【摘要】：目的:通過研究益氣化痰活血方對中醫(yī)氣虛痰阻血瘀型不穩(wěn)定心絞痛患者的血清TNF-α、IL-6、hs-CRP等的炎癥因子影響,來探討益氣化痰活血方對冠脈不穩(wěn)定斑塊的抗炎穩(wěn)斑效應(yīng)。方法:采取臨床觀察的辦法,制定并分析臨床病例報(bào)告表,選擇2014年10月~2015年10月在河南中醫(yī)藥大學(xué)第一附屬醫(yī)院老年病科和心內(nèi)科的門診及住院且確診為中醫(yī)診斷:胸痹氣虛痰阻血瘀證;西醫(yī)診斷:冠心病不穩(wěn)定型心絞痛的患者,共計(jì)60例。將患者按隨機(jī)數(shù)字表法隨機(jī)分為2組,對照組進(jìn)行常規(guī)的抗血小板聚集、抗凝、抗缺血藥物治療并加服阿托伐他汀鈣片20mg/d治療。觀察組在上述西藥治療的基礎(chǔ)上加用中藥復(fù)方益氣化痰活血方。觀察兩組患者的中西醫(yī)療效、血脂和血清炎癥因子TNF-a、IL-6、hs-CRP水平,多排冠脈螺旋CT檢測斑塊平均CT值、斑塊最小CT值及斑塊體積變化。通過統(tǒng)計(jì)軟件包SPSS18.0建立數(shù)據(jù)庫,進(jìn)行數(shù)據(jù)管理與分析,并最終得出結(jié)果。結(jié)果:1.治療前,兩組患者各檢測指標(biāo)并無統(tǒng)計(jì)學(xué)差異(P0.05);2.治療后,兩組患者的中西醫(yī)療效、血脂、TNF-α、IL-6、hs-CRP,冠脈斑塊指標(biāo)與治療前比較,具有統(tǒng)計(jì)學(xué)差異(P0.05);3.治療后,觀察組與對照組比較:(1)觀察組心絞痛癥狀改善顯效16例,有效13例,無效1例,總有效率96.67%,對照組顯效10例,有效12例,無效8例,總有效率73.33%;中醫(yī)證候積分改善方面,觀察組79.32%,對照組53.28%;均具有顯著差異(P0.05),觀察組的改善均優(yōu)于對照組。心電圖療效方面,兩組比較無顯著差異(P0.05);住院期間兩組均未出現(xiàn)心絞痛癥狀加重的病人。(2)血脂:觀察組的TC、TG、LDL-C明顯低于對照組,HDL-C卻明顯高于對照組,并具有統(tǒng)計(jì)學(xué)差異(P0.05);(3)血清炎癥因子:觀察組的TNF-α、IL-6、hs-CRP水平明顯低于對照組,并具有統(tǒng)計(jì)學(xué)差異(P0.05);(4)多排冠脈螺旋CT:平均CT值、最小CT值:組內(nèi)比較,觀察組斑塊治療后較治療前顯著增加(P0.05),對照組僅觀察到有增加的態(tài)勢,但尚無顯著差異(P0.05);組間比較:治療后兩組斑塊平均CT值、斑塊最小CT值有顯著差異,觀察組較對照組顯著增加(P0.05)。斑塊體積:兩組治療前后比較可見縮小,但均未達(dá)到顯著水平(P0.05)。結(jié)論:益氣化痰活血方與阿托伐他汀聯(lián)合能夠降低不穩(wěn)定型心絞痛患者的血清TNF-a、IL-6、hs-CRP等炎癥的因子水平,可以更優(yōu)地發(fā)揮出抗炎癥免疫反應(yīng),從而提高了冠脈不穩(wěn)定斑塊的穩(wěn)定性;不穩(wěn)定型心絞痛患者的心肌缺血癥狀得到更好的緩解,進(jìn)而改善了不穩(wěn)定型心絞痛的臨床預(yù)后;二者具有協(xié)同的治療作用,可以為臨床治療冠脈不穩(wěn)定斑塊,降低不穩(wěn)定型心絞痛患者的惡性心血管事件的發(fā)生率提供較為可靠的理論依據(jù)。
[Abstract]:Objective: to study the effect of Yiqi Huatan Huoxue recipe on inflammatory factors of serum TNF- 偽 and IL-6 hs-CRP in patients with unstable angina pectoris of Qi deficiency and phlegm obstruction and blood stasis type, so as to explore the anti-inflammatory and stable plaque effect of Yiqi Huatan Huoxue recipe on unstable plaque of coronary artery. Methods: clinical observation method was adopted to make and analyze the clinical case report form. From October 2014 to October 2015, the outpatients of geriatrics and cardiology in the first affiliated Hospital of Henan University of traditional Chinese Medicine were selected and diagnosed with TCM diagnosis: Qi deficiency of chest obstruction of phlegm and blood stasis syndrome; Western medicine diagnosis: patients with unstable angina pectoris of coronary heart disease. A total of 60 cases. Patients were randomly divided into two groups according to random digital table. The control group was treated with routine antiplatelet aggregation, anticoagulant, antiischemic drugs and Atto vastatin calcium tablet 20mg/d. Observation group on the basis of the above-mentioned western medicine treatment plus Chinese medicine compound Yiqi Huatan Huoxue prescription. The therapeutic effect of traditional Chinese and western medicine, the level of serum lipid and serum inflammatory factor TNF-a, IL-6hs-CRP, the mean CT value of plaque, the minimum CT value of plaque and the volume of plaque were detected by multi-slice spiral CT. The database is established by SPSS18.0, and the data is managed and analyzed. Finally, the results are obtained. The result is 1: 1. Before treatment, there was no statistical difference between the two groups (P0.05). After treatment, the therapeutic effect of traditional Chinese and western medicine, TNF- 偽 TNF- 偽 IL-6hs-CRPand coronary plaque index were significantly different between the two groups (P0.05). After treatment, the observation group compared with the control group: (1) the angina pectoris in the observation group improved significantly in 16 cases, effective in 13 cases, ineffective in 1 case, the total effective rate was 96.677.67, the control group had remarkable effect in 10 cases, effective in 12 cases, ineffective in 8 cases. The total effective rate was 73.33; the improvement of TCM syndromes integral, observation group 79.32, control group 53.28; there were significant differences (P0.05), the observation group is better than the control group. There was no significant difference in the effect of electrocardiogram between the two groups (P0.05); in the two groups, there was no exacerbation of angina pectoris during hospitalization. (2) Blood lipids: TCU TGG LDL-C in the observation group was significantly lower than that in the control group, but significantly higher than that in the control group. The levels of TNF- 偽 IL-6hs-CRP in the observation group were significantly lower than those in the control group (P0.05); (4). The plaque in the observation group increased significantly after treatment (P0.05), but there was no significant difference in the control group (P0.05). Comparison between the two groups: after treatment, the mean CT value of plaque and the minimum CT value of plaque were significantly different. Compared with the control group, the observation group significantly increased (P0.05). Plaque volume: two groups before and after treatment can be seen reduced, but did not reach a significant level (P0.05). Conclusion: the combination of Yiqi Huatan Huoxue recipe and Atto vastatin can reduce the level of inflammatory factors such as TNF-aji-IL-6hs-CRP in serum of patients with unstable angina pectoris, and can play a better role in anti-inflammatory immune response, thus improving the stability of unstable plaque of coronary artery. The symptoms of myocardial ischemia in patients with unstable angina pectoris were better alleviated, and the clinical prognosis of unstable angina pectoris was improved. Reducing the incidence of malignant cardiovascular events in patients with unstable angina pectoris provides a reliable theoretical basis.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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