【摘要】：背景：冠狀動(dòng)脈慢血流現(xiàn)象(CSFP)的概念最先于1972年由Tamble教授所提出,但此類現(xiàn)象在上世紀(jì)90年代末期被Mangieri和Diver等學(xué)者廣泛關(guān)注：在部分胸痛患者進(jìn)行冠狀動(dòng)脈造影術(shù)過程中,雖然無明顯的冠狀動(dòng)脈病變(排除冠狀動(dòng)脈痙攣,心肌橋,冠狀動(dòng)脈囊性擴(kuò)張、PCI術(shù)后和其他由心臟瓣膜疾病、結(jié)締組織疾病所引起的冠脈阻塞性病變),但冠脈遠(yuǎn)端血液灌注卻出現(xiàn)延遲的現(xiàn)象。近年來隨著冠狀動(dòng)脈造影檢查在我國(guó)的廣泛開展,這一現(xiàn)象已經(jīng)逐漸引起了心臟科臨床醫(yī)生的深度關(guān)注。在我院自2010年至2014年期間對(duì)部分不穩(wěn)定性心絞痛、急性心肌梗死、穩(wěn)定型心絞痛患者進(jìn)行造影檢查中發(fā)現(xiàn),冠狀動(dòng)脈血流延遲現(xiàn)象發(fā)生率較高,給患者的正常生活和工作造成了極其嚴(yán)重的影響,但此類現(xiàn)象的發(fā)生機(jī)制目前尚無準(zhǔn)確定論。因此,應(yīng)加強(qiáng)對(duì)此疾病的治療[1-2]勢(shì)在必行。根據(jù)目前的臨床多項(xiàng)相關(guān)研究提示：阿托伐他汀鈣片,屬HMG-CoA還原酶抑制劑,它的水解產(chǎn)物在體內(nèi)競(jìng)爭(zhēng)地抑制膽固醇合成的限速酶,降低膽固醇的合成,同時(shí)它能夠促進(jìn)肝細(xì)胞表面LDL受體合成的增加,進(jìn)一步降低LDL的水平,除了調(diào)脂以外,它還存在穩(wěn)定血管內(nèi)皮等調(diào)脂以外的作用,則接受阿托伐他汀治療冠狀動(dòng)脈慢血流應(yīng)該可行性程度較高,然而還有一些相關(guān)的臨床研究表明[3],單獨(dú)使用阿托伐他汀治療冠狀動(dòng)脈慢血流效果不佳。本研究采用中西醫(yī)結(jié)合的方法,即阿托伐他汀治療的基礎(chǔ)上使用注射丹參多酚酸鹽(丹參凍干注射)治療冠狀動(dòng)脈慢血流。丹參多酚酸鹽(丹參凍干注射液)是一種采用更現(xiàn)代中藥制劑方法集中生產(chǎn)的丹參活性成分,其中丹參多酚酸鹽醋酸鎂為主要組成部分,它通過抗凝血,增加血流等機(jī)制治療冠狀動(dòng)脈相關(guān)性疾病[4]。本研究旨在探討丹參凍干注射液聯(lián)合阿托伐他汀治療冠狀動(dòng)脈慢血流的臨床療效和安全性,為臨床治療冠狀動(dòng)脈慢血流提供一種有效的方法。目的：研究丹參凍干注射液聯(lián)合阿托伐他汀治療冠狀動(dòng)脈慢血流的臨床療效和安全性。方法：80例冠狀動(dòng)脈血流緩慢患者,包括典型胸痛的不穩(wěn)定心絞痛46例、穩(wěn)定型勞力性心絞痛31例、急性心肌梗死3例。造影后按照1：1比例隨機(jī)分為對(duì)照組和觀察組各40例。對(duì)照組為單用口服阿托伐他汀治療,觀察組則在口服阿托伐他汀治療的基礎(chǔ)上聯(lián)合冠脈內(nèi)注射丹參凍干注射液的治療組。比較兩組治療前后的臨床療效(前后癥狀發(fā)作頻率及平均持續(xù)時(shí)間)、兩組血脂水平的變化情況、心臟EF值的變化、兩組治療前后血管內(nèi)皮功能指標(biāo)水平(根據(jù)Celermajer等超聲法測(cè)算)、兩組治療前后血尿酸及超敏-C反應(yīng)蛋白水平、兩組治療后生活質(zhì)量及不良反應(yīng)發(fā)生率。結(jié)果：(1)治療后,臨床觀察組的總效率與對(duì)照組相比更高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；(2)兩組治療后癥狀發(fā)作頻率及平均持續(xù)時(shí)間較治療前明顯縮短,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),且觀察組治療后癥狀發(fā)作頻率及平均持續(xù)時(shí)間均顯著低于對(duì)照組治療后(P0.05),臨床癥狀明顯改善；(3)對(duì)照組治療前后LVEF超聲結(jié)果差異無統(tǒng)計(jì)學(xué)意義(P0.05),而觀察組治療后LVEF超聲檢查結(jié)果均顯著大于對(duì)照組(P0.05),心肌灌注明顯好轉(zhuǎn)。(4)不同的脂質(zhì)水平在對(duì)照組治療前后無統(tǒng)計(jì)學(xué)意義(P0.05),但治療后觀察組TC和低密度脂蛋白水平在統(tǒng)計(jì)學(xué)上顯著差異(P0.05),血脂中尤其總膽固醇于低密度脂蛋白含量升高,易發(fā)生慢血流現(xiàn)象。(5)兩組治療前后DO及NID水平差異均無統(tǒng)計(jì)學(xué)意義(P0.05),但兩組治療前后FMD水平差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)；(6)兩組治療前后血清Hs-CRP水平差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組治療后血清Hs-CRP水平差異無統(tǒng)計(jì)學(xué)意義(P0.05)；(7)對(duì)照組治療前后UA水平差異無統(tǒng)計(jì)學(xué)意義(P0.05),觀察組治療前后UA水平具有統(tǒng)計(jì)學(xué)差異(P0.05),且觀察組治療后UA水平顯著低于對(duì)照組治療后(P0.05)；(8)根據(jù)生活質(zhì)量評(píng)估量表,觀察組治療后的生活質(zhì)量量表各維度(生理功能、心理功能、身體疼痛,一般健康、活力、社會(huì)功能、角色情感,心理健康,physical-related生活質(zhì)量、心理相關(guān)的生活質(zhì)量)分?jǐn)?shù)明顯高于治療后,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；(9)8周后單用阿托伐他汀(對(duì)照組)發(fā)現(xiàn)兩例患者的丙氨酸轉(zhuǎn)氨酶(ALT)和天冬氨酸轉(zhuǎn)氨酶(AST)增加超過正常上限的兩倍,是停用阿托伐他汀片治療的指征,兩周復(fù)查上述指標(biāo)后,患者的ALT和AST值均已回到正常水平。而阿托阿托伐他汀聯(lián)合丹參凍干注射液組(觀察組),沒有發(fā)現(xiàn)肌炎、肌痛等橫紋肌溶解相關(guān)的并發(fā)癥。同時(shí)觀察組亦未出現(xiàn)藥物過敏、ALT、AST、CK、CKMB升高等藥品不良反應(yīng)的患者。結(jié)論：丹參(凍干)注射液結(jié)合阿托伐他汀改善冠狀動(dòng)脈慢血流現(xiàn)象,安全性高,可以作為有效的治療冠狀動(dòng)脈慢血流的臨床途徑之一,為臨床治療此疾病提供了依據(jù)。
[Abstract]:Background: the concept of slow coronary artery flow (CSFP) was first proposed by Professor Tamble in 1972, but this phenomenon was widely concerned by scholars such as Mangieri and Diver in the late 90s of last century. In the course of coronary arteriography in patients with partial chest pain, there was no obvious coronary artery disease (excluding coronary spasm, heart) during coronary angiography. Muscle bridge, cystic dilatation of coronary arteries, after PCI and other coronary angiopathy caused by heart valve disease, connective tissue disease, but delayed blood perfusion in the distal coronary artery. In recent years, coronary angiography has been widely carried out in our country. This phenomenon has gradually caused the clinicians in the cardiology department. Deep concern. In our hospital from 2010 to 2014, we found that the incidence of coronary artery blood flow delayed in some patients with unstable angina, acute myocardial infarction and stable angina pectoris was higher, which had a severe impact on the normal life and work of the patients, but the mechanism of this kind of phenomenon is still still available. No quasi certainty. Therefore, it is imperative to strengthen the treatment of [1-2] for this disease. According to a number of current clinical studies, Atorvastatin Calcium Tablets, a HMG-CoA reductase inhibitor, its hydrolysates compete in the body to inhibit the speed limit enzyme of cholesterol synthesis, reduce the synthesis of cholesterol, and it can promote the liver cell surface. The increase in LDL receptor synthesis further reduces the level of LDL, in addition to lipid regulating, it still has the role of stabilizing the vascular endothelium, and it is more feasible to accept atorvastatin in the treatment of slow coronary artery blood flow. However, there are some related clinical studies that suggest that [3] alone is used for the treatment of coronary heart disease. The slow flow effect of the artery is not good. This study uses the combination of traditional Chinese and Western medicine, that is, the treatment of atorvastatin on the basis of injection of Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) in the treatment of slow coronary artery blood flow. Salvia miltiorrhiza (Salvia miltiorrhiza freeze-dried injection) is a kind of active ingredient of Salvia miltiorrhiza, which is produced by the method of more modern Chinese medicine. The main component of Salvia miltiorrhiza polyphenolic acid magnesium acetate is to treat coronary artery related diseases through anticoagulant and increased blood flow mechanism [4].. The purpose of this study is to explore the clinical efficacy and safety of Salvia miltiorrhiza combined with atorvastatin in the treatment of slow coronary artery blood flow, and to provide a clinical treatment for slow coronary artery blood flow. Objective: To study the clinical efficacy and safety of Salvia miltiorrhiza freeze-dried injection combined with atorvastatin in the treatment of slow coronary artery blood flow. Methods: 80 patients with slow coronary artery blood flow, 46 cases of unstable angina pectoris with typical chest pain, 31 cases of stable angina pectoris, 3 cases of acute myocardial infarction. The cases were randomly divided into the control group and the observation group of 40 cases. The control group was treated with oral atorvastatin alone. The observation group combined with the treatment of atorvastatin on the basis of oral administration of Salvia miltiorrhiza injection in the treatment group. Compared the clinical efficacy of the two groups before and after treatment (the frequency of the onset of the onset and the average duration), and the two groups of blood lipids. Changes in level, changes in EF value of the heart, the level of vascular endothelial function before and after treatment (measured by Celermajer and other ultrasonic methods), the level of blood uric acid and hypersensitivity -C reaction protein before and after treatment in the two groups, the quality of life and the incidence of adverse reactions in the two groups after treatment. Results: (1) after treatment, the total efficiency of the clinical observation group and the control group Compared with higher, the difference was statistically significant (P0.05); (2) the frequency of symptom onset and the average duration of the two groups were significantly shorter than those before treatment (P0.05), and the frequency and duration of symptoms after treatment in the observation group were significantly lower than those of the control group (P0.05), and the clinical symptoms were significantly improved. 3) there was no significant difference in the results of LVEF ultrasound in the control group before and after treatment (P0.05), but the results of LVEF ultrasound examination in the observation group were significantly greater than those in the control group (P0.05), and the myocardial perfusion was obviously improved. (4) the different lipid levels were not statistically significant before and after treatment in the control group (P0.05), but the level of TC and low density lipoprotein in the observation group was in the observation group after treatment. Statistically significant difference (P0.05), blood lipid especially total cholesterol in low density lipoprotein content increased, prone to slow blood flow phenomenon. (5) there was no significant difference in the level of DO and NID before and after treatment in the two groups (P0.05), but the difference in FMD level between the two groups was all (P0.05), and (6) the level of Hs-CRP in the two groups before and after treatment. The difference was statistically significant (P0.05), but there was no significant difference in serum Hs-CRP level between the two groups (P0.05); (7) there was no significant difference in the level of UA in the control group before and after treatment (P0.05), and the level of UA in the observation group before and after treatment was statistically significant (P0.05), and the level of UA in the observation group was significantly lower than that of the control group after treatment (P0.05). (8) according to the quality of life assessment scale, the scores of each dimension (physiological function, psychological function, body pain, general health, vitality, social function, role emotion, mental health, physical-related quality of life, psychological related living quality) of the observation group were significantly higher than those of the treatment, and the difference was statistically significant (P0.05 (9) after 8 weeks, two cases of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were found to be more than two times more than the normal upper limit of atorvastatin (control group). After two weeks of reexamination of the above indicators, the ALT and AST values of the patients were all returned to normal levels. Combined Salvia miltiorrhiza freeze-dried injection group (observation group), no myositis, myalgia and other rhabdomyolysis related complications were found. At the same time, the observation group had no drug allergy, ALT, AST, CK, CKMB liters of adverse drug reactions. Conclusion: Salvia miltiorrhiza injection combined with atorvastatin can improve the slow flow of coronary artery, it is safe and safe. As an effective way to treat coronary slow flow, it provides a basis for clinical treatment of this disease.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R543.3

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相關(guān)期刊論文 前1條

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本文編號(hào)：2171341