大黄、红曲配伍方案干预颈动脉粥样硬化斑块的临床研究
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摘要
目的:观察解毒活血方案大黄、红曲微粉配伍对颈动脉粥样硬化斑块的临床疗效,探讨作用机制,为应用解毒活血药防治颈动脉粥样硬化斑块及相关心脑血管疾病提供科学依据。方法:将纳入的100例颈动脉粥样硬化斑块患者随机分为五组:大黄微粉组,20例,给予大黄微粉治疗;红曲微粉组,20例,给予红曲微粉治疗;大黄红曲微粉组,20例,给予大黄、红曲微粉配伍治疗;洛伐他汀对照组,20例,给予洛伐他汀治疗;空白对照组,20例,不给予药物治疗。疗程6个月。观察患者的临床症状疗效,治疗前后颈动脉内膜-中层厚度(IMT)、内径、Crouse斑块积分、收缩期峰值流速(PSV)、舒张末期流速(EDV)、斑块超声声像病理学分型、颈动脉超声声像学分型以及血脂、血清炎症因子[超敏C反应蛋白(hs-CRP)、可溶性细胞间粘附分子-1(sICAM-1)、可溶性血管细胞粘附分子-1(sVCAM-1)]、基质降解相关因子[基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶抑制因子-1(TIMP-1)]水平的变化。结果:大黄红曲微粉组显著改善患者的临床症状;减小颈动脉IMT,增大血管内径;提高PSV、EDV;调节血脂;降低血压;降低hs-CRP、sICAM-1、sVCAM-1;降低MMP-1及MMP-1/TIMP-1比值,疗效显著优于大黄微粉组、红曲微粉组和洛伐他汀对照组。结论:大黄、红曲解毒活血配伍方案具有抗动脉粥样硬化、调脂、降压、抗炎、减少细胞外基质降解,稳定斑块的作用,优于单纯解毒或活血,值得临床推广应用。
Objective: To observe therapeutic effect and discuss mechanism of treatment of carotid atherosclerosis plaque with micropowder of Rhubarb with Monascus; to provide scientific proof for prevention and cure of carotid atherosclerosis plaque and related cardiovascular and cerebrovascular diseases with trational Chinese medicine which is Toxin-resolving and Blood-activating. Methods: 100 cases of carotid atherosclerosis plaque were divided into five groups randomly: micropowder of Rhubarb group, 20 cases, was treated with micropowder of Rhubarb; micropowder of Monascus group, 20 cases, was treated with micropowder of Monascus; micropowder of Rhubarb with Monascus group, 20 cases, was treated with compatibility of micropowder of Rhubarb and Monascus; Lovastatin group , 20 cases, was treated with Lovastatin; blank group , 20 cases, was not treated with any medicines. The course of treatment was six months. To observe the effect on clinical symptoms, and changes of intima-media thickness (IMT),inside diameter, Crouse plaque integral, peak systolic velocity (PSV),end diastolic velocity (EDV), plaque pathologic classification and carotid classification in carotid, and the level of blood lipid, hypersensitive C–reactive protein (hs-CRP), soluble intercellular adhesion molecule (sICAM-1), Soluble vascular cell adhesion molecule (sVCAM-1), Matrix metalloproteinase-1 (MMP-1), Matrix metalloproteinase inhibitor-1 (TIMP-1) in blood serum. Results: micropowder of Rhubarb with Monascus group is able to relieve clinical symptoms; reduce IMT and expand inside diameter of the carotid; increase PSV and EDV; regulate blood lipid; decrease blood pressure; and decrease hs-CRP, sICAM-1, sVCAM-1, MMP-1 and MMP-1/TIMP-1. Curative effect of micropowder of Rhubarb with Monascus group is remarkably superior to micropowder of Rhubarb group、micropowder of Monascus group and Lovastatin group. Conclusion: The principle of Toxin-resolving and Blood-activating which is compatibility of micropowder of Rhubarb and Monascus can regulate blood lipid, decrease blood pressure and have therapeutic effects on anti-inflammation and Matrix Degradation. All above is capable of enhancing the stability of atherosclerotic plaque and delaying the process of Atherosclerosis.The therapeutic effect of Toxin-resolving with Blood-activating is superior to pure Toxin-resolving or pure Blood-activating, and deserves further clinical application.
Objective: To observe therapeutic effect and discuss mechanism of treatment of carotid atherosclerosis plaque with micropowder of Rhubarb with Monascus; to provide scientific proof for prevention and cure of carotid atherosclerosis plaque and related cardiovascular and cerebrovascular diseases with trational Chinese medicine which is Toxin-resolving and Blood-activating. Methods: 100 cases of carotid atherosclerosis plaque were divided into five groups randomly: micropowder of Rhubarb group, 20 cases, was treated with micropowder of Rhubarb; micropowder of Monascus group, 20 cases, was treated with micropowder of Monascus; micropowder of Rhubarb with Monascus group, 20 cases, was treated with compatibility of micropowder of Rhubarb and Monascus; Lovastatin group , 20 cases, was treated with Lovastatin; blank group , 20 cases, was not treated with any medicines. The course of treatment was six months. To observe the effect on clinical symptoms, and changes of intima-media thickness (IMT),inside diameter, Crouse plaque integral, peak systolic velocity (PSV),end diastolic velocity (EDV), plaque pathologic classification and carotid classification in carotid, and the level of blood lipid, hypersensitive C–reactive protein (hs-CRP), soluble intercellular adhesion molecule (sICAM-1), Soluble vascular cell adhesion molecule (sVCAM-1), Matrix metalloproteinase-1 (MMP-1), Matrix metalloproteinase inhibitor-1 (TIMP-1) in blood serum. Results: micropowder of Rhubarb with Monascus group is able to relieve clinical symptoms; reduce IMT and expand inside diameter of the carotid; increase PSV and EDV; regulate blood lipid; decrease blood pressure; and decrease hs-CRP, sICAM-1, sVCAM-1, MMP-1 and MMP-1/TIMP-1. Curative effect of micropowder of Rhubarb with Monascus group is remarkably superior to micropowder of Rhubarb group、micropowder of Monascus group and Lovastatin group. Conclusion: The principle of Toxin-resolving and Blood-activating which is compatibility of micropowder of Rhubarb and Monascus can regulate blood lipid, decrease blood pressure and have therapeutic effects on anti-inflammation and Matrix Degradation. All above is capable of enhancing the stability of atherosclerotic plaque and delaying the process of Atherosclerosis.The therapeutic effect of Toxin-resolving with Blood-activating is superior to pure Toxin-resolving or pure Blood-activating, and deserves further clinical application.
引文
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[2] Expert panel on detection, evaluation, and treatment of high blood cho- lesterol in adults, Executive summary of the third report of national cholesterol educational program(NCEP) Expert panel on detection,evalua- tion, and treatment of high blood cholesterol in adults. JAMA,2002;285:2486～2497.
[3] Crouse JR,Harpold GH, Kahl FR,etal.Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound. Stroke,1986;17(2):270.
[4] O’Leary DH,Polak JP, Kronmal PA, etal.Carotid-artery in tima and media thickness as risk factor for myocardial infarction and stroke in older adults. N Engl J Med,1999;340(1):14～22.
[5]周永昌,郭万学.超声医学,北京:科学技术文献出版社,1999;3:717.
[6]黄铮,龚兰生,施中伟,等.冠心病者颈动脉粥样硬化斑块的好发部位及超声分型.中国超声医学杂志,1996;12(5):34～37.
[7]中药新药临床研究指原则,国家药品监督管理局,2002.
[8] Ross R. Atherosclerosis-an inflammatory diseAse. N Engl J Med, 1999; 340: 115～126.
[9]吴宗贵.炎症与动脉粥样硬化:挑战远未结束.上海医药,2004;27(4):211～212.
[10]戴淑婷.急性冠脉综合征患者血清高敏感C-反应蛋白检测的临床分析.实用医技杂志,2005;12(3):762.
[11]朱彦琪.可溶性细胞间粘附分子和可溶性血管细胞粘附分子与动脉粥样硬化.中国动脉硬化杂志,2004;12(5):618～620.
[12]马元辉,孙景芝,刘同宝.不同类型的老年冠心病病人血清CRP与TNF-α、IL-6相关性研究.中西医结合心脑血管病杂志,2005,3(8):698～699.
[13] Ross R.Atherosclerosisan inflammatory diseAse.N Engl J Med,1999,340:115.
[14]李曦铭.核因子-κB的活化机制及其与急性冠脉综合征的关系.天津医科大学学报,2004;10(1):151～154.
[15]郭爱桃,韦立新,石怀银,等.基质金属蛋白酶1与冠状动脉粥样硬化斑块破裂的关系.中华病理学杂志,2000;29(4):263～266.
[16]马运祥,胡燕燕,候彬,等.颈动脉不同类型的粥样硬化斑块与冠状动脉病变的关系.J Arterioscler,2004;13(1):104.
[17] Ballotta E, Da Giau G, Renon L,etal.Carotid plaque gross morphology and clinical presentation:a prospective study of 457 carotid artery specimens.J Surg Res,2000;89(1):78～84.
[18] Wang YQ,Guo DQ,Fu WG.Is there any relation between ischemic cere- brovAscular diseAse and extracranial internal carotid stenosis? Chin Med J,1998;111(6):510.
[19]朱昕.颈动脉粥样硬化与脑梗死关系的研究.临床荟萃,2000;15(12):536～537.
[20]张青萍,李泉水.现代超声显像鉴别诊断学,江西南昌:江西科技技术出版社, 1999;1:753～754.
[21]郑慧,张新书,王玲.彩色多普勒超声诊断颈动脉粥样硬化斑块.安徽医科大学学报,2004;39(3):218～220.
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