大株红景天胶囊对颈动脉不稳定斑块气虚血瘀证的干预分析
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摘要
目的:探讨大株红景天胶囊对颈动脉不稳定斑块气虚血瘀证的干预及抗氧化、抗炎和抗血栓形成的作用机制。方法:将符合要求的123例患者,随机按数字表法分为对照组61例和观察组62例。对照组给予抗血小板和调节血脂药物治疗,口服阿司匹林肠溶片,0.1 g/次,1次/d;瑞舒伐他汀钙胶囊,10 mg/次,1次/d。观察组西药使用同对照组,并给予大株红景天胶囊,4粒/次,3次/d。两组疗程均为患者每2周门诊随访1次,连续观察16周。采用彩色多普勒超声测量颈动脉内膜中层厚度(IMT),斑块数量和斑块大小;检测治疗前后甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平;进行气虚血瘀证评分;检测治疗前后超氧化物歧化酶(SOD),丙二醛(MDA),超敏C反应蛋白(hs-CRP),同型半胱氨酸(Hcy),基质金属蛋白酶-2(MMP-2),MMP-9,基质金属蛋白酶组织抑制剂-2(TIMP-2),血小板α-颗粒膜蛋白-140(GMP-140),血小板表面P-选择素(CD62 p),溶酶体颗粒糖蛋白(CD63)和血管性假血友病因子(v WF)水平。结果:治疗后,观察组患者IMT薄于对照组、斑块数量少于对照组、斑块大小积分小于对照组(P<0.01);治疗后,观察组患者LDL-C低于对照组(P<0.01),HDL-C高于对照组(P<0.01),气虚血瘀证评分低于对照组(P<0.01);观察组患者血清hs-CRP,Hcy,MMP-2,MMP-9均低于对照组,TIMP-2水平高于对照组(P<0.01);观察组患者SOD水平高于对照组,MDA水平低于对照组(P<0.01);观察组患者GMP-140,v WF,CD62 p和CD63水平均低于对照组(P<0.01)。结论:在抗血小板和调节血脂药物治疗的基础上,加服大株红景天胶囊,对治疗气虚血瘀型颈动脉不稳定斑块,具有缩小或减少颈动脉斑块的作用,能调节脂代谢,改善中医证候症状,并具有抗氧化、抗炎和抗血栓形成的作用。
Objective:To discuss the effect of Dazhu Hongjingtian capsule to unstable carotid plaque(Qi deficiency and blood stasis syndrome),and its mechanisms in resisting oxidation,inflammation and thrombosis.Method:One hundred and twenty-three patients were randomly divided into control group(61 cases) and observation group(62 cases) by random number table.Patients in control group got aspirin enteric-coated tablets,0.1 g/time,1 time/day,and rosuvastatin calcium capsules,10 mg/time,1 time/day.In addition to the therapy of control group,patients in observation group were also given Dazhu Hongjingtian capsule,4 grains/days,3 times/days.And the outpatient follow-up was made once every 2 weeks for continued 16 weeks.Intima-media wall thickness(IMT),and number and size of plaque were detected by color Doppler ultrasound.And levels of triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),superoxide dismutase(SOD),malondialdehyde(MDA),hypersensitive C reactive protein(hs-CRP),homocysteine(Hcy),matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of matrix metalloproteinase-2(TIMP-2),platelet alpha granular membrane protein(GMP-140),P-selectin on surface of platelets(CD62 p),lysosome glycoprotein(CD63),and vascular pseudotumor factor(VWF) were detected.Qi deficiency and blood stasis syndrome were graded.Result:After treatment,IMT in observation group was thinner than that in control group,number of plaque was less than that in control group,and size of plaque was smaller than those in control group(P<0.01).After treatment,levels of LDL-C,hs-CRP,Hcy,MMP-2,MMP-9,MDA,GMP-140,vWF,CD62 p and CD63 were lower than those in control group(P<0.01),whereas levels of HDL-C and TIMP-2 were higher than those in control group(P<0.01).And scores of Qi deficiency and blood stasis syndrome were lower than those in control group(P<0.01).Conclusion:In addition to the treatment for resisting platelet and regulating blood lipid,Dazhu Hongjingtian capsule can lessen and reduce arterial speckle regulate lipid metabolism,ameliorate symptoms of traditional Chinese medical(TCM) syndrome,with effects in resisting oxidation,inflammation and thrombotic formation.
Objective:To discuss the effect of Dazhu Hongjingtian capsule to unstable carotid plaque(Qi deficiency and blood stasis syndrome),and its mechanisms in resisting oxidation,inflammation and thrombosis.Method:One hundred and twenty-three patients were randomly divided into control group(61 cases) and observation group(62 cases) by random number table.Patients in control group got aspirin enteric-coated tablets,0.1 g/time,1 time/day,and rosuvastatin calcium capsules,10 mg/time,1 time/day.In addition to the therapy of control group,patients in observation group were also given Dazhu Hongjingtian capsule,4 grains/days,3 times/days.And the outpatient follow-up was made once every 2 weeks for continued 16 weeks.Intima-media wall thickness(IMT),and number and size of plaque were detected by color Doppler ultrasound.And levels of triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),superoxide dismutase(SOD),malondialdehyde(MDA),hypersensitive C reactive protein(hs-CRP),homocysteine(Hcy),matrix metalloproteinase-2(MMP-2),MMP-9,tissue inhibitor of matrix metalloproteinase-2(TIMP-2),platelet alpha granular membrane protein(GMP-140),P-selectin on surface of platelets(CD62 p),lysosome glycoprotein(CD63),and vascular pseudotumor factor(VWF) were detected.Qi deficiency and blood stasis syndrome were graded.Result:After treatment,IMT in observation group was thinner than that in control group,number of plaque was less than that in control group,and size of plaque was smaller than those in control group(P<0.01).After treatment,levels of LDL-C,hs-CRP,Hcy,MMP-2,MMP-9,MDA,GMP-140,vWF,CD62 p and CD63 were lower than those in control group(P<0.01),whereas levels of HDL-C and TIMP-2 were higher than those in control group(P<0.01).And scores of Qi deficiency and blood stasis syndrome were lower than those in control group(P<0.01).Conclusion:In addition to the treatment for resisting platelet and regulating blood lipid,Dazhu Hongjingtian capsule can lessen and reduce arterial speckle regulate lipid metabolism,ameliorate symptoms of traditional Chinese medical(TCM) syndrome,with effects in resisting oxidation,inflammation and thrombotic formation.
引文
[1]李耀新.颈动脉斑块的中西医研究进展[J].中西医结合心脑血管病杂志,2017,15(12):1467-1470.
[2]刘金玉,赵颖馨,刘振东,等.心脑血管病危险因素与颈动脉粥样硬化的相关性[J].中国动脉硬化杂志,2014,22(11):1105-1108.
[3]黄群莲,向淑利,胡运春,等.活血通脉片对颈动脉易损斑块的干预作用[J].中国实验方剂学杂志,2017,23(8):184-189.
[4]杨芳,杨茜.蒲参胶囊对颈动脉不稳定斑块的干预作用及机制探讨[J].中国实验方剂学杂志,2016,22(21):177-181.
[5]沈国满,樊世明,田香山.大株红景天胶囊对不稳定性心绞痛患者血栓形成的影响[J].中国实验方剂学杂志,2014,20(16):200-203.
[6]柴雅晴,赵国华,王仁久,等.大株红景天的化学成分及体外抗肿瘤转移活性研究[J].中国中药杂志,2015,40(2):258-263.
[7]张立平,马双陶,杨大春,等.红景天甙对低压低氧诱导的Apo E-/-小鼠动脉粥样硬化斑块及MMP-2,MMP-9和TIMP-2表达的影响[J].中华中医药杂志,2015,30(6):2043-2046.
[8]李天奇,范维琥,李勇,等.红景天水煎剂和红景天苷悬浊液对兔股动脉粥样斑块稳定性的影响[J].上海中医药杂志,2009,43(6):75-79.
[9]李秀芩,陈少鹏,邵伟华.大株红景天注射液对原发性高血压患者血清高敏C-反应蛋白、动脉粥样硬化程度的影响[J].陕西中医,2017,38(2):161-162.
[10]周永昌,郭万学.超声医学[M].北京:科学技术文献出版社,2003:799-800.
[11]徐辉,顾耘.颈动脉粥样硬化的中医症候特征及分类[J].中国老年学,2012,32(22):122-124.
[12]赵春滔,张志强,王志军.颈动脉内中膜厚度、颈动脉斑块总积分及P选择素水平与急性冠状动脉综合征患者冠状动脉病变的关系[J].中国心血管杂志,2015,20(6):447-451.
[13]冯立群.评估颈动脉粥样硬化易损斑块探索缺血性脑卒中分层处理[J].血管与腔内血管外科杂志,2016,2(4):284-285.
[14]金龙,乔爱科.颈动脉易损斑块的生物力学机制和破裂风险评价指标[J].医用生物力学,2016,31(1):89-94.
[15]王慧梅,李淮玉.颈动脉易损斑块临床特征及其与缺血性卒中关系的研究进展[J].中国脑血管病杂志,2012,9(5):270-275.
[16]陆伟恒,苏斌儒,曾惠权,等.强化他汀与支架成形术治疗颈动脉易损斑块的效果[J].广东医学,2017,38(s2):134-135.
[17]谢盈彧,张军平,仲爱芹,等.从痰瘀立论探讨分期治疗颈动脉粥样硬化[J].中华中医药杂志,2017,32(1):101-104.
[18]钟伟,王永刚,于远望,等.中医药防治颈动脉粥样硬化的作用机制研究进展[J].时珍国医国药,2017,28(1):190-192.
[19]左晓利,黄红莹,孟祥毅.红景天苷通过激活AMPK/PI3K/Akt/e NOS途径减轻Apo E-/-小鼠动脉粥样硬化[J].实用药物与临床,2018,21(5):481-486.
[20]许寅宏,徐恩,林清原,等.血清同型半胱氨酸与脑梗死患者颈动脉粥样硬化斑块稳定性的关系[J].中风与神经疾病杂志,2014,31(7):603-605.
[21]熊敏琪,贾成林,崔金刚,等.熊胆粉在麝香通心滴丸抗动脉粥样硬化中的作用机制研究[J].中国中西医结合杂志,2015,35(9):1083-1089.
[22]刘耀萌,崔莹雪,哈略,等.艾灸及艾烟对动脉粥样硬化模型小鼠血清TNF-α,hs-CRP及v WF的影响[J].中华中医药杂志,2016,31(4):1377-1379.
[2]刘金玉,赵颖馨,刘振东,等.心脑血管病危险因素与颈动脉粥样硬化的相关性[J].中国动脉硬化杂志,2014,22(11):1105-1108.
[3]黄群莲,向淑利,胡运春,等.活血通脉片对颈动脉易损斑块的干预作用[J].中国实验方剂学杂志,2017,23(8):184-189.
[4]杨芳,杨茜.蒲参胶囊对颈动脉不稳定斑块的干预作用及机制探讨[J].中国实验方剂学杂志,2016,22(21):177-181.
[5]沈国满,樊世明,田香山.大株红景天胶囊对不稳定性心绞痛患者血栓形成的影响[J].中国实验方剂学杂志,2014,20(16):200-203.
[6]柴雅晴,赵国华,王仁久,等.大株红景天的化学成分及体外抗肿瘤转移活性研究[J].中国中药杂志,2015,40(2):258-263.
[7]张立平,马双陶,杨大春,等.红景天甙对低压低氧诱导的Apo E-/-小鼠动脉粥样硬化斑块及MMP-2,MMP-9和TIMP-2表达的影响[J].中华中医药杂志,2015,30(6):2043-2046.
[8]李天奇,范维琥,李勇,等.红景天水煎剂和红景天苷悬浊液对兔股动脉粥样斑块稳定性的影响[J].上海中医药杂志,2009,43(6):75-79.
[9]李秀芩,陈少鹏,邵伟华.大株红景天注射液对原发性高血压患者血清高敏C-反应蛋白、动脉粥样硬化程度的影响[J].陕西中医,2017,38(2):161-162.
[10]周永昌,郭万学.超声医学[M].北京:科学技术文献出版社,2003:799-800.
[11]徐辉,顾耘.颈动脉粥样硬化的中医症候特征及分类[J].中国老年学,2012,32(22):122-124.
[12]赵春滔,张志强,王志军.颈动脉内中膜厚度、颈动脉斑块总积分及P选择素水平与急性冠状动脉综合征患者冠状动脉病变的关系[J].中国心血管杂志,2015,20(6):447-451.
[13]冯立群.评估颈动脉粥样硬化易损斑块探索缺血性脑卒中分层处理[J].血管与腔内血管外科杂志,2016,2(4):284-285.
[14]金龙,乔爱科.颈动脉易损斑块的生物力学机制和破裂风险评价指标[J].医用生物力学,2016,31(1):89-94.
[15]王慧梅,李淮玉.颈动脉易损斑块临床特征及其与缺血性卒中关系的研究进展[J].中国脑血管病杂志,2012,9(5):270-275.
[16]陆伟恒,苏斌儒,曾惠权,等.强化他汀与支架成形术治疗颈动脉易损斑块的效果[J].广东医学,2017,38(s2):134-135.
[17]谢盈彧,张军平,仲爱芹,等.从痰瘀立论探讨分期治疗颈动脉粥样硬化[J].中华中医药杂志,2017,32(1):101-104.
[18]钟伟,王永刚,于远望,等.中医药防治颈动脉粥样硬化的作用机制研究进展[J].时珍国医国药,2017,28(1):190-192.
[19]左晓利,黄红莹,孟祥毅.红景天苷通过激活AMPK/PI3K/Akt/e NOS途径减轻Apo E-/-小鼠动脉粥样硬化[J].实用药物与临床,2018,21(5):481-486.
[20]许寅宏,徐恩,林清原,等.血清同型半胱氨酸与脑梗死患者颈动脉粥样硬化斑块稳定性的关系[J].中风与神经疾病杂志,2014,31(7):603-605.
[21]熊敏琪,贾成林,崔金刚,等.熊胆粉在麝香通心滴丸抗动脉粥样硬化中的作用机制研究[J].中国中西医结合杂志,2015,35(9):1083-1089.
[22]刘耀萌,崔莹雪,哈略,等.艾灸及艾烟对动脉粥样硬化模型小鼠血清TNF-α,hs-CRP及v WF的影响[J].中华中医药杂志,2016,31(4):1377-1379.