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目的观察活血通脉汤联合西医常规治疗防治冠状动脉支架植入术后再狭窄的疗效及可能机制。方法将成功行冠状动脉支架置入术的急性冠脉综合征患者60例随机分为治疗组和对照组各30例。对照组给予西医常规治疗,治疗组在对照组的基础上加服活血通脉汤,每日1剂,两组均治疗6个月。于术前、术后及服药6个月后观察两组血浆患者氧化低密度脂蛋白(ox-LDL)、高敏C-反应蛋白(hs-CRP)、血脂[包括总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、中医证候积分及心绞痛症状积分的变化,并比较术后支架再狭窄支数。结果两组术后hs-CRP、ox-LDL、TC、TG及LDL-C、中医证候积分和心绞痛症状积分与术前比较明显减低,HDL-C明显升高(P<0.05);治疗组服药6个月后hs-CRP低于术后,ox-LDL、心绞痛症状积分和中医证候积分高于术后,而对照组hsCRP、TC、TG、LDL-C、心绞痛症状积分和中医证候积分均高于术后,HDL-C低于术后(均P<0.05);治疗6个月后治疗组hs-CRP、ox-LDL、TC、TG和LDL-C低于术前,HDL-C高于术前(均P<0.05),心绞痛症状积分和中医证候积分两组均低于术前(P<0.05);治疗组服药6个月后hs-CRP、ox-LDL、TC、TG、LDL-C、心绞痛症状积分和中医证候积分与对照组同时间比较明显减低,而HDL-C高于对照组(P<0.05)。治疗组患者术后普通支架(1支)、药物洗脱支架(0支)及总支架再狭窄数(1支)与对照组比较(分别为5支、2支、7支)均明显降低(P<0.05)。结论活血通脉汤联合西医常规治疗能够减少冠状动脉支架植入术后再狭窄情况,明显缓解术后患者的临床症状,其作用机理可能与改善血脂及降低血浆ox-LDL、hs-CRP水平有关。
Objective To observe the curative effect and possible mechanism of Huoxuetongmaitang combined with conventional western medicine in prevention and treatment of restenosis after coronary stent implantation. Methods Sixty patients with acute coronary syndrome who underwent coronary stent implantation were randomly divided into treatment group (n = 30) and control group (n = 30). The control group was given routine treatment of Western medicine. The treatment group added Huoxuetongmai Decoction on the basis of the control group, one day. Both groups were treated for 6 months. The plasma levels of ox-LDL, hs-CRP, blood lipid [including total cholesterol (TC), triglyceride TG, LDL-C, HDL-C, TCM syndrome scores and angina symptom score were analyzed. The number of stent restenosis after operation was compared. Results The scores of hs-CRP, ox-LDL, TC, TG and LDL-C, TCM syndrome scores and angina pectoris scores were significantly decreased and HDL-C significantly increased in both groups The hs-CRP was lower than postoperative at 6 months after treatment, and the scores of ox-LDL, angina pectoris symptom scores and TCM syndromes were higher than those of the postoperative patients. However, the scores of hsCRP, TC, TG, LDL-C, The levels of HDL-C in the treatment group were lower than those in the control group (all P0.05). The levels of hs-CRP, ox-LDL, TC, TG and LDL- (P <0.05). Angina pectoris symptom scores and TCM syndrome scores were lower in both groups (P <0.05). The levels of hs-CRP, ox-LDL, TC, TG, LDL-C, angina pectoris symptom scores and TCM syndrome scores were significantly decreased compared with the control group, while HDL-C was higher than the control group (P <0.05). In the treatment group, the average number of stent (1 piece), drug-eluting stent (0 piece) and total stent restenosis number (1 piece) was significantly lower than that of the control group (5 pieces, 2 pieces and 7 pieces) P <0.05). Conclusions Huoxuetongmai combined with conventional western medicine can reduce the restenosis after coronary stenting and relieve the clinical symptoms of postoperative patients. The mechanism may be related to the improvement of serum lipids and the level of plasma ox-LDL and hs-CRP .