2022 年第 4 期 第 17 卷

消斑化浊汤联合西医治疗稳定性冠心病合并颈动脉斑块的效果观察

Curative effect of Xiaoban Huazhuo decoction combined with western medicine on stable coronary atherosclerotic heart disease and carotid plaque

作者：王筱炜1魏希进2李焱2

英文作者：Wang Xiaowei1 Wei Xijin2 Li Yan2

单位：1山东中医药大学中医学院，济南250355；2山东中医药大学附属医院特检科，济南250011

英文单位：1School of Traditional Chinese Medicine Shandong University of Traditional Chinese Medicine Jinan 250355 China; 2Department of Special Laboratory Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250011 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；消斑化浊汤；颈动脉斑块

英文关键词：Coronaryatheroscleroticheartdisease;XiaobanHuazhuodecoction;Carotidplaque

• 摘要：

• 目的 观察消斑化浊汤联合西医治疗稳定性冠心病（冠状动脉粥样硬化性心脏病）合并颈动脉斑块的效果。方法 选取2019年12月至2020年6月山东中医药大学附属医院收治的94例稳定性冠心病合并颈动脉斑块患者，按照随机数字表法分为观察组和对照组，各47例。对照组进行冠心病常规治疗，观察组在对照组基础上予消斑化浊汤，均治疗4个月。比较2组中医疗效及治疗前后中医证候评分、血脂、血管新生功能指标、颈动脉超声指标及超声心动图指标。结果 观察组2例因不能耐受消斑化浊汤治疗而脱落，实际纳入45例；对照组1例因个人原因自行退出治疗、1例因未按医嘱服用药物而剔除，实际纳入45例。治疗后，观察组总有效率高于对照组［84.4%（38/45）比62.2%（28/45）］（P<0.05）；治疗后，2组胸闷、气喘、肢体沉重、痰多口黏评分均低于治疗前，且观察组均低于对照组［（1.15±0.27）分比（2.47±0.82）分、（1.41±0.43）分比（2.93±0.85）分、（1.65±0.72）分比（3.08±0.81）分、（1.89±0.93）分比（3.95±1.42）分］（均P＜0.001）。治疗后，2组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、血管内皮生长因子及碱性成纤维细胞生长因子水平均低于治疗前，且观察组均低于对照组，高密度脂蛋白胆固醇水平均高于治疗前，且观察组高于对照组（均P＜0.001）。治疗后，2组颈动脉内膜中层厚度、斑块面积、双侧脉搏波传导速度均小于治疗前，且观察组均小于对照组（均P＜0.001）；2组左心室舒张末期内径、左心室收缩末期内径均小于治疗前，且观察组均小于对照组，左心室射血分数、每搏输出量均高于治疗前，且观察组均高于对照组（均P＜0.001）。结论 消斑化浊汤联合西医治疗稳定性冠心病合并颈动脉斑块临床疗效显著，可有效改善患者心功能，缓解颈动脉狭窄，降低血脂水平。

• Objective To observe the curative effect of Xiaoban Huazhuo decoction combined with western medicine on stable coronary atherosclerotic heart disease and carotid plaque. Methods From December 2019 to June 2020, 94 patients with stable atherosclerotic coronary heart disease complicated with carotid plaque admitted to Affiliated Hospital of Shandong University of Traditional Chinese Medicine were enrolled. They were randomly divided into observation group and control group, with 47 cases in each group. The control group was treated with conventional western medicine, and the observation group was treated with Xiaoban Huazhuo decoction based on the control group, both for 4 months. The Chinese curative effect, traditional Chinese medicine syndrome score, serum lipid, angiogenic function indexes, carotid ultrasound and echocardiography indexes before and after treatment were compared between the two groups. Results Two patients in the observation group were removed due to intolerance to Xiaoban Huazhuo decoction, and 45 cases were included; in the control group, 1 case withdrew from the treatment personally, 1 case was removed due to ineffective medical compliance, and 45 cases were included. After treatment, the total effective rate of the observation group was higher than that of the control group［84.4%（38/45） vs 62.2%（28/45）］（P<0.05）; after treatment, scores of chest tightness, asthma, heavy limbs, and sputum and mucus of both group were lower than those before treatment, and those of the observation group were lower than those of the control group［（1.15±0.27） vs （2.47±0.82）,（1.41±0.43） vs （2.93±0.85），（1.65±0.72） vs （3.08±0.81）,（1.89±0.93） vs （3.95±1.42）］（all P＜0.001）. After treatment, levels of total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, vascular endothelial growth factor and basic fibroblast growth factor of both groups were lower than those before treatment, and those of the observation group were lower than those of the control group; the level of high-density lipoprotein cholesterol of both groups was higher than that before treatment, and that of the observation group was higher than that of the control group (all P<0.001). After treatment, carotid intima-media thickness, plaque area and bilateral pulse wave velocity of both groups were less than those before treatment, and those of the observation group were less than those of the control group (all P<0.001). After treatment, left ventricular end diastolic diameter and left ventricular end systolic diameter of both groups were smaller than those before treatment, and those of the observation group were smaller than those of the control group; left ventricular ejection fraction and stroke volume of both groups were higher than those before treatment, and those of the observation group were higher than those of the control group (all P<0.001). Conclusions Xiaoban Huazhuo decoction combined with western medicine has obviously clinical effects on stable coronary atherosclerotic heart disease complicated with carotid plaque. It can effectively improve patients′ cardiac function, relieve carotid artery stenosis and reduce blood lipid levels.