标题：瓜蒌薤白半夏汤联合阿托伐他汀治疗冠心病心绞痛的疗效及对患者微炎性反应的影响

      作者：仇卫锋，雒军强    宝鸡市中医医院心血管内科，陕西 宝鸡 721000

      卷次： 2021年32卷17期

      【摘要】 目的 观察瓜蒌薤白半夏汤联合阿托伐他汀治疗冠心病心绞痛的临床疗效，探讨其对患者微炎症反应的影响。方法 将2019年3月至2020年8月在宝鸡市中医医院接受治疗的84例冠心病伴心绞痛症状的患者作为研究对象，按随机数表法将患者分为观察组和对照组各42例，对照组患者接受阿托伐他汀治疗，观察组患者在对照组治疗基础上联合瓜蒌薤白半夏汤治疗，均治疗1个月。比较两组患者的临床疗效、治疗前后的中医症候积分、射血分数(EF)、心脏指数(CI)、氨基末端脑钠前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、白介素-6 (IL-6)和肿瘤坏死因子-α (TNF-α)水平。结果 治疗前两组患者的中医证候积分比较差异无统计学意义(P>0.05)，治疗后，观察组患者的中医证候积分为(8.77±2.35)分，明显低于对照组的(10.92±2.77)分，差异有统计学意义(P<0.05)；治疗后，观察组患者的心绞痛和心电图的疗效分别为90.48%、85.71%，明显高于对照组的76.19%、69.05%，差异均有统计学意义(P<0.05)；治疗前，两组患者的EF、CI、NT-proBNP水平比较差异均无统计学意义(P>0.05)，治疗后，观察组患者的EF、CI指标分别为(62.57±7.44)%、(5.36±0.11) L/(min·m)，明显高于对照组的(49.68±6.92)%、(4.27±0.20) L/(min·m)，NT-proBNP为(254.68±21.37) pg/L，明显低于对照组的(344.92±26.55) pg/L，差异均有统计学意义(P<0.05)；治疗前，两组患者的 hs-CRP、IL-6、TNF-α水平比较差异均无统计学意义(P>0.05)，治疗后，观察组患者的 hs-CRP、IL-6、TNF-α水平分别为(0.68±0.03) mg/L、(3.77±0.42) pg/L、(4.26±2.54) pg/L，明显低于对照组的(0.87±0.01) mg/L、(5.28±1.67) pg/L、(6.78±2.71) pg/L，差异均有统计学意义(P<0.05)。结论 瓜蒌薤白半夏汤联合阿托伐他汀治疗冠心病心绞痛能够有效缓解患者的临床症状，改善心脏功能及微炎症状态，临床治疗效果显著。
      【关键词】 冠心病；心绞痛；瓜蒌薤白半夏汤；阿托伐他汀；心功能；中医证候积分；炎症
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2021）17—2197—04

Clinical effect of Gualou Xiebai Banxia decoction combined with atorvastatin in the treatment of angina pectorisof coronary heart disease and its influence on micro-inflammatory reaction of patients.
QIU Wei-feng, LUOJun-qiang. Department of Cardiovascular Medicine, Baoji Traditional Chinese Medicine Hospital, Baojin 721000, Shaanxi,CHINA
【Abstract】 Objective To study and analyze the clinical effect of Gualou Xiebai Banxia decoction combinedwith atorvastatin in the treatment of angina pectoris of coronary heart disease and its influence on micro-inflammatory re-action. Methods Eighty-four patients with coronary heart disease and angina pectoris treated in Baoji Traditional Chi-nese Medicine Hospital from March 2019 to August 2020 were selected as the research objects. According to the randomnumber table method, the patients were divided into the observation group and the control group, with 42 patients ineach group. The patients in the control group were treated with atorvastatin, while the patients in the observation groupwere treated with Gualou Xiebai Banxia Decoction on the basis of the treatment in the control group. The clinical effica-cy, TCM symptom score, ejection fraction (EF), cardiac index (CI), N-terminal pro-brain natriuretic peptide (NT proB-NP), high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor α level (TNF-α) werecompared between the two groups before and after treatment. Results Before treatment, there was no significant differ-ence in TCM syndrome score between the two groups (P>0.05), but after treatment, the TCM syndrome score of the ob-servation group was (8.77±2.35) points, which was significantly lower than (10.92±2.77) points (P<0.05). The curativeeffects of angina pectoris (90.48%) and electrocardiogram (85.71%) in the observation group were significantly higherthan those of angina pectoris (76.19%) and electrocardiogram (69.05%) in the control group (P<0.05). Before treatment,there was no significant difference in the levels of EF, CI, and NT proBNP between the two groups (P>0.05). After treat-ment, the EF and CI indexes of the observation group were (62.57±7.44)%, (5.36±0.11) L/(min·m), significantly higherthan (49.68±6.92)%, (4.27±0.20) L/(min·m) in the control group; NT-proBNP was (254.68±21.37) pg/L, which was sig-nificantly lower than (344.92±26.55) pg/L in the control group (P<0.05). Before treatment, the levels of hs-CRP, IL-6,and TNF-α showed no statistically significant difference between the two groups; after treatment, the hs-CRP, IL-6, andTNF-α levels of the observation group were (0.68±0.03) mg/L, (3.77±0.42) pg/L, (4.26±2.54) pg/L, significantly higher