【摘要】：目的:基于對(duì)冠心病穩(wěn)定型心絞痛病因病機(jī)和辨證論治的認(rèn)識(shí)和歸納,現(xiàn)觀察驗(yàn)方“調(diào)肝健脾通陽(yáng)方”對(duì)穩(wěn)定型心絞痛證屬肝郁脾虛、胸陽(yáng)痹阻型患者的中醫(yī)證候、臨床癥狀及相關(guān)實(shí)驗(yàn)室檢查變化等方面的改善情況,并對(duì)其安全性進(jìn)行評(píng)價(jià)。方法:將符合納入標(biāo)準(zhǔn)的穩(wěn)定型心絞痛患者遵循隨機(jī)數(shù)字表法劃分為治療組和對(duì)照組各36例,兩組患者在性別、年齡、病程、合并疾病、基礎(chǔ)用藥、中醫(yī)癥候總積分、各單項(xiàng)癥狀積分、相關(guān)實(shí)驗(yàn)室檢查上經(jīng)統(tǒng)計(jì)學(xué)軟件分析,均未有統(tǒng)計(jì)學(xué)差異,存在可比性。兩組病例均予以西醫(yī)常規(guī)基礎(chǔ)治療,但治療組加用調(diào)肝健脾通陽(yáng)方中藥湯藥治療。連續(xù)給藥14天,以治療前后兩組病例的中醫(yī)癥候療效、中醫(yī)癥候積分、硝酸甘油停減率、心電圖總有效率、超敏C反應(yīng)蛋白(High sensitivity C reactive protein hs-CRP)、腫瘤壞死因子-α(Tumor Necrosis Factor alpha TNF-α)、白介素-6(Interleukin-6 IL-6)的變化情況等評(píng)價(jià)其療效。研究結(jié)果:經(jīng)過(guò)14天的臨床觀察,通過(guò)統(tǒng)計(jì)分析各項(xiàng)指標(biāo),研究結(jié)果表明:1、在改善中醫(yī)癥候療效方面:治療組顯效率38.2%,總有效率88.2%,對(duì)照組顯效率19.4%,總有效率72.2%,組間比較P=0.037(P0.05),差異有統(tǒng)計(jì)學(xué)意義,治療組優(yōu)于對(duì)照組。2、中醫(yī)癥候積分方面:治療后兩組患者中醫(yī)癥候總積分及各單項(xiàng)癥狀積分均較治療前有顯著改善(P0.01),治療后治療組的總積分及胸悶、心悸、疲倦乏力、善太息、口苦癥狀的改善情況均優(yōu)于對(duì)照組(P0.05),胸痛的組間比較無(wú)統(tǒng)計(jì)學(xué)差異(P=0.155)。3、在硝酸甘油停減率方面:治療組硝酸甘油停減率為82.4%,對(duì)照組為50%,組間比較P=0.010(P0.05),差異有統(tǒng)計(jì)學(xué)意義,治療組優(yōu)于對(duì)照組。4、在心電圖總有效率方面:治療組和對(duì)照組的心電圖總有效率分別為76.5%和66.7%,治療組總有效率優(yōu)于對(duì)照組,但組間比較P=0.209(P0.05),無(wú)統(tǒng)計(jì)學(xué)差異。5、炎癥因子方面:治療后兩組患者組內(nèi)比較hs-CRP、TNF-α、IL-6水平均較治療前有顯著下調(diào)(P0.01),治療后兩組組間hs-CRP比較,P=0.039(P0.05),治療組優(yōu)于對(duì)照組;組間TNF-α、IL-6比較,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。6、安全性方面:兩組患者治療前后各實(shí)驗(yàn)室指標(biāo)組內(nèi)、組間均無(wú)統(tǒng)計(jì)學(xué)差異且均在正常范圍內(nèi),未見(jiàn)任何不良反應(yīng),治療期內(nèi)兩組用藥均是安全的。結(jié)論:調(diào)肝健脾通陽(yáng)方聯(lián)合西藥治療肝郁脾虛、胸陽(yáng)痹阻型穩(wěn)定型心絞痛,能進(jìn)一步改善患者臨床癥狀、中醫(yī)癥候、硝酸甘油停減率、hs-CRP,并且治療期內(nèi)是安全的,值得臨床推廣運(yùn)用及進(jìn)一步研究。
[Abstract]:Objective: based on the understanding and induction of the etiology and pathogenesis of stable angina pectoris of coronary heart disease and differentiation of symptoms and signs, the author observed the TCM syndromes of "Tiaogan Jianpi Tongyang prescription" in treating stable angina patients with syndrome of liver stagnation and spleen deficiency, chest stagnation and yang obstruction. Clinical symptoms and related laboratory changes were improved and their safety was evaluated. Methods: the patients with stable angina pectoris according to the inclusive criteria were divided into treatment group (n = 36) and control group (n = 36). The patients in the two groups were divided into two groups: sex, age, course of disease, combined diseases, basic medication, total score of TCM symptoms. There was no statistical difference and comparability between the symptom scores of each item and the statistical software analysis on the related laboratory examination. The two groups were treated with routine western medicine, but the treatment group was treated with the decoction of regulating liver and invigorating spleen and tonifying yang. After 14 days of continuous administration, the two groups of patients were treated with TCM symptom efficacy, TCM symptom score, nitroglycerin reduction rate, total effective rate of electrocardiogram (ECG), hypersensitive C-reactive protein (High sensitivity C reactive protein hs-CRP). The changes of tumor necrosis factor-偽 (Tumor Necrosis Factor alpha TNF- 偽 and interleukin-6 (Interleukin-6 IL-6) were evaluated. Results: after 14 days of clinical observation, through statistical analysis of the indicators, the results show that: 1, in improving the efficacy of TCM symptoms: the treatment group effective rate of 38.2, the total effective rate of 88.2um, The effective rate of the control group was 19.4% and the total effective rate was 72.2%. The difference between the two groups was statistically significant (P0.05), and the treatment group was better than the control group (P < 0.05). The scores of TCM symptoms and symptoms in the two groups were significantly improved after treatment (P0.01). After treatment, the total score and chest tightness, palpitations, tiredness, fatigue, good information were improved in the treatment group, and there was no significant difference between the two groups in the scores of TCM symptoms and symptoms (P0.01). The improvement of oral bitter symptoms was better than that of the control group (P0.05), but there was no statistical difference between the two groups (P0. 155). 3. In the treatment group, the reduction rate of nitroglycerin was 82.4%, while in the control group it was 50%. The difference between the two groups was statistically significant. The treatment group was better than the control group. 4. The total effective rate of electrocardiogram in the treatment group and the control group was 76. 5% and 66. 7%, respectively. The total effective rate of the treatment group was better than that of the control group, but there was no significant difference between the two groups (P0.05). The level of IL-6 was significantly lower than that before treatment (P0.01). After treatment, compared with the two groups of hs-CRP, P0. 039 (P0.05), the treatment group was better than the control group; There was no significant difference in TNF- 偽 and IL-6 between the two groups (P0.05, P 0.05). 6. Safety: there was no significant difference between the two groups in laboratory indexes before and after treatment, and no adverse reactions were found in the two groups. Both groups were safe in the treatment period. Conclusion: Tiaogan Jianpi Tongyang prescription combined with western medicine in treating stable angina pectoris with liver stagnation and spleen deficiency, chest and yang obstruction can further improve the clinical symptoms, TCM symptoms, nitroglycerin stopping and decreasing rate, and hs-CRP, is safe during the treatment period. It is worthy of clinical application and further study.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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