Effects of Qili Qiangxin Capsule on blood lipid metabolism and hemorheology in patients with coronary heart disease and angina pectoris
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摘要:目的
探讨芪苈强心胶囊影响冠心病心绞痛患者血脂代谢和血液流变学的临床机制。
方法将2020年4月—2021年8月100例冠心病心绞痛患者纳入本研究，按照随机分组原则将其分为观察组和对照组，每组50例，对照组采用常规治疗措施进行治疗，观察组在常规治疗基础上接受芪苈强心胶囊治疗。采用全自动血液流变仪分析患者治疗前后的血液流变学指标，采用自动生化分析仪检测患者血脂水平。按照《中药新药临床研究指导原则》对患者的中医证候进行评分，通过冠状动脉CT检查和光学相干断层成像（OCT）检查及图像分析冠状动脉狭窄程度。使用酶联免疫吸附测定法检测患者治疗前后炎症水平，并分析2组的治疗效果。
结果治疗后，2组患者血液流变学相关指标较治疗前降低，观察组血液流变学相关指标低于对照组，差异有统计学意义（P < 0.05）。2组患者治疗后总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）较治疗前降低，高密度脂蛋白胆固醇（HDL-C）较治疗前升高，差异有统计学意义（P < 0.05）；观察组以上指标与对照组比较，差异有统计学意义（P < 0.05）。治疗后，2组中医证候评分和冠状动脉狭窄程度较治疗前降低，且观察组中医证候评分和冠状动脉狭窄程度低于对照组，差异有统计学意义（P < 0.05）。治疗后，2组患者肿瘤坏死因子-α（TNF-α）、可溶性尿激酶纤溶酶原激活物受体（suPAR）和C反应蛋白（CRP）水平较治疗前降低，且观察组TNF-α、suPAR和CRP水平较对照组低，差异有统计学意义（P < 0.05）。观察组总有效率为84.00%，高于对照组的66.00%，差异有统计学意义（P < 0.05）。
结论芪苈强心胶囊能显著改善冠心病心绞痛患者临床症状，可降低血脂水平，调节脂蛋白代谢紊乱，改善血液流变学指标，降低血液黏度。
Abstract:ObjectiveTo explore the clinical mechanism of Qili Qiangxin Capsule on blood lipid metabolism and hemorheology in patients with angina pectoris of coronary heart disease.
MethodsA total of 100 coronary heart disease patients with angina pectoris admitted to our hospital from April 2020 to August 2021 were recruited as the research objects. According to the principle of random grouping, they were divided into observation group and control group with 50 cases each group. The control group was treated with conventional treatment measures, and the observation group was treated with Qiliqiangxin capsule on the basis of conventional treatment. All patients had informed consent and signed an informed consent form before participating in the study. The general data of patients are counted according to the file information. The hemorheology indexes of patients before and after treatment were analyzed with automatic hemorheometer. Automatic biochemical analyzer was used to detect blood lipid of patients. The TCM syndrome score was conducted according to the Guiding Principles for Clinical Research of New Chinese Medicine, and the degree of coronary artery stenosis was analyzed through coronary artery CT and OCT examinations and images. Enzyme linked immunosorbent assay was used to detect the level of inflammation before and after treatment. The therapeutic effects of the two groups were analyzed.
ResultsAfter treatment, hemorheological related indexes in the two groups were lower than before treatment, and the hemorheological related indexes in the observation group were lower than those in the control group (P < 0.05). Total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) were decreased after treatment, while high density lipoprotein cholesterol (HDL-C) was increased after treatment, and the above indexes in the observation group showed statistically significant differences compared with the control group (P < 0.05). After treatment, TCM syndrome score and coronary artery stenosis degree of the two groups were lower than before treatment, and were lower in the observation group than those in the control group (P < 0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α), soluble urokinase plasminogen activator receptor (suPAR) and C-reactive protein (CRP) in the two groups were lower than before treatment, and their levels in the observation group were lower than those in the control group (P < 0.05). The total effective rate was 84.00%, which was higher than 66.00% in the control group, and the difference was statistically significant (P < 0.05).
ConclusionQili Qiangxin Capsules can significantly improve the clinical symptoms of patients with coronary heart disease and angina pectoris, reduce blood lipid levels, regulate lipoprotein metabolism disorders, improve blood rheology indicators, and reduce blood viscosity.
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表 1 2组患者治疗前后血液流变学指标比较(x ±s)
指标 时点 对照组(n=50) 观察组(n=50) 全血高切黏度/(mPa·s) 治疗前 6.24±0.43 6.18±0.41 治疗后 5.58±0.30* 4.32±0.26*# 全血低切黏度/(mPa·s) 治疗前 11.94±0.70 12.02±0.69 治疗后 10.49±0.61* 9.37±0.58*# 血浆黏度/(mPa·s) 治疗前 1.94±0.28 1.95±0.26 治疗后 1.41±0.20* 1.06±0.12*# 纤维蛋白原/(g/L) 治疗前 6.37±0.35 6.40±0.31 治疗后 4.38±0.25* 3.25±0.21*# 红细胞聚集指数 治疗前 5.81±0.26 5.76±0.24 治疗后 4.52±0.20* 3.97±0.19*# 与治疗前比较, * P＜0.05; 与对照组比较, #P＜0.05。 
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表 2 2组患者治疗前后血脂代谢指标比较(x ±s)
指标 时点 对照组(n=50) 观察组(n=50) TG/(mmol/L) 治疗前 2.19±0.15 2.20±0.13 治疗后 2.03±0.10* 1.86±0.09*# TC/(mmol/L) 治疗前 5.52±0.30 5.53±0.28 治疗后 5.11±0.32* 5.02±0.25*# HDL-C/(mmol/L) 治疗前 1.17±0.04 1.18±0.03 治疗后 1.27±0.03* 1.30±0.02*# LDL-C/(mmol/L) 治疗前 3.15±0.10 3.16±0.11 治疗后 2.86±0.09* 2.70±0.07*# TG: 甘油三酯; TC: 总胆固醇; LDL-C: 低密度脂蛋白胆固醇;
HDL-C: 高密度脂蛋白胆固醇。与治疗前比较, * P＜0.05;
与对照组比较, #P＜0.05。
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表 3 2组中医证候评分和冠状动脉CT检查结果比较(x ±s)
指标 时点 对照组(n=50) 观察组(n=50) 中医证候评分/分 治疗前 37.29±2.46 38.51±2.19 治疗后 26.58±1.62* 13.47±1.38*# 冠状动脉狭窄程度/% 治疗前 68.32±9.73 70.40±8.61 治疗后 57.29±6.88* 42.56±5.23*# 与治疗前比较, * P＜0.05; 与对照组比较, #P＜0.05。
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表 4 2组炎症标记物比较(x ±s)
指标 时点 对照组(n=50) 观察组(n=50) TNF-α/(pg/mL) 治疗前 4.57±0.46 4.63±0.44 治疗后 4.12±0.26* 3.56±0.25*# suPAR/(ng/mL) 治疗前 4.25±0.26 4.28±0.27 治疗后 3.69±0.23* 3.15±0.20*# CRP/(mg/L) 治疗前 2.34±0.15 2.41±0.11 治疗后 2.18±0.12* 1.95±0.10*# TNF-α: 肿瘤坏死因子α;
suPARL: 可溶性尿激酶纤溶酶原激活物受体;
CRP: C反应蛋白。与治疗前比较, * P＜0.05;
与对照组比较, #P＜0.05。
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