| | | 心脉通胶囊对冠心病患者心肌缺血总负荷影响及其作用机制探讨
| | 中药学论文内容提要 目的中药学论文：观察心脉通胶囊对缺血性心脏病的中药学论文治疗作用。方法：60例冠心病心肌缺血患者随机分为心脉通组(30例，常规西药加心脉通胶囊治疗)与对照组(30例，单用常规西药治疗)，观察治疗前后临床症状计分、心肌缺血总负荷(TIB)、血浆内皮素(ET)、一氧化氮(NO)和血清超氧化物歧化酶(SOD)、丙二醛(MDA)的变化。结果：治疗后心脉通组临床症状计分、TIB、ET、MDA下降幅度明显大于对照组(P＜0.01)，NO、SOD上升水平明显高于对照组(P＜0.01)。结论：心脉通胶囊有较好抗心肌缺血作用，血管内皮保护效应及抗脂质过氧化损伤是其作用机理之一，加用心脉通胶囊治疗缺血性心脏病比单用西药效果更好。
Effect of Xinmaitong Capsule on Total Ischemia Burden in Coronary Heart Disease Patients with Myocardial Ischemia and Analysis of Its Therapeutical Mechanism
Objective: To assess the effect of Xinmaitong (XMT) capsule in treating ischemial cardiac disease.Methods: Sixty coronary heart disease (CHD) patients with myocardial ischemia were divided randomly into two groups. XMT group (30 cases) was treated with XMT plus western medicine, and control group (30 cases) with western medicine alone. The changes of the scores for clinical symptoms, the total ischemia burden (TIB), the plasma endothelin (ET), the nitric oxide (NO), the superoxide dismutase (SOD), and the malonyldialdeyde (MDA) levels were observed before and after treatment.Results: After treatment with XMT the scores of clinica l symptoms, TIB, ET and MDA levels were significantly decreased (P＜0.01), the levels of NO and SOD were significantly increased (P＜0.01) in the XMT group, comparing with the control group these changes were statistically different (P＜0.01).Conclusions: XMT capsule can act against myocardial ischemia effectively, one of the mechanisms of which is protecting the function of vascular endothelium and resisting lipid peroxidation injury. The effects of adding XMT capsule on conventional treatment of western medicine were better than those of using western medicine alone.
Key words Xinmaitong capsule, myocardial ischemia, total ischmia burden, vascular endothelium, lipid peroxidation
近年来动态心电图(Holter)已成为有效的评价心肌缺血方法之一(1，2)，动态心电图心肌缺血总负荷(total ischemia burden, TIB)应用，使心肌缺血监测进一步定量化，并作为冠心病治疗依据和疗效评价有价值指标之一。我们以心肌缺血总负荷为主要观测指标，观察中药复方心脉通胶囊(简称心脉通)抗心肌缺血作用，同时观察用药前后血浆内皮素(ET)、一氧化氮(NO)和血清超氧化物歧化酶(SOD)、丙二醛(MDA)水平的变化，以探讨心脉通对心肌的保护作用可能机制。
资料和方法
1 病例选择及分组 病例来源于本院心内科、中医科病房和心血管专科门诊患者，根据WHO《缺血性心脏病的命名及诊断标准》(3)，选择经动态心电图检查发现有明显发作性心肌缺血者60例，随机分为心脉通组30例，常规西药治疗组(对照组)30例。按卫生部1993年制订发布《中药新药治疗胸痹(冠心病心绞痛)的临床研究指导原则》(4)，确定冠心病分型和中医证型。心脉通组男12例，女18例；年龄47～70岁，平均56.4岁；病程8周～10年，平均2.7年。中医分型：气滞血瘀型14例，气阴两虚型13例，痰浊血瘀型3例；西医分型：冠心病心绞痛26例(劳力型14例，自发型9例，混合型3例)，无痛性心肌缺血4例；对照组男11例，女19例；年龄45～72岁，平均58.5岁；病程6周～11年，平均2.9年。中医分型：气滞血瘀型12例，气阴两虚型14例，痰浊血瘀型4例；西医分型：冠心病心绞痛27例(劳力型15例，自发型10例，混合型2例)，无痛性心肌缺血3例；两组一般情况相似，具可比性。
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