【摘要】：目的:觀察在常規(guī)西藥的基礎上加用益腎活血解毒湯對老年冠心病不穩(wěn)定型心絞痛的臨床療效,以及對血管內(nèi)皮功能、IL-18、和肽素(Copeptin)、hs-CRP等相關指標水平的影響,以探索其作用機制。方法:依據(jù)UA西醫(yī)診斷及中醫(yī)證候診斷標準,納入老年冠心病不穩(wěn)定型心絞痛(腎虛血瘀型)患者40例,按照隨機數(shù)字表法分組,研究組和對照組各20例。對照組采用常規(guī)西藥治療,研究組在常規(guī)西藥治療的基礎上加用益腎活血解毒湯,療程為4周。觀察治療前后兩組患者臨床療效和相關實驗室指標變化結果:1.兩組患者治療后心絞痛癥狀及靜息ECG表現(xiàn)均有改善。心絞痛療效組間治療后比較,研究組總有效率(95%)高于對照組(80%);靜息ECG表現(xiàn)比較,研究組總有效率(80%)高于對照組(70%),但差異無有統(tǒng)計學意義(P㧐0.05)。2.兩組患者治療后中醫(yī)證候積分均明顯下降,差異有統(tǒng)計學意義(P0.05);治療后研究組較對照組證候積分下降更顯著(P0.01)。3.兩組患者治療后硝酸甘油的用量均減少,組間比較,研究組總停減率(90%)高于對照組(50%),差異具有統(tǒng)計學意義(P0.05)。4兩組患者治療后血管內(nèi)皮功能均(NO、6-keto-PGF1α水平均升高,ET、TXB2水平均下降)改善,同組比較,統(tǒng)計學差異顯著(P0.01);組間比較,研究組NO、6-keto-PGF1α水平升高更明顯(P0.05),ET、TXB2水平下降更明顯(P0.05)。5.兩組患者治療后IL-18、Copeptin和hs-CRP水平均顯著下降(P0.01);組間比較,研究組IL-18、copeptin和hs-CRP水平下降更顯著(P0.01)。結論:1.益腎活血解毒湯聯(lián)合常規(guī)西藥治療較單純西藥治療對腎虛血瘀型老年冠心病不穩(wěn)定型心絞痛的療效更確切,對患者中醫(yī)證候改善、減少硝酸甘油用量方面,療效優(yōu)于常規(guī)西藥治療。對患者心絞痛癥狀及靜息ECG表現(xiàn)均有一定程度改善,但組間差異無統(tǒng)計學意義(P㧐0.05)。2.益腎活血解毒湯聯(lián)合常規(guī)西藥治療腎虛血瘀型老年冠心病不穩(wěn)定型心絞痛能顯著改善患者的血管內(nèi)皮功能(升高NO、6-keto-PGF1α水平,降低ET、TXB2水平)、IL-18、Copeptin和hs-CRP等指標。說明益腎活血解毒湯具有改善血管內(nèi)皮功能、保護血管內(nèi)膜及抑制炎癥反應等功能,產(chǎn)生穩(wěn)定動脈粥樣硬化斑塊的作用,達到治療老年冠心病不穩(wěn)定型心絞痛的目的。
[Abstract]:Objective: to observe the clinical effect of Yishen Huoxue jiedu decoction on unstable angina pectoris of coronary heart disease (CHD) in elderly patients, and to observe the effect of Yishen Huoxue jiedu decoction on vascular endothelial function, IL-18, and peptide (Copeptin), hs-CRP in order to explore its mechanism. Methods: 40 patients with unstable angina pectoris (kidney deficiency and blood stasis type) were divided into two groups according to the method of random digital table, 20 cases in the study group and 20 cases in the control group according to the criteria of western medicine diagnosis and TCM syndrome diagnosis of UA. The control group was treated with routine western medicine and the study group was treated with Yishen Huoxue jiedu decoction for 4 weeks. Observe the two groups of patients before and after treatment of clinical efficacy and related laboratory indicators change results: 1. The symptoms of angina pectoris and resting ECG were improved in both groups. The total effective rate (95%) in the study group was higher than that in the control group (80%), the total effective rate in the study group (80%) was higher than that in the control group (70%), but there was no significant difference between the two groups (P0. 05). 2. Two groups of patients after treatment of TCM syndrome score significantly decreased, the difference was statistically significant (P0.05); after treatment, the study group than the control group syndrome score decreased more significantly (P0.01). After treatment, the dosage of nitroglycerin was decreased in both groups. The total reduction rate (90%) in the study group was higher than that in the control group (50%), the difference was statistically significant (P0.05). 4 the vascular endothelial function (NO,6-keto-PGF1 偽 level was increased and ET,TXB2 level was decreased) in the two groups. In the same group, the statistical difference was significant (P0.01), and the level of NO,6-keto-PGF1 偽 in the study group was higher than that in the study group (P0.05), and the level of ET,TXB2 decreased more significantly (P0.05). After treatment, the levels of IL-18,Copeptin and hs-CRP decreased significantly in both groups (P0.01), and the levels of IL-18,copeptin and hs-CRP decreased more significantly in the study group than in the control group (P0.01). Conclusion: 1. The therapeutic effect of Yishen Huoxue jiedu decoction combined with conventional western medicine on unstable angina pectoris of coronary heart disease in elderly patients with kidney deficiency and blood stasis is more accurate than that of western medicine alone. It can improve the TCM syndrome of patients and reduce the dosage of nitroglycerin. The curative effect is superior to that of conventional western medicine. The symptoms of angina pectoris and the manifestation of resting ECG were improved to some extent, but there was no significant difference between the two groups (P0. 05). 2. Yishen Huoxue jiedu decoction combined with routine western medicine in the treatment of unstable angina pectoris of coronary heart disease with kidney deficiency and blood stasis can significantly improve vascular endothelial function (raise the level of NO,6-keto-PGF1 偽 and decrease the level of ET,TXB2), IL-18,Copeptin and hs-CRP, etc. It is suggested that Yishen Huoxue jiedu decoction can improve the function of vascular endothelium, protect the intima of blood vessel and inhibit inflammatory reaction, so as to stabilize atherosclerotic plaques and achieve the purpose of treating unstable angina pectoris of coronary heart disease in the elderly.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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