2023 年第 4 期 第 18 卷

参芪丹鸡黄精汤加减联合西药治疗冠状动脉慢性完全闭塞病变患者的临床效果

Clinical effects of modified Shenqidanjihuangjing decoction combined with western medicine on the treatment of patients with coronary chronic total occlusion

作者：张娟1武佶2魏希进3薛一涛1

英文作者：Zhang Juan1 Wu Ji2 Wei Xijin3 Xue Yitao1

单位：1山东中医药大学附属医院心血管病二科，济南250000；2中国中医科学院广安门医院心血管科，北京100053；3山东中医药大学附属医院特检科，济南250000

英文单位：1The Second Department of Cardiovascular， Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250000 China; 2Department of Cardiovascular， Guang′anmen Hospital China Academy of Chinese Medical Sciences Beijing 100053 China; 3Department of Special Laboratory Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250000 China

关键词：冠状动脉慢性完全闭塞；参芪丹鸡黄精汤；主要不良心脑血管事件

英文关键词：Coronarychronictotalocclusion;Shenqidanjihuangjingdecoction;Majoradversecardiovascularandcerebrovascularevents

• 摘要：

• 目的 探讨参芪丹鸡黄精汤加减联合西药治疗冠状动脉慢性完全闭塞（CTO）病变患者的临床效果。方法 选择2019年4月至2020年2月于山东中医药大学附属医院就诊的冠状动脉CTO病变患者74例，根据随机数字表法分为观察组与对照组，各37例。对照组给予双联抗血小板聚集等西药治疗，观察组在对照组基础上给予参芪丹鸡黄精汤加减治疗。2组均治疗3个月。观察2组治疗前后中医证候评分、心脏彩色多普勒超声指标、血管内皮功能指标、西雅图心绞痛量表（SAQ）评分和随访6个月的主要不良心脑血管事件（MACCE）发生情况。结果 治疗后2组胸闷刺痛、心慌乏力、神疲气短、腹胀便溏评分均低于治疗前，且观察组均低于对照组（均P＜0.05）。治疗后2组左心室射血分数均高于治疗前，左心室舒张末期内径均低于治疗前，且观察组均优于对照组（均P＜0.05）。治疗后2组血栓素B2水平均低于治疗前，一氧化氮及血管内皮生长因子水平均高于治疗前，且观察组均优于对照组（均P＜0.05）。治疗后2组SAQ评分均高于治疗前，且观察组均高于对照组（均P＜0.05）。治疗后观察组全因死亡、急性致死性心肌梗死、急性心力衰竭发生率均低于对照组［2.7%(1/37)比18.9%(7/37)、0(0/37)比16.2%(6/37)、10.8%(4/37)比29.7%(11/37)］（均P＜0.05）。结论 参芪丹鸡黄精汤加减联合西药治疗可降低冠状动脉CTO病变患者中医证候评分，改善心功能及血管内皮功能，提高SAQ评分，降低心脏不良事件发生率。

• Objective To investigate the clinical effects of modified Shenqidanjihuangjing decoction combined with western medicine on the treatment of patients with coronary chronic total occlusion （CTO）. Methods From Apirl 2019 to February 2020, 74 patients with coronary CTO who visited to Affiliated Hospital of Shandong University of Traditional Chinese Medicine were selected. They were divided into observation group and control group according to the random number table method, with 37 cases in each group. The control group was treated with dual anti-platelet aggregation and other western drugs, while the observation group was treated with modified Shenqidanjihuangjing decoction on the basis of the control group. Both groups were treated for 3 months. The following aspects were observed in the two groups including traditional Chinese medicine syndrome score, cardiac color Doppler ultrasonography indexes, vascular endothelial function indexes and Seattle angina scale (SAQ) score before and after treatment, as well as the occurrence of major adverse cardiovascular and cerebrovascular events at 6 months follow-up. Results After treatment, the scores of chest tightness and tingling, palpitation and fatigue, tired and short of breath, abdominal distension and loose stool in the two groups were lower than those before treatment, and the above scores in the observation group were lower than those in the control group (all P＜0.05). Left ventricular ejection fraction increased and left ventricular end-diastolic diameter decreased in both groups compared with those before treatment, and the observation group was better than the control group (all P＜0.05). After treatment, levels of thromboxetin B2 in the two groups decreased, levels of nitric oxide and vascular endothelial growth factor increased, and the levels in the observation group were better than those in the control group (all P＜0.05). The SAQ scores in the two groups after treatment were higher than those before treatment, and the score in the observation group was higher than that in the control group (all P＜0.05). The incidences of all-cause death, acute fatal myocardial infarction and acute heart failure in the observation group were lower than those in the control group［2.7%(1/37) vs 18.9%(7/37), 0(0/37) vs 16.2%(6/37), 10.8%(4/37) vs 29.7%(11/37)］ (all P＜0.05). Conclusion Shenqidanjihuangjing decoction combined with western medicine can reduce the traditional Chinese medicine syndrome score, improve cardiac function, vascular endothelial function and SAQ score, and reduce the incidence of cardiac adverse events in patients with coronary CTO.