麝香保心丸、丹参酮ⅡA 磺酸钠联合阿托伐他汀治疗急性心肌梗死临床研究
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R542.22

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Clinical Study on Shexiang Baoxin Pills and Sodium Tanshinone IIA Sulfonate Combined with Atorvastatin for Acute Myocardial Infarction
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    摘要:

    目的:观察麝香保心丸、丹参酮ⅡA 磺酸钠联合阿托伐他汀治疗急性心肌梗死的疗效。方法:选取116 例急性心肌梗死患者,按随机数字表法分为对照组及观察组各58 例。对照组给予阿托伐他汀治疗,观察组在对照组基础上给予麝香保心丸、丹参酮ⅡA 磺酸钠注射液治疗,2 组均连续治疗2 周。观察2 组临床疗效、并发症及不良反应发生情况,比较2 组治疗前后心室重构相关指标[左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)]、心肌损伤指标[心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)]、超敏C-反应蛋白(hs-CRP)、半乳糖凝集素-3(Gal-3)、转化生长因子-β1(TGF-β1)、免疫调节指标[辅助性T 细胞17(Th17)、调节性T 细胞(Treg)、辅助性T 细胞17/调节性T 细胞(Th17/Treg)] 的变化。结果:观察组临床疗效总有效率为94.83%,对照组为82.76%,2 组比较,差异有统计学意义(P<0.05)。治疗后,2 组LVEDV、LVESV 指标值均较治疗前下降,LVEF 指标值均较治疗前上升,差异均有统计学意义(P<0.05);治疗后,观察组LVEDV、LVESV 指标值均低于对照组,LVEF 指标值高于对照组,差异均有统计学意义(P<0.05)。治疗后,2 组cTnI、CK-MB、Mb 指标值均较治疗前下降,观察组上述3 项指标值均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2 组血清hs-CRP、Gal-3、TGF-β1 水平均较治疗前下降,观察组上述3 项水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后,2 组Th17、Th17/Treg 指标值均较治疗前下降,Treg 指标值均较治疗前上升,差异均有统计学意义(P<0.05);治疗后,观察组Th17、Th17/Treg 指标值均低于对照组,Treg 指标值高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为17.24%,对照组并发症发生率为34.48%,2 组比较,差异有统计学意义(P<0.05)。治疗过程中,对照组不良反应发生率为18.97%,观察组不良反应发生率为10.34%,2 组比较,差异无统计学意义(P>0.05)。结论:在阿托伐他汀基础上采用麝香保心丸、丹参酮ⅡA 磺酸钠联合治疗急性心肌梗死可提高临床疗效,逆转患者心室重构,这可能与抑制炎症、抗心肌纤维化、纠正Th17/Treg 免疫失衡等有关,且在减少不良心血管事件的发生、降低死亡风险方面更具优势。

    Abstract:

    Abstract: Objective: To observe the curative effect of Shexiang Baoxin pills and sodium tanshinone ⅡA sulfonate combined with atorvastatin for acute myocardial infarction. Methods:A total of 116 cases of patients with acute myocardial infarction were selected and divided into the control group and the observation group according to the random number table method,with 58 cases in each group. The control group was treated with atorvastatin, and the observation group was additionally treated with Shexiang Baoxin pills and sodium tanshinone ⅡA sulfonate injection based on the treatment of the control group. Both groups were treated for two weeks. The clinical effects,complications and adverse reactions in the two groups were observed. Before and after treatment, ventricular remodeling related indexes including left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV) and left ventricular ejection fraction(LVEF), myocardial injury indexes including cardiac troponin I(cTnI), creatine kinase isoenzyme(CK-MB) and myoglobin(Mb),hypersensitive C-reactive protein(hs-CRP),galectin- 3(Gal- 3), transforming growth factor- β1(TGF- β1),and immunoregulatory indexes including helper T cell 17(Th17), regulatory T cell(Treg) and helper T cell 17/regulatory T cell(Th17/Treg) in the two groups were compared. Results:The total effective rate of clinical effect was 94.83% in the observation group and 82.76% in the control group,the difference being significant(P<0.05). After treatment,the values of LVEDV and LVESV in the two groups were decreased when compared with those before treatment,and the values of LVEF were increased,differences being significant(P<0.05). After treatment,the values of LVEDV and LVESV in the observation group were lower than those in the control group,and the value of LVEF was higher, differences being significant(P<0.05). After treatment, the values of cTnI, CK- MB and Mb in the two groups were decreased when compared with those before treatment,and the values of the above three indexes in the observation group were lower than those in the control group,differences being significant (P<0.05). After treatment,the levels of hs- CRP,Gal- 3 and TGF- β1 in serum in the two groups were decreased when compared with those before treatment, and the above three levels in the observation group were lower than those in the control group,differences being significant(P<0.05). After treatment, the values of Th17 and Th17/Treg in the two groups were decreased when compared with those before treatment, and the values of Treg were increased, differences being significant(P<0.05). After treatment,the values of Th17 and Th17/Treg in the observation group were lower than those in the control group, and the value of Treg was higher, differences being significant(P<0.05). The incidence of complications was 17.24% in the observation group and 34.48% in the control group,the difference being significant(P<0.05). During treatment,the incidence of adverse reactions was 18.97% in the control group and 10.34% in the observation group,there being no significance in the difference(P>0.05). Conclusion: Based on the treatment of atorvastatin, the additional therapy of Shexiang Baoxin pills combined with sodium tanshinone ⅡA sulfonate can improve the clinical effect and reverse the ventricular remodeling in patients,which may be related to inhibiting inflammation,resisting myocardial fibrosis,correcting Th17/ Treg immune imbalance. And it has more advantages in reducing the incidence of adverse cardiovascular events and the risk of death.

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胡俊杰,朱卿,汪伟哲,陈华珍,余敏.麝香保心丸、丹参酮ⅡA 磺酸钠联合阿托伐他汀治疗急性心肌梗死临床研究[J].新中医,2022,54(20):32-38

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  • 在线发布日期: 2022-10-28
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