| 引用本文:杨艳，朱波，乔克，苏仁意，许细平.瓜蒌薤白桂枝汤对老年冠心病患者脂代谢及血浆血红素加氧酶1和基质金属蛋白酶9水平的影响[J].世界中医药,2019,(10):. |
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| 瓜蒌薤白桂枝汤对老年冠心病患者脂代谢及血浆血红素加氧酶1和基质金属蛋白酶9水平的影响 |
| Effects of Gualou Xiebai Guizhi Decoction on Lipid Metabolism and Plasma Heme Oxygenase-1 and Matrix Metalloproteinase-9 Levels in Elderly Patients with Coronary Heart Disease |
| 投稿时间：2018-10-07 |
| DOI：10.3969/j.issn.1673-7202.2019.10.039 |
| 中文关键词: 老年冠心病 瓜蒌薤白桂枝汤 加减辨治 血红素加氧酶1 血流动力学 基质金属蛋白酶9 心血管不良事件 临床疗效 不良反应 |
| English Keywords:Elderly coronary heart disease Gualou Xiebai Guizhi Decoction Modification and syndrome differentiation treatment Heme oxygenase 1 Hemodynamics Matrix metalloproteinase 9 Cardiovascular adverse events Clinical efficacy Adverse reactions |
| 基金项目:襄阳市科技研发项目（EK2012D140143001063） |
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| 中文摘要: |
| 目的：探究瓜蒌薤白桂枝汤加减辨治老年冠心病患者的临床疗效，及其对患者脂代谢、血浆血红素加氧酶1（HO-1）和基质金属蛋白酶9(MMP-9)的影响，探讨瓜蒌薤白桂枝汤治疗老年冠心病的疗效机制，为优化该治疗方案奠定基础。方法：选取2015年12月至2017年12月襄阳市第一人民医院收治的老年冠心病患者104例作为研究对象，按照入组顺序编号，奇数纳入对照组，偶数纳入观察组，每组52例。2组患者均按照冠心病常规诊疗指南予以综合治疗，研究在此基础上再予以瓜蒌薤白桂枝汤加减辨治。2组患者均连续治疗2个月。比较2组患者治疗前后的血脂代谢如胆固醇（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），口服耐糖量（OGTT）、血浆血红素加氧酶1（HO-1）和基质金属蛋白酶9(MMP-9)、血流动力学如心搏出量(SV)、心输出量(CO)、心脏指数(CI)、左室舒张末压(LVEDP)、血管顺应性(AC)变化。比较2组患者治疗期间心血管不良事件率及药物不良反应和治疗后临床疗效率。结果：治疗后，2组患者TC、TG、LDL-C、OGTT均较治疗前明显降低，且观察组低于对照组，差异有统计学意义（P<0.05），HDL-C较治疗前明显升高，且观察组高于对照组，差异有统计学意义（P<0.05）。2组患者治疗后，血浆HO-1较治疗前明显升高，且观察组高于对照组，差异有统计学意义（P<0.05），MMP-9较治疗前明显降低且观察组低于对照组，差异有统计学意义（P<0.05）。2组患者治疗后，SV、CO、CI、AC均较治疗前明显升高，且观察组高于对照组，差异有统计学意义（P>0.05），LVEDP均较治疗前明显下降，且观察组低于对照组，差异有统计学意义（P<0.05）；观察组患者治疗期间心血管不良事件率明显低于对照组，差异有统计学意义（P<0.05）；2组患者治疗过程中均未收集到严重药物不良反应，组间比较差异无统计学意义（P>0.05）；治疗后，观察组患者临床治疗有效率明显高于对照组，差异有统计学意义（P<0.05）。结论：瓜蒌薤白桂枝汤加减辨治可有效改善老年冠心病患者脂代谢水平，提升患者血流动力学功能，提升HO-1，降低MMP-9，降低心血管不良事件率，改善老年冠心病患者的临床疗效。 |
| English Summary: |
| To explore the clinical effects of modified Gualou Xiebai Guizhi Decoction on lipid metabolism，plasma heme oxygenase-1(HO-1）and matrix metalloproteinase-9(MMP-9）in elderly patients with coronary heart disease，so as to explore the therapeutic mechanism of Gualou Xiebai Guizhi Decoction on elderly patients with coronary heart disease and lay a foundation for optimizing the therapeutic regimen.Methods:A total of 104 elderly patients with coronary heart disease from December 2015 to December 2017 in Xiangyang First People's Hospital were selected as the study subjects.According to the order of grouping，odd numbers were included in the control group，and even numbers were included in the observation group，with 52 cases in each group.Both groups of patients were given comprehensive treatment according to the routine diagnosis and treatment guidelines of coronary heart disease.On this basis，modified Gualou Xiebai Guizhi Decoction was added.The 2 groups were treated for 2 months.The changes of blood lipid metabolism(TC，TG，HDL-C，LDL-C，OGTT)，plasma HO-1，MMP-9，and hemodynamics(SV，CO，CI，LVEDP，AC）before and after treatment were compared between the 2 groups.The rates of adverse cardiovascular events and adverse drug reactions/side effects and the clinical curative effect rate after treatment were compared between the 2 groups.Results:1）After treatment，TC，TG，LDL-C and OGTT of the 2 groups were significantly decreased than those before treatment，and the observation group was lower than the control group(P<0.05).HDL-C was significantly increased than before treatment，and the observation group was higher than the control group(P<0.05). 2）After treatment，the level of HO-1 was significantly increased in the observation group than in the control group(P<0.05)，and the level of MMP-9 was significantly decreased in the observation group than in the control group(P<0.05). 3）After treatment，SV，CO，CI，AC in both groups were significantly higher than before treatment，and the observation group was higher than the control group(P>0.05).LVEDP were significantly decreased than before treatment，and the observation group was lower than the control group(P<0.05). 4）The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group(P<0.05). 5）No serious adverse drug reactions/toxic side effects were collected during the treatment of the 2 groups.There was no significant difference between the 2 groups(P>0.05). 6）After treatment，the total effective rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:Modified Gualou Xiebai Guizhi Decoction can effectively improve lipid metabolism，enhance hemodynamic function，enhance HO-1，reduce MMP-9，reduce the incidence of adverse cardiovascular events in elderly patients with coronary heart disease，and achieve the effect of improving clinical efficacy in many ways.It has high clinical value. |
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