通心络胶囊对急性冠状动脉综合征患者介入治疗后血小板活化和血管内皮功能及预后的影响

Effect of Tongxinluo Capsule on Platelet Activities and Vascular Endothelial Functions as well as Prognosis in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

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中文关键词: 通心络胶囊急性冠状动脉综合征介入治疗血小板活化血管内皮功能

英文关键词:Tongxinluo Capsule acute coronary syndrome intervention platelet activation the endothelial function

基金项目:江西省中医药管理局科技计划资助项目(No.2007A054)

作者	单位
尹秋林	江西省人民医院心内二科江西省心血管病研究所
王洪	江西省人民医院心内二科江西省心血管病研究所
陆林祥	江西省人民医院心内二科江西省心血管病研究所
赖珩莉	江西省人民医院心内二科江西省心血管病研究所
洪浪	江西省人民医院心内二科江西省心血管病研究所
陈章强	江西省人民医院心内二科江西省心血管病研究所

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中文摘要:

目的探讨通心络胶囊对急性冠状动脉综合征(ACS)患者介入治疗后不同时期血小板活化状态和内皮功能以及预后的影响。方法 160例ACS患者随机分为通心络胶囊治疗组(80例,简称通心络组)和常规治疗组(80例,简称常规组),另设健康对照组50名,分别检测血浆血小板活化因子CD62p、CD63和糖蛋白(GP)Ⅱb/Ⅲa受体复合物水平,测定反映血管内皮功能的血浆血管性假血友病因子(vWF),内皮素-1(ET-1)和一氧化氮(NO),并测量内皮依赖性血管舒张功能(FMD)。在服用通心络胶囊治疗2个月和6个月后分别复查上述指标,进行治疗前后比较及两组间比较。结果与健康对照组比较,ACS患者血小板活化指标CD62p、CD63及GPⅡb/Ⅲa受体复合物、vWF因子及ET-1显著升高(P<0.01),NO及FMD显著降低(P<0.01)。冠脉介入术后CD62p、CD63、GPⅡb/Ⅲa受体复合物及vWF因子又较术前升高(P<0.05),FMD降低(P<0.05),但ET-1和NO差异无统计学意义(P>0.05)。治疗2个月和6个月后,常规组和通心络组CD62p、CD63、GPⅡb/Ⅲa受体复合物及vWF因子、ET-1均较治疗前显著下降(P<0.05,P<0.01),NO和FMD增加(P<0.05,P<0.01)。与常规组比较,通心络组CD62p、CD63、GPⅡb/Ⅲa受体复合物、vWF因子以及ET-1的水平降低更明显(P<0.05,P<0.01),NO和FMD的水平明显增加(均P<0.05),治疗6个月与本组治疗2个月比较,两组以上指标变化差异均有统计学意义(P<0.05,P<0.01)。常规组6个月发生心绞痛7例,心力衰竭6例,室速/室颤3例,猝死发生2例,而通心络组6个月仅发生心绞痛1例,心力衰竭1例,无室速/室颤和猝死的发生。结论通心络胶囊可用于ACS患者介入治疗后预防和治疗冠脉内血栓及保护血管内皮功能,改善预后。

英文摘要:

Objective To observe the effect of Tongxinluo Capsule on platelet activities and vascular endothelial functions as well as prognosis in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) at different stages.Methods 160 patients with acute coronary syndrome were randomly assigned to Tongxinluo(TXL) group(80 patients) and the conventional treatment group(80 patients).And 50 healthy subjects were set up as the health control group.Patients’ plasma platelet activating factors(CD62p,CD63),and glucose protein(GP) Ⅱb/Ⅲa,and endothelium-1(ET-1),von Willebrand factor(vWF),nitric oxide(NO) levels,and endothelium dependent flow-mediated dilatation(FMD) were detected respectively.Patients in the TXL group orally took TXLC for six months.The aforesaid indices were re-detected in all patients after two months and six months.Comparison between before and after treatment in the same group and inter-group comparison were performed in the two groups.Results Compared with the health control group,CD62p,CD63,GPⅡb/Ⅲa,vWF,and ET-1 levels increased significantly in ACS patients after PCI(all P<0.01),NO and FMD significantly decreased(P<0.01).CD62p,CD63,GPⅡb/Ⅲa and,vWF also increased,and FMD decreased after PCI(all P<0.05),but insignificant difference was found in ET-1 and NO(P>0.05).In the TXL group and the conventional treatment group,the levels of CD62p,CD63,GPⅡb/Ⅲa,vWF and ET-1 decreased significantly(P<0.05,P<0.01),NO and FMD increased(P<0.05,P<0.01) when compared with before treatment.Compared with the conventional treatment group,the decrement of CD62p,CD63,GPⅡb/Ⅲa and vWF(P<0.05,P<0.01),and the increment of FMD and NO(both P<0.05) were more obvious in the TXL group.The aforesaid indices were more obviously different between 6-month treatment and 2-month treatment in the TXL group and the conventional treatment group(P<0.05,P<0.01).Seven patients suffered from angina,six from heart failure,three from ventricular tachycardiac(VT)/ventricular fibrillation(VF),and two died suddenly in the conventional treatment group after six months of treatment,while only one suffered from angina,one from heart failure,and none from VT/VF or died suddenly in the TXL treatment group after 6 months of treatment.Conclusion TXL could be used in the prevention and treatment of coronary thrombosis,protect the vascular endothelial functions,as well as improve the prognosis of ACS patients after PCI.

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