桂枝茯苓汤对非ST段抬高急性冠脉综合征患者YKL-40及hs-CRP的影响

目的探讨非ST段抬高急性冠脉综合征（acute coronary syndrome， ACS）患者血清几丁质酶-3样蛋白-1（chitinase-3-like-1 protein， YKL-40）、高敏C-反应蛋白（high-sensitivity C-reactive protein， hs-CRP）水平变化及其与疾病严重程度的关系；观察桂枝茯苓汤对其血脂、YKL-40和hs-CRP水平的影响。方法选择新乡医学院第一附属医院中西医结合科2010年8月—2011年6月就诊的不稳定型心绞痛（unstable angina， UA）或非 ST段抬高型心肌梗死（non-ST segment elevation myocardial infarction， NSTEMI）患者72例，随机分为治疗组（36例）和对照组（36例）。两组均给予常规治疗，治疗组加用桂枝茯苓汤口服，共4周。所有患者入院时按病情严重程度UA分为低危、中危、高危及NSTEMI 4个等级。分析YKL-40、hs-CRP水平及病情严重程度间相关性。检测两组治疗前后甘油三酯（triglyceride， TG）、总胆固醇（total cholesterol， TC）、高密度脂蛋白胆固醇（high density lipoprotein cholesterol， HDL-C）、低密度脂蛋白胆固醇（low density lipoprotein cholesterol， LDL-C）。检测两组治疗前、治疗2周及治疗后血清YKL-40和hs-CRP水平。结果 YKL-40 及hs-CRP与病情严重程度间存在显著正相关（r=0.729，P<0.05；r=0.655，P<0.05）；YKL-40与hs-CRP间也存在显著正相关（r=0.848，P<0.05）。治疗前两组血脂水平及YKL-40、hs-CRP比较，差异均无统计学意义（P>0.05）。与本组治疗前比较，两组治疗2 周后YKL-40、hs-CRP均降低，治疗后TG、TC、LDL-C、YKL-40、hs-CRP均降低（P<0.05），HDL-C均升高（P<0.05）。与对照组同期比较，治疗组治疗后HDL-C升高（P<0.05），YKL-40、hs-CRP降低（P<0.05）。结论桂枝茯苓汤能在西药抗炎、改善血脂的基础上进一步降低ACS患者血清hs-CRP和YKL-40，升高HDL-C，起到抗动脉粥样硬化（atherosclerosis， AS）的作用。

英文摘要:

Objective To investigate the changes of serum levels of chitinase-3-like-1 protein （YKL-40） and high-sensitivity C-reactive protein （hs-CRP） in patients with non-ST segment elevation acute coronary syndrome （ACS）， to explore its correlation with its severity， and to observe the effects of Guizhi Fuling Decoction （GFD） on levels of blood lipids， YKL-40， and hs-CRP. MethodsRecruited were 72 patients with unstable angina （UA） or non-ST segment elevation myocardial infarction （NSTEMI） at Department of Integrative Medicine， First Affiliated Hospital of Xinxiang Medical College from August 2010 to June 2011. They were randomly assigned to the treatment group （36 cases） and the control group （36 cases）. All patients were treated by routine treatment， but patients in the treatment group took GFD additionally. The course of treatment was four weeks. According to the severity degree， all patients were graded to four ranks： low-risk group of UA， medium-risk group of UA， high-risk group of UA， and NSTEMI. The levels of YKL-40 and hs-CRP， and the correlation of severity degree were analyzed. Before and after treatment levels of triglyceride （TG）， total cholesterol （TC）， high density lipoprotein cholesterol （HDL-C）， low density lipoprotein cholesterol （LDL-C） were measured. Before treatment， at two weeks， and after treatment the serum levels of YKL-40 and hs-CRP were detected. The relationship of YKL-40， hs-CRP and the severity of the disease were analyzed. ResultsLevels of YKL-40 and hs-CRP were positively correlated with the severity of the disease respectively （r=0.729， P<0.05； r=0.655， P<0.05）. The positive correlation also existed between YKL-40 and hs-CRP （r=0.848， P<0.05）. There was no statistical difference in the levels of blood lipids， YKL-40， or hs-CRP between the two groups before treatment （P>0.05）. Compared with before treatment， the levels of YKL-40 and hs-CRP significantly decreased in both groups after two weeks of treatment （P<0.05）. The levels of TG， TC， LDL-C， YKL-40， and hs-CRP significantly decreased， while the HDL-C level increased in both groups after treatment （P<0.05）. The level of HDL-C in the treatment group was higher， while levels of YKL-40 and hs-CRP were lower after treatment， when compared with the control group （all P<0.05）. ConclusionOn the basis of anti-inflammation and adjusting blood lipids by Western medicine， GFD could further reduce the serum levels of YKL-40 and hs-CRP of ACS patients， elevate the HDL-C level， and play anti-atherosclerosis effects.

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