2019 年第 11 期 第 14 卷

酒石酸美托洛尔片联合稳心颗粒对冠状动脉粥样硬化性心脏病室性期前收缩患者心功能及纤溶因子水平的影响

Effect of metoprolol tartrate tablets combined with Wenxin granules on cardiac function and fibrinolytic factors in patients with coronary atherosclerotic heart disease and ventricualr premature beats

作者：蔡传耿夏冬何炳洪姚健

英文作者：

单位：510000广州,南方医科大学第三附属医院药学部（蔡传耿、夏冬、何炳洪）；110001沈阳医学院附属第二医院心胸外科（姚健）

英文单位：

关键词：冠状动脉疾病；室性期前收缩；酒石酸美托洛尔片；稳心颗粒；心功能；纤溶因子

英文关键词：

• 摘要：

• 【摘要】目的    探讨酒石酸美托洛尔片联合稳心颗粒对冠状动脉粥样硬化性心脏病(冠心病)室性期前收缩患者心功能及纤溶因子水平的影响。方法    选取2016年6月至2017年12月南方医科大学第三附属医院收治的冠心病室性期前收缩患者82例，按随机数字表法分为观察组和对照组，各41例。对照组口服酒石酸美托洛尔片治疗，观察组在对照组治疗基础上联合稳心颗粒治疗，2组均连续治疗3个月。比较2组治疗后临床疗效及中医证候积分疗效。比较2组患者治疗前后各中医证候积分及总积分、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）和血浆组织性纤溶酶原激活物（t-PA）、纤溶酶原活化剂抑制物1（PAI-1）水平。结果    治疗后观察组临床总有效率及中医证候积分总有效率均明显高于对照组［87.8%(36/41)比63.4%(26/41)、92.7%(38/41)比73.2%(30/41)］，差异均有统计学意义（均P＜0.001）。治疗前，2组各中医证候积分、LVESD、LVEDD、LVEF、t-PA、PAI-1水平比较，差异均无统计学意义（均P＞0.05）。治疗后，2组各中医证候(神疲乏力、心悸不安、少气懒言、胸闷气短、头晕健忘)积分及总积分、LVESD、LVEDD、血浆PAI-1水平均明显低于治疗前，且观察组明显低于对照［（0.9±0.8）分比（1.6±0.8）分、（0.7±0.6）分比（1.5±0.8）分、（0.9±0.7）分比（1.8±0.7）分、（0.9±0.7）分比（1.7±0.6）分、（1.0±0.7）分比（1.6±0.6）分、（4.4±3.1）分比（8.2±2.9）分、（32.6±2.5）mm比（41.7±3.6）mm、（49±4）mm比（54±5）mm、（61.8±2.8）μg/L比（73.2±3.6）μg/L］，LVEF、血浆t-PA水平均明显高于治疗前，且观察组明显高于对照组［（55±8）%比（49±8）%、（18.0±3.7）μg/L比（13.0±3.1）μg/L］，差异均有统计学意义（均P＜0.01）。结论    酒石酸美托洛尔片联合稳心颗粒可明显改善冠心病室性期前收缩患者临床症状及心功能，调节其纤溶系统功能，且疗效明显优于单独酒石酸美托洛尔片治疗。

• 【Abstract】Objective    To investigate the effect of metoprolol tartrate tablets combined with Wenxin granules on cardiac function and fibrinolytic factors in patients with coronary atherosclerotic heart disease(CHD) and ventricualr premature beats. Methods    A total of 82 patients with CHD and ventricualr premature beats admitted to the Third Affiliated Hospital of Southern Medical University from June 2016 to December 2017 were randomly divided into observation group and control group, with 41 cases in each group. The control group took metoprolol tartrate tablets. The observation group took metoprolol tartrate tablets and Wenxin granules. Both groups were treated for 3 months. Clinical efficacy was assessed. Traditional Chinese medicine（TCM） syndrome score, left ventricular end-systolic diameter(LVESD), left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), plasma tissue plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1) were analyzed before and after treatment. Results    Clinical total effective rate and the effective rate with respect to TCM syndrome score in observation group were significantly higher than those in control group［87.8%(36/41) vs 63.4%(26/41), 92.7%(38/41) vs 73.2%(30/41)］(both P＜0.001). Before treatment, there were no significant differences in TCM syndrome score, LVESD, LVEDD, LVEF, t-PA and PAI-1 levels between groups(all P＞0.05). TCM syndrome scores of separate items（fatigue, palpitation, lack of strength, chest tightness and shortness of breath, dizziness and forgetfulness） and the total score, LVESD, LVEDD and plasma PAI-1 level significantly decreased after treatment, and the indexes in observation group were lower than those in control group［（0.9±0.8） vs （1.6±0.8）, （0.7±0.6） vs （1.5±0.8）, （0.9±0.7） vs （1.8±0.7）, （0.9±0.7） vs （1.7±0.6）, （1.0±0.7） vs （1.6±0.6）, （4.4±3.1） vs （8.2±2.9）, （32.6±2.5）mm vs （41.7±3.6）mm, （49±4）mm vs （54±5）mm, （61.8±2.8）μg/L vs （73.2±3.6）μg/L］（all P＜0.01）. LVEF and plasma t-PA level significantly increased after treatment and they were higher in observation group than those in control group［（55±8）% vs （49±8）%, （18.0±3.7）μg/L vs （13.0±3.1）μg/L］(both P＜0.01). Conclusion    Metoprolol tartrate tablets combined with Wenxin granules treating coronary atherosclerotic heart disease with ventricualr premature beats can obviously ameliorate clinical symptoms, improve cardiac function and regulate fibrinolytic function, and the clinical effect is superior to taking metoprolol tartrate tablets alone.