余 霞,张 娴,陈飞龙,王丹妮,闻加升

目的：探讨通脉宽痹方对心血瘀阻型冠心病的血脂四项、炎症因子、颈动脉IMT以及斑块面积及稳定性的影响。方法：选取在2023年3月至2025年9月诊断为心血瘀阻型冠心病合并颈动脉粥样硬化的病人，纳入120例，随机分为对照组、中药组两组。对照组给予常规西药治疗；中药组在此基础上加用通脉宽痹方治疗。方组：三七、瓜蒌、元胡、生地黄、郁金、石菖蒲，治疗12周。比较两组血脂四项、外周血PLT、GGT、hs-CRP、Lp-PLA2，颈动脉IMT与颈动脉内膜斑块面积。结果：治疗后，两组TC、TG、LDL-C较前明显降低，HDL-C有所升高，IMT与颈动脉内膜斑块面积均较治疗前明显降低；两组hs-CRP、Lp-PLA2与治疗前相比有所降低，中药组治疗后PLT/GGT较前升高，有统计学差异（P＜0.05）；与对照组相比，中药组TC、TG、LDL-C、hs-CRP、Lp-PLA2、GGT及颈动脉内膜斑块面积降低，PLT/GGT、HDL-C有所升高，差异有统计学意义（P＜0.05）。结论：通脉宽痹方可以改善心血瘀阻型冠心病患者血脂水平，具有抗炎稳定斑块的作用，可降低心血管残余风险。

冠心病；心血瘀阻型；通脉宽痹方；血脂；炎症因子；斑块稳定性

[1] Infante T,Forte E,Schiano C,et al.An integrated approach to coronary heart disease diagnosis and clinical management.Am J Transl Res,2017,9(7):3148-3166. [2] Mao W,Lu P,Wan R,et al.Efficacy and safety of Danlou tablets in traditional Chinese medicine for coronary heart disease:a systematic review and meta-analysis[J].Front Cardiovasc Med,2023,10:1100006. [3] Tsao C W,Aday A W,Almarzooq Z I,et al.Heart Disease and Stroke Statistics-2023 Update:A Report From the American Heart Association[J].Circulation,2023,147(8). [4] 许颖,牛银铃,李霞.颈动脉超声相关参数与冠脉粥样硬化病变程度的相关性[J].心血管康复医学杂志,2024,33(1):75-79.) [5] Colledanchise KN,Mantella LE,Bullen M,Hétu MF,Abunassar JG,Johri AM.Combined Femoral and Carotid Plaque Burden Identifies Obstructive Coronary Artery Disease in Women.J Am Soc Echocardiogr.,2020,33(1):90-100. [6] 王子焱,范金茹.冠心病心绞痛中医现代研究进展[J].中西医结合心脑血管病杂志,2020,18(24):4. [7] 商淑慧,靳贺超,胡翠平,等.参芪柔脉合剂对颈动脉粥样硬化病人血脂､血清炎症因子及颈动脉内中膜厚度的影响[J].中西医结合心脑血管病杂志,2019,17(11):1719-1722. [8] 远东,张林,赵晓平,等.不同剂量阿托伐他汀治疗老年糖尿病并颈动脉粥样斑块60例临床观察[J].海南医学,2009,20(6):47-8. [9] 王颖,蔡喆燚,陈献,等.子午流注择时循经按摩对心血瘀阻型心绞痛的效果评价[J].中医药导报,2020,26(16):101-103. [10] 杨天睿,苗云波,段靳岚,等.血液生化指标与颈动脉粥样硬化斑块稳定性的相关性研究[J].中华老年心脑血管病杂志,2022, 24(3):237-239. [11] Mach F,Baigent C,Catapano AL,et al.2019 ESC/EAS guidelines for the management of dyslipidaemias:lipid modification to reduce cardiovascular risk[J].Atherosclerosis,2019,290:140–205. [12] Martinet W,Coornaert I,Puylaert P,et al.Macrophage Death as a Pharmacological Target in Atherosclerosis[J].Front Pharmacol,2019,10:306. [13] 赵德龙,周海燕,岳凤娟,等.不同前蛋白转化酶枯草溶菌素9抑制剂在高胆固醇血症中的应用研究[J].实用临床医药杂志, 2024,28(9):29-33,39. [14] Tall AR,Thomas DG,Gonzalez-Cabodevilla AG,et al.Addressing dyslipidemic risk beyond LDL-cholesterol[J].Journal of Clinical Investigation,2022,1(132):1-10. [15] Wang A,Guan B,Shao C,et al.Qing-Xin-Jie-Yu Granule alleviates atherosclerosis by reshaping gut microbiota and metabolic homeostasis of ApoE-/-mice[J].Phytomedicine,2022,103:154220. [16] 郭猛,张行行,杨琪琪,等.中药成分抗血小板作用的研究现状[J].中国临床药理学杂志,2021,37(13):1728-1731. [17] 滕龙,李琼,洪芳.何建成治疗冠心病经验撷英[J].浙江中医杂志,2016,51(12):878. [18] 邢娜,彭东辉,张志宏,等.炮制对三七化学成分及药理作用影响的研究进展[J].中国实验方剂学杂志,2020,26(16):210-217. [19] ZHANG L,LI Y,MA X,et al.Ginsenoside Rg1-Notoginsenoside R1-Protocatechuic Aldehyde Reduces Atherosclerosis and Attenuates Low-Shear Stress-Induced Vascular Endothelial Cell Dysfunction[J].Frontiers in Pharmacology,2021,11:588259. [20] 张月婷,李新春,关玲霞,等.三七皂苷对动脉内膜损伤后血管内膜炎症､应激和增生的影响[J].中华实验外科杂志,2023,40(7):1347-1349. [21] 刘剑刚,刘立新,马晓斌,等.延胡索碱注射液对大鼠实验性急性心肌梗塞和红细胞流变性的作用[J].中药新药与临床药理,2000, 11(2):76-78. [22] 邹纯才,鄢海燕,王莉丽,等.基于网络药理学分析瓜蒌阿司匹林配伍抗血小板聚集和抗血栓的作用机制研究[J].中国中药杂志,2019,44(8):1654-1659. [23] YU X,TANG L,WU H,et al.Trichosanthis fructus:botany,traditional uses,phytochemistry and pharmacology[J].Journalof Ethnophar- macology,2018,224:177-194. [24] Harja E,Bu DX,Hudson BI,et al.Vascular and inflammatory stresses mediate atherosclerosis via RAGE and its ligands in apoE-/-mice[J].J Clin Invest,2008,118(1):183-194. [25] Waisundara VY,Huang M,Hsu A,et al.Characterization of the anti-diabetic and antioxidant effects of rehmannia glutinosa in streptozotocin-induced diabetic Wistar rats[J].Am J Chin Med,2008,36(6):1083-1104. [26] Singh L,Sharma S,Xu S,et al.Curcumin as a Natural Remedy for Atherosclerosis:A Pharmacological Review[J].Molecules,2021,26(13):4036. [27] 唐梅玲,卢健棋,庞延,等.石菖蒲及其化学成分防治心血管病的研究进展[J].时珍国医药,2020,31(4):926-928. [28] Wang M,Tang HP,Wang S,et al.Acorus tatarinowii Schott:A Review of Its Botany,Traditional Uses,Phytochemistry,and Pharmacology [J].Molecules,2023,11(28):4525. [29] 黄毅军,史伟浩,朱磊,等.颈动脉斑块稳定性的研究进展[J].实用临床医药杂志,2022,26(1):134-138. [30] Lin L,Teng J,Shi Y,et al.Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis:a 7-year prospective cohort study[J].Lipids Health Dis,2024,23(1):15. [31] 王李伟,尤曦.外周血血小板与γ-谷氨酰转移酶对冠心病斑块稳定性的评估价值[J].中国医师进修杂志,2024,47(1):39-43.

点击下载PDF