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顾菁,张美玲.参苓白术散合五苓散加减治疗痰湿体质冠心病合并高脂血症的临床研究[J].湖南中医药大学学报,2020,40(2):236-241[点击复制] |
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| 参苓白术散合五苓散加减治疗痰湿体质冠心病合并高脂血症的临床研究 |
| 顾菁,张美玲 |
| (苏州市吴江区中医医院/吴江区第二人民医院心内科, 江苏 苏州 215221) |
| 摘要: |
| 目的 观察参苓白术散合五苓散加减治疗痰湿体质冠心病合并高脂血症的临床疗效，探讨其对患者血管保护、红细胞免疫功能、心血管事件的影响。方法 选取2016年1月至2019年3月本院收治的痰湿体质冠心病合并高脂血症患者116例，按照随机数字表法分为对照组和观察组各58例。对照组患者给予常规西药口服，治疗组患者在对照组基础上加用参苓白术散合五苓散加减方内服。检测治疗前后心功能指标、血脂指标、血管内皮功能指标、红细胞免疫指标变化，治疗后随访半年，统计两组患者发生心血管不良事件的情况。结果 观察组患者治疗后与对照组比较，左室舒张末内径（left ventricular end diastolic diameter，LVEDd）降低更明显，左室射血分数（left ventricular ejection fraction，LVEF）、心排血量（cardiac output，CO）、心脏指数（cardiac index，CI）水平升高更明显（P<0.05）；血脂甘油三酯（triglyceride，TG）、总胆固醇（total cholesterol，TC）、低密度脂蛋白-C（low-density lipoprotein-C，LDL-C）水平降低更明显，高密度脂蛋白-C（high-density lipoprotein-C， HDL-C）水平则升高更明显（P<0.05）；内皮素-1（endothelin-1，ET-1）、血管性血友病因子（von Willebrand factor，vWF）、同型半胱氨酸（homocysteine，Hcy）水平降低更明显，一氧化氮（nitric oxide，NO）水平上升更明显（P<0.05）；红细胞免疫复合物花环率（RBC immunecomplex rosette， RBC-ICR）、红细胞免疫抑制因子（RBC immune adherence inhibitor factor，RFIR）水平降低更明显，红细胞免疫促进因子（RBC immune adherence enhance factor，RFER）、红细胞C3b受体花环率（RBC-c3b receptor rosette，RBCC3bRR）水平上升更明显（P<0.05）。治疗后随访半年，两组患者均有发生缺血性脑卒中、心力衰竭、心肌梗死等不良事件，观察组患者期间发生率6.90%，显著低于对照组发生率18.97%（P<0.05）。结论 参苓白术散合五苓散加减利于改善痰湿体质冠心病合并高脂血症患者的心肌功能，改善脂质代谢紊乱，保护血管内皮功能，提高红细胞免疫功能，且心血管不良事件的发生率明显降低，效果理想，值得临床推广。 |
| 关键词: 冠心病 高脂血症 痰湿体质 参苓白术散 五苓散 血管保护 红细胞免疫功能 心血管事件 |
| DOI：10.3969/j.issn.1674-070X.2020.02.024 |
| 投稿时间：2019-08-19 |
| 基金项目:苏州市吴江区科技计划项目(SYSD2012045)。 |
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| Clinical Efficacy of Modified Shenling Baizhu Powder Plus Wuling Powder in Treating Phlegm-Dampness Constitution Coronary Heart Disease Combined with Hyperlipidemia |
| GU Jing,ZHANG Meiling |
| (Department of Cardiology, Wujiang District Chinese Medicine Hospital Wujiang District Second People's Hospital, Suzhou, Jiangsu 215221, China) |
| Abstract: |
| Objective To observe the clinical effect of modified Shenling Baizhu Powder Combined with Wuling Powder in the treatment of phlegm-dampness constitution coronary heart disease combined with hyperlipidemia, and to explore its effects on the patient's vascular protection, erythrocyte immune function and cardiovascular events. Methods A total of 116 patients with phlegm-dampness constitution coronary heart disease complicated with hyperlipidemia admitted to our hospital from January 2016 to March 2019 were randomly divided into a control group (n=58) and an observation group (n=58) according to the random number table method. Patients in the control group were given conventional western medicine orally. The treatment group patients were given oral administration of modified Shenling Baizhu Powder Combined with Wuling Powder on the basis of the control group. Changes of cardiac function index, blood lipid index, vascular endothelial function index and erythrocyte immune index before and after treatment were detected. After treatment, patients were followed up for half a year, and the incidence of cardiovascular adverse events was analyzed. Results Compared with the control group, patients in the observation group showed more significant reduction in left ventricular end diastolic diameter (LVEDd), and more significant increase in left ventricular ejection fraction (LVEF), cardiac output (CO), and cardiac index (CI) levels (P<0.05). The levels of lipid triglyceride (TG), total cholesterol (TC) and low-density lipoprotein-C (LDL-C) were decreased more significantly, while the levels of high-density lipoprotein-C (HDL-C) were increased more significantly (P<0.05). The levels of endothelin-1 (ET-1), von Willebrand factor (vWF) and homocysteine (Hcy) were more significantly decreased, and the levels of nitric oxide (NO) were more significantly increased (P<0.05). RBC immunecomplex rosette (RBC-ICR) and RBC immune adherence inhibitor factor (RFIR) levels were significantly decreased, and RBC immune adherence enhance factor (RFER) and RBC-c3b receptor rosette (RBCC3bRR) levels were significantly increased (P<0.05). Patients in both groups were followed up for half a year after treatment. Adverse events such as ischemic stroke, heart failure and myocardial infarction occurred in both groups. The incidence rate during the observation group was 6.90%, which was significantly lower than 18.97% of the control group (P<0.05). Conclusion Modified Shenling Baizhu Powder combined with Wuling Powder can improve the myocardial function of patients with phlegm-dampness constitution coronary heart disease combined with hyperlipidemia, improve lipid metabolism disorder, protect vascular endothelial function, improve red blood cell immune function, and the incidence of cardiovascular adverse events is significantly reduced. The effect is ideal, and it is worthy of clinical promotion. |
| Key words: coronary heart disease hyperlipidemia phlegm-dampness constitution Shenling Baizhu Powder Wuling Powder vascular protection erythrocyte immune function cardiovascular events |
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