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目的评价病证结合模式干预冠状动脉粥样硬化性心脏病(冠心病)患者的临床疗效和长期预后。方法随机选择自2011年8月~2012年2月住院治疗的冠心病患者630例,随机分为病证结合治疗组(干预组,315例)和西医常规治疗组(对照组,315例)。干预组在西医常规治疗基础上根据不同中医症候加服中成药治疗,连服6个月,然后从临床症状、实验室检查结果以及不良预后方面评估两种治疗模式的疗效。结果与治疗前比较,治疗6个月后两组中医主症积分、焦虑和抑郁评分均显著降低,且与对照组相比,干预组上述三个评分降低幅度更大(P<0.05)。干预组中,使用心可舒片治疗的亚组患者有97例,与对照组相比,该亚组患者治疗6个月后焦虑和抑郁评分降低更明显(P<0.05)。与治疗前比较,两组患者血清超敏C反应蛋白(hs-CRP)水平及ADP、AA介导的血小板聚集率均显著降低;干预组上述三个指标降低幅度均较对照组更大(P<0.05)。2年随访中,干预组主要不良心血管事件(MACEs)发生率显著低于对照组(P<0.05)。结论中西医病症结合模式能够改善冠心病患者中医症候,有抗炎,降低血小板聚集率,调节情志等作用,并且可改善患者远期预后。
Objective To evaluate the clinical efficacy and long-term prognosis of patients with coronary atherosclerotic heart disease (CHD) treated by combination of disease and syndromes. Methods 630 patients with coronary heart disease admitted to hospital from August 2011 to February 2012 were randomly divided into treatment group (intervention group, 315 cases) and conventional treatment group (control group, 315 cases). The intervention group was treated with traditional Chinese medicine plus traditional Chinese medicine on the basis of conventional treatment of Western medicine for 6 months, then the curative effect of the two treatment modes was evaluated in terms of clinical symptoms, laboratory test results and adverse prognosis. Results Compared with those before treatment, the main symptom scores, anxiety and depression scores of the two groups were significantly decreased after 6 months of treatment. Compared with the control group, the above three scores of the intervention group decreased more significantly (P <0.05). In the intervention group, there were 97 patients in the subgroup treated with XK tablets. The anxiety and depression scores of this subgroup decreased more significantly (P <0.05) 6 months after treatment compared with the control group. Compared with those before treatment, serum hs-CRP and ADP and AA-mediated platelet aggregation were significantly decreased in both groups (P <0.05). The three indexes in intervention group were significantly lower than those in control group (P <0.05). At 2-year follow-up, the incidence of major adverse cardiovascular events (MACEs) in the intervention group was significantly lower than that in the control group (P <0.05). Conclusion The combination of TCM and WM can improve TCM symptoms in patients with coronary heart disease, have anti-inflammatory, reduce platelet aggregation rate, regulate emotion and so on, and can improve long-term prognosis of patients.