rate for traditional Chinese medicine syndrome was 93.51%, higher than 72.73% in control group (P<0.01). After treatment, attack times of angina pectoris in observation group were less than those in control group. The duration time was less than that in control group, and consumption of glyceryl trinitrate was also less than that in control group (P<0.01). Leads number of ST segment down shift, leads number of T wave lowering, and leads number of T wave inverting were all less than those in control group (P<0.01). After treatment, TG abnormal rate in observation group was 10.39%, lower than 22.08% in control group (P<0.05).TC abnormal rate was 9.09, lower than 25.97% in control group (P<0.01). HDL-C abnormal rate was 12.99%, lower than 28.57% in control group (P<0.05).And SAQ scores were higher than those in control group, while heart-blood stasis syndrome score was lower than that in control group (P<0.01). In addition, the levels of hs-CRP, HCY, CysC, CD63 and MMP-9 were lower than those in control group, while level of CD42 b was higher than that in control group after treatment (P<0.01). Conclusion: Guanxin granules can reduce the degree of angina pectoris attacks, regulate lipid metabolism, inhibit the inflammatory response and platelet activation, thereby improving myocardial ischemia, and increasing clinical efficacy in the treatment of stable angina pectoris with heart-blood stasis syndrome