理气化痰祛瘀法治疗冠心病合并高脂血症（痰瘀互阻证）45例

Liqi Huatan Qutan Method Treatment on Coronary Heart Disease Combine Hyperlipidaemia (Stasis Stagnation Syndrome) with 45 Cases

摘要:

目的：观察半夏白术天麻汤与丹参饮加减治疗冠心病稳定型心绞痛合并高脂血症（痰瘀互阻证）临床疗效及对脂蛋白相关磷脂酶A₂（Lp-PLA₂）、小板α-膜颗粒蛋白（GMP-140）和血小板聚集率（ADP）的影响。方法：将90例患者随机按门诊前后顺序分为观察组和对照组各45例。两组均给予基础治疗，包括拜阿司匹林肠溶片，0.1 g/次，1次/d，口服；硝酸甘油片，1片/次，必要时舌下含服。对照组采用阿托伐他汀钙片，20 mg/次，1次/d，晚餐后口服。观察组在对照组治疗的基础上加服半夏白术天麻汤与丹参饮加减，1剂/d。两组疗程均为12周。检测治疗前后血脂水平，记录每周心绞痛发作次数及硝酸甘油片的用量；进行治疗前后心电图检查；检测Lp-PLA₂，GMP-140，高敏c-反应蛋白（hs-CRP）及血小板聚集率（ADP）水平。结果：观察组心电图疗效总有效率为82%优于对照组的60%（P<0.05）；观察组每周心绞痛发作次数及硝酸甘油片用量均少于对照组（P<0.01）；观察组降脂疗效总有效率95.6%，对照组为91.1%，两组比较差异无统计学意义；治疗后观察组胆固醇（TC）和甘油三酯（TG）水平低于对照组（P<0.01），两组治疗后低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）组间比较差异无统计学意义；治疗后观察组Lp-PLA₂，GMP-140，hs-CRP及ADP均低于对照组（P<0.01）。结论：半夏白术天麻汤与丹参饮加减能改善冠心病稳定型心绞痛合并高脂血症患者血脂水平，减轻心绞痛症状，起到综合的治疗效应；还能降低炎性因子，抑制血小板聚集，从而对冠心病不良事件起到预防作用。

Abstract:

Objective: The purpose is to observe the clinical effects of Banxiao Baizhu Tianma decoction combined with Danshen decoction add and subtract treatment on coronary heart disease stable angina pectoris combine hyperlipidaemia(stasis stagnation syndrome).Beside, to observe the influence of these treatment on lipoprotein associated phospholipase A₂(Lp-PLA₂), α-granule membrane protein on platelet surface(GMP-140) and platelet maximum condensation rate (ADP). Method: Ninety cases of patients were randomly divided into control group (45 cases) and observation group (45 cases) by sequential order of outpatient. Both groups received basic treatment, including bayaspirin enteric-coated tablets, 0.1 g/time, 1 piece/day, taken sublingual buccal immunotherapy.Nitroglycerin tablets, 1 piece/day, taken buccally when necessary.For patients in control group, they took atorvastatin, 20 mg/time, 1 does/day, taken orally.Patients in observation group took Banxiao Baizhu Tianma decoction combined Danshen decoction, 1 does/day.Treatment courses continued 12 weeks.Detect blood lipid level, record attack frequency of angina pectoris each week and nitroglycerin tablet before and after treatment.Conduct electrocardiographic examination before and after treatment.Test the level of Lp-PLA₂, GMP-140, high-sensitivity C-reactive protein(hs-CRP)and ADP. Result: The total curative effective rate of electrocardiogram of the observation group was 82.0% superior to 60% of the control group(P<0.05), for the observation group, the time of stenocardia and the dosage of nitroglycerin tablets were both less than that of the control group(P<0.01), and the total curative effective rate of reducing lipid of the observation group was 95.6% higher than 91.1% of the control group, and there was no statistically significant difference, after treatment, the level of cholesterol(TC) and triglyceride(TG) of the observation group was lower than that of the control group(P<0.01), and there was no statistically significant difference between low density lipoprotein cholesterol(LDL-C) group and high density lipoprotein cholesterol(HDL-C) group, Besides, the level of Lp-PLA₂, GMP-140, hs-CRP and ADP of the observation group were all lower than that of the control group(P<0.01). Conclusion: It can ameliorate patients' level of blood lipid of when Banxia Baizhu Tianma decoction which combined with Danshen decoction was used in coronary heart disease and stable angina pectoris pooling hyperlipidemia, and it can also relief angina symptom, we can get comprehensive curative effect. What's more it can relief inflammatory factors, inhibit platelet aggregation, there is a preventive effect to adverse events coronary heart disease.