蛭龍活血通瘀膠囊對冠心病患者PCI術后心臟保護作用研究
發(fā)布時間：2018-08-24 19:35
【摘要】：目的:觀察蛭龍活血通瘀膠囊對PCI術后患者的血清一氧化氮(NO)、內皮素(ET)、肌酸激酶同工酶(CK-MB)、肌鈣蛋白I(cTnI)、超敏C反應蛋白(hs-CRP)及心臟左心射血分數(shù)(LVEF)的影響,并記錄不良心血管事件(MACE)發(fā)生情況,探討蛭龍活血通瘀膠囊對PCI術后患者的心臟保護作用機制。方法:(1)病例的選擇:2015年11月到2016年4月在西南醫(yī)科大學附屬中醫(yī)醫(yī)院心腦病科住院的擬行PCI手術的冠心病患者60例。隨機分成對照組和實驗組,兩組患者在基本情況(年齡、性別)、既往病史(高血壓病、糖尿病、高脂血癥)、用藥情況(β受體阻滯劑、ARB、CCB、ACEI)、危險因素(吸煙、飲酒)等方面無統(tǒng)計學差異,具有可比性。(2)治療方案:兩組患者在PCI術后均給予西醫(yī)常規(guī)治療即抗凝(低分子肝素5000U q12使用3天)、抗血小板聚集(拜阿司匹林100mg qd,硫酸氫氯吡格雷75mg qd)及調脂(阿托伐他汀鈣片20mg qn或者瑞舒伐他汀5mg qn)等。實驗組除了常規(guī)治療外,加用蛭龍活血通瘀膠囊(1.2g,tid),療程6個月。(3)觀察指標:分別在PCI術前、術后24小時、術后72小時檢測cTnI、CK-MB、hs-CRP;分別在PCI術前、術后24小時、術后1月檢測NO、ET;分別在PCI術前、術后3月檢查心臟彩超,以觀察左心射血分數(shù)(lvef);術后6月進行電話隨訪,以記錄不良心血管事件發(fā)生情況。(4)統(tǒng)計軟件spss20.0用于相關數(shù)據的統(tǒng)計描述與分析。結果:(1)hs-crp:pci術前,對照組與實驗組hs-crp比較差異無統(tǒng)計學意義(p0.05)。pci術后兩組hs-crp均有所升高,在術后72小時hs-crp有所降低,與術前相比,差異有統(tǒng)計學意義(p0.05);與對照組相比,實驗組hs-crp降低更為明顯,差異有統(tǒng)計學意義(p0.05);(2)ck-mb:pci術前,對照組與實驗組ck-mb比較差異無統(tǒng)計學意義(p0.05)。pci術后兩組ck-mb均有所升高,在術后72小時ck-mb有所下降,與術前比較,差異有統(tǒng)計學意義(p0.001);與對照組相比,實驗組ck-mb降低更為明顯,差異有統(tǒng)計學意義(p0.001);(3)ctni:pci術前,對照組與實驗組ctni比較差異無統(tǒng)計學意義(p0.05)。pci術后兩組ctni均有所升高,在術后72小時ctni有所下降,與術前比較,差異具有統(tǒng)計學意義(p0.001);與對照組比較,實驗組ctni下降更為明顯,差異具有統(tǒng)計學意義(p0.01);(4)no:pci術前,對照組與實驗組no比較差異無統(tǒng)計學意義(p0.05)。pci術后24小時,兩組no均有所下降,與術前比較,差異具有統(tǒng)計學意義(p0.001);與對照組比較,實驗組no略低于對照組,但差異無統(tǒng)計學意義(p0.05);pci術后1月,兩組no均升高,與術前比較,差異具有統(tǒng)計學意義(p0.001);與對照組比較,實驗組no升高幅度明顯高于對照組,差異有統(tǒng)計學意義(p0.001);(5)et:pci術前,對照組與實驗組et比較差異無統(tǒng)計學意義(p0.05)。pci術后24小時,兩組et均有所升高,與術前比較,差異具有統(tǒng)計學意義(p0.001);與對照組比較,實驗組et略高于對照組,但差異無統(tǒng)計學意義(p0.05);pci術后1月,兩組et均下降,與術前比較,差異具有統(tǒng)計學意義(p0.001);與對照組比較,實驗組et降低幅度明顯大于對照組,差異有統(tǒng)計學意義(p0.001);(6)lvef:pci術前,對照組與實驗組lvef比較差異無統(tǒng)計學意義(p0.05)。pci術后3月,對照組lvef有升高的趨勢,但與術前比較,差異無統(tǒng)計學意義(p0.05);實驗組lvef有明顯升高,與術前及對照組比較,差異均有統(tǒng)計學意義(p0.05);(6)lvef:pci術前,對照組與實驗組lvef比較差異無統(tǒng)計學意義(p0.05)。pci術后3月,對照組lvef有升高的趨勢,但與術前比較,差異無統(tǒng)計學意義(p0.05);實驗組lvef有明顯升高,與術前及對照組比較,差異均有統(tǒng)計學意義(p0.05);(7)mace隨訪情況:pci術后6月,實驗組在不良心血管事件單項及總數(shù)方面均低于對照組,但差異無統(tǒng)計學意義(p0.05);(8)no、et與心肌損傷標志物之間的相關性:pci術后1月no與ck-mb及ctni均成負相關關系(p0.05),et與ctni成正相關關系(p0.001);(9)hs-crp與心肌損傷標志物之間的相關性:術后24小時,hs-crp與ck-mb及ctni呈正相關關系(p0.001);術后72小時,hs-crp與ctni均成正相關關系(p0.05)。結論:1.冠心病患者pci術后可出現(xiàn)心肌的損傷、炎癥反應及血管內皮功能的損傷,術后24小時最為明顯。心肌損傷與血管內皮功能及炎癥反應密切相關,炎癥越輕、血管內皮功能越好,則心肌損傷越輕;反之則越重。2.蛭龍活血通瘀膠囊對PCI術后患者的心臟功能有一定的保護作用,減少不良心血管事件發(fā)生。療效優(yōu)于常規(guī)西藥治療。3.蛭龍活血通瘀膠囊膠囊對心臟保護作用的機制,可能與其降低CK-MB、cTnI;降低ET、升高NO及抑制炎癥反應有關。
[Abstract]:Objective: To observe the effects of Zhilong Huoxue Tongyu Capsule on serum nitric oxide (NO), endothelin (ET), creatine kinase isoenzyme (CK-MB), troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP) and left ventricular ejection fraction (LVEF) in patients after PCI, and to record the occurrence of adverse cardiovascular events (MACE). Methods: (1) Case selection: From November 2015 to April 2016, 60 patients with coronary heart disease undergoing PCI were randomly divided into two groups: control group and experimental group. Urinary disease, hyperlipidemia, drug use (beta blockers, ARB, CCB, ACEI), risk factors (smoking, drinking) and other aspects of no statistical difference, comparable. (2) Treatment: two groups of patients after PCI were given conventional Western medicine treatment that anticoagulation (low molecular weight heparin 5000U Q12 for 3 days), anti-platelet aggregation (aspirin 100mg qd, sulfuric acid) Hydroclopidogrel 75 mg QD and lipid lowering (atorvastatin calcium tablets 20 mg QN or rosuvastatin 5 mg qn). The experimental group was given Zhilong Huoxue Tongyu capsule (1.2 g, tid) for 6 months in addition to routine treatment. (3) Observation indicators: cTnI, CK-MB, hs-CRP were detected before PCI, 24 hours after PCI, 72 hours after PCI, respectively. No and ET were detected at 1 month after PCI, left ventricular ejection fraction (lvef) was observed at 3 months after PCI, and adverse cardiovascular events were recorded at 6 months after PCI. (4) Statistical software SPSS 20.0 was used to describe and analyze the related data. Results: (1) Before hs-crp: pci, the control group and the experimental group had hs-cr. There was no significant difference between the two groups (p0.05). after pci, the hs-CRP of the two groups were increased, and at 72 hours after pci, the hs-CRP decreased, compared with the preoperative, the difference was statistically significant (p0.05); compared with the control group, the experimental group hs-CRP decreased more significantly, the difference was statistically significant (p0.05); (2) before pci, ck-mb: pci, the control group and the experimental group CK-MB was worse than the experimental group ck-mb. There was no significant difference between the two groups (p0.05). after pci, CK-MB increased in both groups, and at 72 hours after pci, CK-MB decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group CK-MB decreased more significantly, the difference was statistically significant (p0.001); (3) before ctni: pci, there was no statistical difference between the control group and the experimental group ctni. The cTnI of the two groups increased after pci, and decreased 72 hours after pci, compared with the preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group cTnI decreased more significantly, the difference was statistically significant (p0.01); (4) no: PCI preoperative, the control group and the experimental group no difference was not statistically significant (p0.05). (pci) 24 hours after surgery, the two groups of no decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no slightly lower than the control group, but there was no significant difference (p0.05); PCI 1 month after surgery, the two groups of no increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no increased. High amplitude was significantly higher than the control group, the difference was statistically significant (p0.001); (5) et: PCI preoperative, the control group and the experimental group et difference was not statistically significant (p0.05). 24 hours after pci, the two groups et increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et slightly higher than the control group, but the difference was not uniform. (p0.05); one month after pci, the two groups et decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et decreased significantly greater than the control group, the difference was statistically significant (p0.001); (6) lvef: PCI before the operation, the control group and the experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, on LVEF in the control group increased, but there was no significant difference compared with preoperative (p0.05); LVEF in the experimental group increased significantly, compared with preoperative and control group, the difference was statistically significant (p0.05); (6) lvef: PCI preoperative, the control group and experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, LVEF in the control group increased. However, there was no significant difference between the two groups (p0.05); LVEF in the experimental group was significantly higher than that in the control group (p0.05); (7) mace follow-up: 6 months after pci, the number of adverse cardiovascular events in the experimental group was lower than that in the control group, but there was no significant difference (p0.05); (8) no, ET and heart rate. Correlation between myocardial injury markers: no was negatively correlated with CK-MB and cTnI 1 month after PCI (p0.05), ET was positively correlated with cTnI (p0.001); (9) correlation between hs-CRP and myocardial injury markers: 24 hours after pci, hs-CRP was positively correlated with CK-MB and cTnI (p0.001); 72 hours after pci, hs-CRP was positively correlated with cTnI (p0.001). Conclusion: 1. Myocardial injury, inflammation and vascular endothelial function damage can occur in patients with coronary heart disease after pci, the most obvious 24 hours after pci. Myocardial injury is closely related to vascular endothelial function and inflammation. The lighter inflammation, the better vascular endothelial function, the lighter myocardial injury; otherwise, the more serious. 2. Zhilong Huoxue Tongyu Capsule is right. The effect of Zhilong Huoxue Tongyu Capsule on cardioprotective effect may be related to the decrease of CK-MB, cTnI, ET, NO and inflammation.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
[Abstract]:Objective: To observe the effects of Zhilong Huoxue Tongyu Capsule on serum nitric oxide (NO), endothelin (ET), creatine kinase isoenzyme (CK-MB), troponin I (cTnI), hypersensitive C-reactive protein (hs-CRP) and left ventricular ejection fraction (LVEF) in patients after PCI, and to record the occurrence of adverse cardiovascular events (MACE). Methods: (1) Case selection: From November 2015 to April 2016, 60 patients with coronary heart disease undergoing PCI were randomly divided into two groups: control group and experimental group. Urinary disease, hyperlipidemia, drug use (beta blockers, ARB, CCB, ACEI), risk factors (smoking, drinking) and other aspects of no statistical difference, comparable. (2) Treatment: two groups of patients after PCI were given conventional Western medicine treatment that anticoagulation (low molecular weight heparin 5000U Q12 for 3 days), anti-platelet aggregation (aspirin 100mg qd, sulfuric acid) Hydroclopidogrel 75 mg QD and lipid lowering (atorvastatin calcium tablets 20 mg QN or rosuvastatin 5 mg qn). The experimental group was given Zhilong Huoxue Tongyu capsule (1.2 g, tid) for 6 months in addition to routine treatment. (3) Observation indicators: cTnI, CK-MB, hs-CRP were detected before PCI, 24 hours after PCI, 72 hours after PCI, respectively. No and ET were detected at 1 month after PCI, left ventricular ejection fraction (lvef) was observed at 3 months after PCI, and adverse cardiovascular events were recorded at 6 months after PCI. (4) Statistical software SPSS 20.0 was used to describe and analyze the related data. Results: (1) Before hs-crp: pci, the control group and the experimental group had hs-cr. There was no significant difference between the two groups (p0.05). after pci, the hs-CRP of the two groups were increased, and at 72 hours after pci, the hs-CRP decreased, compared with the preoperative, the difference was statistically significant (p0.05); compared with the control group, the experimental group hs-CRP decreased more significantly, the difference was statistically significant (p0.05); (2) before pci, ck-mb: pci, the control group and the experimental group CK-MB was worse than the experimental group ck-mb. There was no significant difference between the two groups (p0.05). after pci, CK-MB increased in both groups, and at 72 hours after pci, CK-MB decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group CK-MB decreased more significantly, the difference was statistically significant (p0.001); (3) before ctni: pci, there was no statistical difference between the control group and the experimental group ctni. The cTnI of the two groups increased after pci, and decreased 72 hours after pci, compared with the preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group cTnI decreased more significantly, the difference was statistically significant (p0.01); (4) no: PCI preoperative, the control group and the experimental group no difference was not statistically significant (p0.05). (pci) 24 hours after surgery, the two groups of no decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no slightly lower than the control group, but there was no significant difference (p0.05); PCI 1 month after surgery, the two groups of no increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group no increased. High amplitude was significantly higher than the control group, the difference was statistically significant (p0.001); (5) et: PCI preoperative, the control group and the experimental group et difference was not statistically significant (p0.05). 24 hours after pci, the two groups et increased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et slightly higher than the control group, but the difference was not uniform. (p0.05); one month after pci, the two groups et decreased, compared with preoperative, the difference was statistically significant (p0.001); compared with the control group, the experimental group et decreased significantly greater than the control group, the difference was statistically significant (p0.001); (6) lvef: PCI before the operation, the control group and the experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, on LVEF in the control group increased, but there was no significant difference compared with preoperative (p0.05); LVEF in the experimental group increased significantly, compared with preoperative and control group, the difference was statistically significant (p0.05); (6) lvef: PCI preoperative, the control group and experimental group LVEF difference was not statistically significant (p0.05). 3 months after pci, LVEF in the control group increased. However, there was no significant difference between the two groups (p0.05); LVEF in the experimental group was significantly higher than that in the control group (p0.05); (7) mace follow-up: 6 months after pci, the number of adverse cardiovascular events in the experimental group was lower than that in the control group, but there was no significant difference (p0.05); (8) no, ET and heart rate. Correlation between myocardial injury markers: no was negatively correlated with CK-MB and cTnI 1 month after PCI (p0.05), ET was positively correlated with cTnI (p0.001); (9) correlation between hs-CRP and myocardial injury markers: 24 hours after pci, hs-CRP was positively correlated with CK-MB and cTnI (p0.001); 72 hours after pci, hs-CRP was positively correlated with cTnI (p0.001). Conclusion: 1. Myocardial injury, inflammation and vascular endothelial function damage can occur in patients with coronary heart disease after pci, the most obvious 24 hours after pci. Myocardial injury is closely related to vascular endothelial function and inflammation. The lighter inflammation, the better vascular endothelial function, the lighter myocardial injury; otherwise, the more serious. 2. Zhilong Huoxue Tongyu Capsule is right. The effect of Zhilong Huoxue Tongyu Capsule on cardioprotective effect may be related to the decrease of CK-MB, cTnI, ET, NO and inflammation.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
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