世界中医药

作者	单位
刘亚荣1，孙婧2	1 陕西省西安市中医医院心病科，西安，710003； 2 陕西省西安市长安医院心血管内科，西安，710016

摘要点击次数: 569

全文下载次数: 491

中文摘要:

目的：分析黄连解毒汤对颈动脉粥样硬化（CAS）的治疗作用及对患者炎性指标、血脂代谢、血管内皮功能水平的影响，探讨黄连解毒汤治疗CAS患者的作用机制，为临床进一步优化CAS治疗方案提供参考。方法：选取2016年1月至2018年1月西安市中医医院收治的CAS患者148例作为研究对象，将其按照入组前后顺序编号，单号设置为对照组，双号设置为观察组，每组74例。2组患者均采用常规西药治疗CAS，观察组在此基础上再予以黄连解毒汤加减辨治治疗。比较2组患者治疗前后血清炎性指标：超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6）、肿瘤坏死因子（TNF-ɑ），血脂代谢水平指标：胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)，血管内皮细胞功能指标：一氧化氮(NO)、内皮素(ET）、血管内皮生长因子(VEGF)的变化。比较2组患者治疗前后患侧颈动脉内径、患侧颈动脉中一内膜厚度、最大斑块体积、斑块数量变化，及治疗过程种的药物不良反应及不良反应。结果：1）完成治疗后2组患者血清hs-CRP、IL-6、TNF-ɑ水平均较治疗前明显下降，且观察组患者低于对照组患者(P<0.05)。2）2组患者完成治疗后，TC、TG、HDL-C均较治疗前下降，且观察组低于对照组，LDL-C均较治疗前上升，且观察组高于对照组（P<0.05）。3）完成治疗后，2组患者血清NO、ETVEGF均较治疗前明显上升，且观察组高于对照组（P<0.05）；4）2组患者完成治疗后，患侧颈动脉内径、患侧颈动脉中一内膜厚度、最大斑块体积、斑块数量变化均较治疗前明显降低，且观察组患者低于对照组患者（P<0.05）；5）2组患者治疗过程中药物不良反应率比较，差异无统计学意义（P>0.05）。结论：黄连解毒汤通过改善CAS患者血脂代谢、炎性反应状态及血管内皮功能，达到降低CAS患者颈动脉硬化斑块数量、大小、颈动脉内径等指标，有效改善CAS患者颈动脉硬化状态，且安全性高，具有较高的临床价值。

English Summary:

To explore therapeutic effect of Huanglian Jiedu Decoction in carotid atherosclerosis(CAS)，effects on inflammatory indexes，blood lipid metabolism and vascular endothelial function of patients，and mechanism of Huanglian Jiedu Decoction in the treatment of CAS patients，and to provide reference for further optimization of CAS treatment.Methods:A total of 148 cases of CAS patients in the Xi'an Hospital of Traditional Chinese Medicine from January 2016 to January 2018 were selected as research objects，and they were numbered according to the order of entering groups.The odd number was set as the control group(74 cases)，and the even number was set as the observation group(74 cases).The 2 groups of patients were treated with conventional western medicine for CAS，and the observation group was also treated with modified Huanglian Jiedu Decoction according to syndrome differentiation.Serum inflammatory indicators including hypersensitivity C reactive protein(hs-CRP)，interleukin-6(IL-6）and tumor necrosis factor(TNF-ɑ)，level indicators of blood lipid metabolism including cholesterol(TC)，triglyceride(TG)，high-density lipoprotein cholesterol(HDL-C）and low density lipoprotein cholesterol(LDL-C)，and functional indicators of vascular endothelial cells including nitric oxide(NO)，endothelin(ET)，vascular endothelial growth factor(VEGF）in the 2 groups were compared before and after the treatment.Internal diameter of the carotid artery，carotid intima-media thickness(IMT)，volume of the largest plaque，number of plaque，adverse drug reactions and toxic and side effects in the 2 groups were compared before and after the treatment.Results:1）After the treatment，the levels of serum hs-CRP，IL-6 and TNF-ɑ in the 2 groups were significantly decreased than those before the treatment，and those in the observation group were lower than those in the control group(P<0.05). 2）After the 2 groups of patients completed the treatment，the TC，TG and HDL-C were lower than those before the treatment，and those in the observation group was lower than those in the control group; the LDL-C was higher than that before the treatment，and that in the observation group was higher than that in the control group(P<0.05). 3）After the treatment，the serum NO，ET and VEGF in the 2 groups were significantly higher than those before the treatment，and those in the observation group were higher than those in the control group(P<0.05). 4）After the 2 groups of patients completed the treatment，the internal diameter of the carotid artery，the IMT，the maximum plaque volume and the number of plaque in the carotid artery were significantly lower than those before the treatment.And those in the observation group were lower than those in the control group(P<0.05). 5）There was no significant difference in the rate of adverse drug reaction between the 2 groups during the treatment(P>0.05).Conclusion:Huanglian Jiedu Decoction can reduce indicators like the number and size of carotid atherosclerotic plaque and the internal diameter of the carotid artery in CAS patients by improving the blood lipid metabolism，inflammatory state and vascular endothelial function of CAS patients.It can effectively improve the carotid atherosclerosis of CAS patients with high safety and high clinical value.

查看全文查看/发表评论下载PDF阅读器