復方丹參滴丸聯合氯吡格雷治療冠心病穩定型心絞痛的效果分析

覃智芳 付磊 茍慶林 蔣昭隆 曾國樺

*基金項目：貴州省科技計劃項目（黔科合成果：20204Y008）

【摘要】 目的：探究復方丹參滴丸聯合氯吡格雷治療冠心病穩定型心絞痛的效果。方法：選擇2021年5月—2023年4月在貴州茅臺醫院治療的冠心病穩定型心絞痛患者98例，應用隨機數字表法將其分為對照組（氯吡格雷）及觀察組（聯合復方丹參滴丸），各49例。對比兩組24 h動態心電圖變化情況[缺血發作次數、持續時間]、血管內皮功能[一氧化氮（NO）、內皮素-1（ET-1）、血管內皮生長因子（VEGF）、可溶性血栓調節蛋白（sTM）]、心臟自主神經功能[低頻功率/高頻功率（LF/HF）、RR間期標準差（SDNN）、相鄰NN間期差值的均方根（RMSSD）]、氧化應激反應[丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽過氧化物酶（GSH-Px）]。結果：治療前，兩組24 h心電圖變化比較，差異均無統計學意義（P>0.05）；治療后，兩組缺血發作次數均較治療前減少，缺血持續時間較治療前均縮短，觀察組均優于對照組，差異均有統計學意義（P<0.05）。治療前，兩組NO、VEGF、ET-1、sTM比較，差異均無統計學意義（P>0.05）；治療后，兩組NO、VEGF均較治療前升高、ET-1、sTM均降低，觀察組NO、VEGF均高于對照組、ET-1、sTM均低于對照組，差異均有統計學意義（P<0.05）。治療前，兩組LF/HF、SDNN、RMSSD比較，差異均無統計學意義（P>0.05）；治療后，兩組LF/HF、SDNN、RMSSD均較治療前升高，且觀察組均高于對照組，差異均有統計學意義（P<0.05）。治療前，兩組SOD、GSH-Px、MDA比較，差異均無統計學意義（P>0.05）；治療后，兩組MDA均較治療前降低，SOD、GSH-Px均升高，觀察組MDA低于對照組，SOD、GSH-Px均高于對照組，差異均有統計學意義（P<0.05）。結論：復方丹參滴丸聯合氯吡格雷治療冠心病穩定型心絞痛，可改善心肌缺血情況，降低氧化應激反應，改善血管內皮、心臟自主神經功能。

【關鍵詞】 復方丹參滴丸 氯吡格雷 冠心病穩定型心絞痛 血管內皮功能

Analysis of the Effect of Compound Danshen Dripping Pills Combined with Clopidogrel in the Treatment of Stable Angina in Coronary Heart Disease/QIN Zhifang， FU Lei， GOU Qinglin， JIANG Zhaolong， ZENG Guohua. //Medical Innovation of China， 2024， 21（15）： -105

[Abstract] Objective： To explore the effect of Compound Danshen Dripping Pills combined with Clopidogrel in the treatment of stable angina pectoris in coronary heart disease. Method： A total of 98 patients with stable angina pectoris of coronary heart disease who were treated in Kweichow Moutai Hospital from May 2021 to April 2023 were selected， they were divided into control group （Clopidogrel） and observation group （combined with Compound Danshen Dripping Pills） by random number table method， with 49 cases in each group. The changes in 24-hour dynamic electrocardiogram [number and duration of ischemic attacks]， vascular endothelial function [nitric oxide （NO）， endothelin-1 （ET-1）， vascular endothelial growth factor （VEGF）， soluble thrombomodulin （sTM）]， cardiac autonomic function [low-frequency power/high-frequency power （LF/HF）， RR interval standard deviation （SDNN）， root mean square of adjacent NN interval difference （RMSSD）]， oxidative stress response [malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）] were compared between two groups. Result： Before treatment， there were no statistically significant differences in the 24-hour electrocardiogram changes between the two groups （P>0.05）; after treatment， the number of ischemic attacks in both groups were decreased compared to those before treatment， the duration of ischemia in both groups was shortened compared to those before treatment， those in the observation group were better than those in the control group， the differences were statistically significant （P<0.05）. Before treatment， there were no statistically significant differences in NO， VEGF， ET-1 and sTM between the two groups （P>0.05）; after treatment， the levels of NO and VEGF in both groups were increased compared to those before treatment， while ET-1 and sTM were decreased， NO and VEGF in the observation group were higher than those in the control group， ET-1 and sTM were lower than those in the control group， the differences were statistically significant （P<0.05）. Before treatment， there were no statistically significant differences in LF/HF， SDNN and RMSSD between the two groups （P>0.05）; after treatment， LF/HF， SDNN and RMSSD in both groups were increased compared to those before treatment， and those in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. Before treatment， there were no statistically significant differences in SOD， GSH-Px and MDA between the two groups （P>0.05）; after treatment， MDA levels in both groups were decreased compared to those before treatment， while SOD and GSH-Px levels were increased. MDA level in the observation group was lower than that in the control group， while SOD and GSH-Px levels were higher than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： The combination of Compound Danshen Dripping Pills and Clopidogrel in the treatment of stable angina pectoris in coronary heart disease can improve myocardial ischemia， reduce oxidative stress response， and improve vascular endothelial and cardiac autonomic function.

[Key words] Compound Danshen Dripping Pills Clopidogrel Coronary heart disease stable angina Vascular endothelial function

First-author's address： Department of Cardiovascular Medicine， Kweichow Moutai Hospital， Zunyi 564500， China

doi：10.3969/j.issn.1674-4985.2024.15.024

心臟主要由冠狀動脈為其提供血液，由多種因素導致膽固醇和其他多種沉積物導致的斑塊在動脈壁處積聚，導致冠狀動脈發生狹窄、閉塞，誘發粥樣硬化，如若發生粥樣改變，可導致心肌缺氧、缺血，最終導致多種心臟疾病發生[1]。冠心……