通脉养心丸干预冠心病稳定性心绞痛气阴两虚证的临床生化基础研究
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摘要
[目的]通过多中心、精细化的临床研究,旨在对比通脉养心丸干预的冠心病稳定性心绞痛气阴两虚证患者和健康人的临床生化指标,探讨其临床生化基础。[方法]从全国7家临床研究中心共入组受试者82例,其中脱失3例,最终纳入冠心病气阴两虚证患者39例,在西医常规治疗的基础上加服中药通脉养心丸治疗,健康人40例不予干预。分别检测内皮细胞损伤、脂质代谢、黏附分子、炎症介质、金属蛋白酶、同型半胱氨酸和凝血功能共7类28项指标,冠心病患者分别检测0、8、12周水平,健康人检测第0周水平。[结果]冠心病气阴两虚证与载脂蛋白B、低密度脂蛋白、血管紧张素Ⅱ相关性较大,经过通脉养心丸的治疗,血管紧张素Ⅰ、血浆内皮素升高,可溶性CD40配体水平下降(P<0.05)。整体炎症因子水平有下降趋势。[结论]通脉养心丸调控冠心病稳定性心绞痛气阴两虚证的生化基础与内皮损伤、脂质代谢、炎症因子有关,可为进一步研究提供参考依据。
[Objective] To explore the qi and yin deficiency syndrome of coronary heart disease by clinical biochemical basis through comparing the strict screening of coronary heart disease stable angina pectoris by clinical and biochemical indexes of patients and healthy people with the multicenter, small sample and fineness clinical research. [Methods] From the seven clinical research centers, 82 cases were selected to the observation. With 3 cases deletion, 79 cases were eventually into the subjects, including 39 cases of qi and yin deficiency syndrome, which were treated with traditional Chinese medicine on the basis of the routine treatment of Western medicine, and40 healthy people were not involved in the treatment. Endothelial cell injury was detected, lipid metabolism, adhesion molecules and inflammatory mediators, metalloproteinases, homocysteine and blood coagulation function 7 class 28 indicators, were detected in patients with coronary heart disease(CHD) level 0, 8, 12 weeks, healthy people group testing at 0 week. [Results] The correlation between qi and yin deficiency syndrome of CHD and ApoB, LDL-C, AngⅡ was larger. After treatment of Tongmai Yangxin Pills, the level of AngⅠ, ET and sCD40 L level were decreased(P<0.05). Overall levels of inflammatory cytokines tended to decrease. [Conclusion] The biochemical basis of Tongmai Yangxin Pills for the regulation of stable angina pectoris with CHD qi and yin deficiency syndrome is related to endothelial injury, lipid metabolism and inflammatory factors, which can provide reference for the next study.
[Objective] To explore the qi and yin deficiency syndrome of coronary heart disease by clinical biochemical basis through comparing the strict screening of coronary heart disease stable angina pectoris by clinical and biochemical indexes of patients and healthy people with the multicenter, small sample and fineness clinical research. [Methods] From the seven clinical research centers, 82 cases were selected to the observation. With 3 cases deletion, 79 cases were eventually into the subjects, including 39 cases of qi and yin deficiency syndrome, which were treated with traditional Chinese medicine on the basis of the routine treatment of Western medicine, and40 healthy people were not involved in the treatment. Endothelial cell injury was detected, lipid metabolism, adhesion molecules and inflammatory mediators, metalloproteinases, homocysteine and blood coagulation function 7 class 28 indicators, were detected in patients with coronary heart disease(CHD) level 0, 8, 12 weeks, healthy people group testing at 0 week. [Results] The correlation between qi and yin deficiency syndrome of CHD and ApoB, LDL-C, AngⅡ was larger. After treatment of Tongmai Yangxin Pills, the level of AngⅠ, ET and sCD40 L level were decreased(P<0.05). Overall levels of inflammatory cytokines tended to decrease. [Conclusion] The biochemical basis of Tongmai Yangxin Pills for the regulation of stable angina pectoris with CHD qi and yin deficiency syndrome is related to endothelial injury, lipid metabolism and inflammatory factors, which can provide reference for the next study.
引文
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病2016》概要[J].中国循环杂志,2017,32(6):521-530.
[2]国家卫生和计划生育委员会.《2016年中国卫生和计划生育统计年鉴》[M].北京:人民卫生出版社,2016.
[3]毕颖斐,王贤良,赵志强,等.冠心病现代中医证候特征的临床流行病学调查[J].中医杂志,2017,58(23):2013-2019.
[4]杨凯伦,王莹,艾乐,等.基于网络药理学方法探讨通脉养心方辨治冠心病的研究思路[J].中草药,2015,46(20):2979-2984.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206
[6]徐一兰,高杉,许慧愚,等.冠心病稳定性心绞痛痰瘀互结证多中心、小样本、精细化临床研究方案[J].天津中医药,2018,35(2):86-90.
[7]李珂,孙兰军,高克俭,等.通脉养心丸治疗冠心病室性早搏(气阴两虚证)多中心临床研究[J].中西医结合心脑血管病杂志,2010,8(4):401-403.
[8]蒋伟.试述冠心病的中医药治疗[J].中国中医药现代远程教育,2010,8(10):109.
[9]Levy.Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B-NEJM[J].New England Journal of Medicine,1990,323(19):1289-1298.
[10]Toth PP,Barylski M,Nikolic D,et al.Should low high-density lipoprotein cholesterol(HDL-C)be treated?[J].Best Practice&Research Clinical Endocrinology&Metabolism,2014,28(3):353-368.
[2]国家卫生和计划生育委员会.《2016年中国卫生和计划生育统计年鉴》[M].北京:人民卫生出版社,2016.
[3]毕颖斐,王贤良,赵志强,等.冠心病现代中医证候特征的临床流行病学调查[J].中医杂志,2017,58(23):2013-2019.
[4]杨凯伦,王莹,艾乐,等.基于网络药理学方法探讨通脉养心方辨治冠心病的研究思路[J].中草药,2015,46(20):2979-2984.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性稳定性心绞痛诊断与治疗指南[J].中华心血管病杂志,2007,35(3):195-206
[6]徐一兰,高杉,许慧愚,等.冠心病稳定性心绞痛痰瘀互结证多中心、小样本、精细化临床研究方案[J].天津中医药,2018,35(2):86-90.
[7]李珂,孙兰军,高克俭,等.通脉养心丸治疗冠心病室性早搏(气阴两虚证)多中心临床研究[J].中西医结合心脑血管病杂志,2010,8(4):401-403.
[8]蒋伟.试述冠心病的中医药治疗[J].中国中医药现代远程教育,2010,8(10):109.
[9]Levy.Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B-NEJM[J].New England Journal of Medicine,1990,323(19):1289-1298.
[10]Toth PP,Barylski M,Nikolic D,et al.Should low high-density lipoprotein cholesterol(HDL-C)be treated?[J].Best Practice&Research Clinical Endocrinology&Metabolism,2014,28(3):353-368.