Clinical efficacy of Shexiang Tongxin Dropping Pill combined with conventional therapy in patients with myocardial ischemia reperfusion injury
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摘要:目的
探讨麝香通心滴丸联合常规治疗对心肌缺血再灌注损伤(MIRI)患者的临床疗效和相关机制。
方法选取96例经冠状动脉介入(PCI)治疗发生MIRI的急性心肌梗死(AMI)患者为研究对象，将其分为联合组和常规组，每组48例。联合组在常规组基础上加用麝香通心滴丸, 2组均连续治疗1个月。比较2组治疗前后心功能及心脏病理性重构指标、血清心肌损伤标志物、血清炎症相关指标水平及治疗效果。
结果联合组治疗总有效率为97.83%, 高于常规组的87.50%, 差异有统计学意义(P < 0.05); 2组患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、每搏心输出量(SV)、血清肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、N-末端脑钠肽前体(NT-ProBNP)较治疗前均有所改善，且联合组较常规组改善效果更显著，差异有统计学意义(P < 0.05); 2组患者治疗后血清NOD样受体家族3(NLRP3)炎症小体、超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)水平均下降，且联合组低于常规组，差异有统计学意义(P < 0.05)。
结论麝香通心滴丸联合常规治疗可缓解MIRI患者持续性心肌损伤，改善心功能和心脏病理性重构，治疗效果优于单纯西药治疗。
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关键词:
- 急性心肌梗死 /
- 心肌缺血再灌注损伤 /
- 麝香通心滴丸 /
- 炎性因子 /
- NOD样受体家族3炎症小体
Abstract:ObjectiveTo investigate the clinical efficacy and related mechanism of Shexiang Tongxin Dropping Pill combined with conventional therapy in patients with myocardial ischemia reperfusion injury (MIRI).
MethodsA total of 96 acute myocardial infarction (AMI) patients with MIRI after percutaneous coronary intervention (PCI) were selected as study objects, and were randomly divided into combined group and conventional group, with 48 cases per group. On the basis of conventional group, Shexiang Tongxin Dropping Pills were added to the combined group, and both groups were treated for 1 month. The indicators of cardiac function and cardiomyopathological remodeling, serum myocardial injury markers, inflammation indicators and efficacy before and after treatment were compared.
ResultsThe effective rate in the combined group was 97.83%, which was higher than 87.50% in the conventional group (P < 0.05); the left ventricular end diastolic diameter (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF), stroke volume (SV), serum creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-ProBNP) were improved in both groups compared with those before treatment, and the combined group had more improvement than the conventional group (P < 0.05); the serum levels of nod-like receptor protein 3 (NLRP3) inflammasome, hypersensitive C-reactive protein (hs-CRP) and interleukin-1β (IL-1β) in the two groups were decreased after treatment, and the combined group decreased more significantly than the conventional group (P < 0.05).
ConclusionShexiang Tongxin Dropping Pill combined with conventional treatment can relieve persistent myocardial injury, improve cardiac function and cardiomyopathological remodeling in patients with MIRI, and the therapeutic effect is superior to western medicine alone.
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表 1 2组患者基线资料比较(x±s)[n(%)]
指标 联合组(n=48) 常规组(n=48) 性别 男 31(64.58) 32(66.67) 女 17(35.42) 16(33.33) 吸烟史 30(62.50) 31(64.58) 饮酒史 24(50.00) 22(45.83) 高血压 38(79.17) 39(81.25) 植入支架数量/个 1.56±0.61 1.54±0.54 血红蛋白/(g/L) 133.77±9.56 127.38±11.76 血小板/(×109/L) 221.08±34.02 233.17±27.96 空腹血糖/(mmol/L) 7.92±2.43 7.75±2.53 甘油三酯/(mmol/L) 2.58±0.82 2.35±1.37 LDL-C/(mmol/L) 2.30±0.79 2.24±0.70 ALT/(U/L) 32.06±3.86 29.13±5.31 AST/(U/L) 47.29±12.24 50.56±10.32 尿素氮/(mmol/L) 6.88±1.77 7.08±1.82 肌酐/(μmol/L) 84.15±18.11 82.40±16.82 LDL-C: 低密度脂蛋白胆固醇; ALT: 丙氨酸氨基转移酶;
AST: 天门冬氨酸氨基转移酶。
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表 2 2组患者心电图疗效比较[n(%)]
组别 n 显效 有效 无效 总有效 联合组 48 25(52.08) 21(43.75) 2(4.17) 46(95.83) 常规组 48 20(41.67) 22(45.83) 6(12.50) 42(87.50)
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表 3 2组患者治疗前后心脏超声指标比较(x±s)
组别 时点 LVEDD/mm LVESD/mm LVEF/% SV/mL 联合组(n=48) 治疗前 59.65±9.37 43.66±6.86 46.47±8.32 51.54±6.17 治疗后 51.32±6.76*# 32.34±5.24*# 61.43±7.86*# 70.31±4.56*# 常规组(n=48) 治疗前 60.18±8.67 44.17±6.33 45.81±9.25 50.33±7.48 治疗后 55.41±7.13* 37.81±5.86* 52.76±6.61* 61.37±5.92* LVEDD: 左心室舒张末期内径; LVESD: 左心室收缩末期内径; LVEF: 左心室射血分数; SV: 每搏心输出量。
与治疗前比较, *P < 0.05; 与常规组比较, #P < 0.05。
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表 4 2组治疗前后血清心肌损伤标志物水平比较(x±s)
组别 时点 CK-MB/(U/L) cTnI/(ng/mL) NT-ProBNP/(pg/mL) 联合组(n=48) 治疗前 276.44±38.62 27.58±5.71 2 654.34±968.56 治疗后 12.13±4.28*# 0.05±0.08*# 167.47±43.23*# 常规组(n=48) 治疗前 269.37±44.31 29.49±4.62 2 824.75±712.76 治疗后 21.46±4.72* 0.17±0.12* 392.36±54.77* CK-MB: 肌酸激酶同工酶; cTnI: 肌钙蛋白I; NT-ProBNP: N-末端脑钠肽前体。
与治疗前比较, *P < 0.05; 与常规组比较, #P < 0.05。
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表 5 2组患者治疗前后血清炎症相关指标比较(x±s)
组别 时点 hs-CRP/(mg/L) NLRP3炎症小体/(pg/mL) IL-1β/(ng/mL) 联合组(n=48) 治疗前 36.24±8.64 89.56±15.42 23.61±6.53 治疗后 7.54±1.33*# 13.22±11.68*# 4.36±1.37*# 常规组(n=48) 治疗前 38.15±6.72 91.26±13.14 21.87±8.85 治疗后 18.65±4.87* 29.41±14.56* 10.16±2.94* hs-CRP: 超敏C反应蛋白; NLRP3: NOD样受体家族3; IL-1β: 白细胞介素-1β。
与治疗前比较, *P < 0.05; 与常规组比较, #P < 0.05。
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