Evaluation of the Effect of Suxiao Jiuxin Pills on Myocardial Damage in Acute STEMI with Qi Stagnation and Blood Stasis Based on Intracoronary Electrocardiogram
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摘要: 目的 基于冠状动脉腔内心电图评价速效救心丸对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)气滞血瘀证心肌损伤的影响。方法 选择2019年3月至2020年2月于南京中医药大学附属中西医结合医院行经皮冠状动脉介入治疗(Percutaneous coronary intervention, PCI)术的急性STEMI气滞血瘀证60例, 采用随机数字表法分为对照组和研究组各30例。2组均给予术前标准治疗, 研究组术前加予速效救心丸含服。观察PCI术前及术后1周2组患者中医证候积分变化、临床疗效, 以及术后冠状动脉罪犯血管腔内心电图ST段回落值(ΔIST)和心肌梗死溶栓治疗(Thrombolysis myocardial infarction, TIMI)血流。结果 治疗后, 研究组中医临床疗效和ΔIST显著高于对照组(P < 0.05);2组各项中医证候积分均显著下降(P < 0.01), 且研究组胸闷、胸胁胀满、自汗证候积分显著低于对照组(P < 0.05)。2组患者术后TIMI血流分级以及不良反应无统计学差异(P>0.05)。结论 术前给予速效救心丸可进一步减少急性STEMI气滞血瘀证患者的心肌损伤, 改善临床症状, 提高中医临床疗效, 且不增加不良反应。Abstract: OBJECTIVE To evaluate the effect of Suxiao Jiuxin pills on myocardial damage in acute ST-segment elevation myocardial infarction (STEMI) with qi stagnation and blood stasis based on intracoronary electrocardiogram.METHODS 60 acute STEMI patients with qi stagnation and blood stasis who underwent percutaneous coronary intervention (PCI) directly from March 2019 to February 2020 at Integrated Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine were selected. Besides, according to the random number table, these patients were divided into the control group and the study group, with 30 cases in each group. The two groups were given standard preoperative treatment, while based on that, the study group was given sublingual administration of Suxiao Jiuxin pills. The clinical efficacy of traditional Chinese medicine (TCM), as well as TCM syndrome score and adverse reactions were compared between the two groups after one week of treatment. In addition, the value of ST-segment resolution (ΔIST) of intracoronary electrocardiogram combined with the blood flow of thrombolysis and thrombin inhibition in myocardial infarction (TIMI) were compared after PCI.RESULTS The TCM clinical efficacy and ΔIST in the study group were significantly higher than those in the control group (P < 0.05), while the TCM syndrome scores of both groups were decreased significantly (P < 0.01). In addition, the syndrome scores of chest distress, distention and fullness in the chest and hypochondriac region, as well as spontaneous sweating in the study group were significantly lower than those in the control group (P < 0.05). However, there was no statistical difference in the postoperative TIMI flow grades and adverse reactions between the two groups (P>0.05).CONCLUSION Preoperative administration of Suxiao Jiuxin pills can further reduce myocardial damage, alleviate clinical symptoms, and enhance the TCM clinical efficacy without increasing adverse reactions in patients with acute STEMI with qi stagnation and blood stasis.
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表 1 2组基线资料比较(x±s, n=30)
组别 性别 年龄/岁 危险因素 血肌酐/(μmol·L-1) 男 女 高血压 糖尿病 吸烟 对照组 25 5 62.43±13.34 16 12 9 76.70±36.99 研究组 25 5 59.67±12.68 13 15 13 80.10±49.70 组别 血脂 炎症指标 TC/(mmol·L-1) LDL-C/(mmol·L-1) HDL-C/(mmol·L-1) h-CRP/(mg·L-1) IL-6/(pg·mL-1) 对照组 4.43±1.72 2.82±1.24 1.03±0.28 24.57±22.98 34.87±23.85 研究组 4.28±1.02 2.93±0.98 1.07±0.43 26.50±25.51 39.26±27.00 组别 cTn 胸痛时间/h 罪犯血管 术后用药 cTnT/(pg·mL-1) cTnⅠ/(ng·mL-1) RCA LAD LCX β阻剂 硝酸酯类 ACEI/ARB 对照组 2 554.21±2 507.28 18.05±16.75 5.95±5.70 10 16 4 24 14 27 研究组 2 641.02±2 565.45 16.47±11.96 6.63±5.78 12 12 6 26 16 25 注: TC.总胆固醇; LDL-C.低密度脂蛋白; HDL-C.高密度脂蛋白; h-CRP.高敏C反应蛋白; IL-6.白细胞介素6;cTn.肌钙蛋白; cTnT.肌钙蛋白T; cTnⅠ.肌钙蛋白Ⅰ; RCA.右冠状动脉; LAD.左前降支; LCX.回旋支; β阻剂.β受体阻滞剂; ACEI.血管紧张素转换酶抑制剂; ARB.血管紧张素Ⅱ受体抑制剂。 
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表 2 2组患者中医临床疗效比较(n=30)
组别 显效 有效 无效 加重 有效率/% 对照组 18 7 4 1 83.33 研究组 22 6 2 0 93.33# 注: 2组比较, χ2=4.735, #P < 0.05。
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表 3 2组患者治疗前后中医证候积分比较[中位数(四分位间距), n=30]
组别 时间 胸痛 胸闷 胸胁胀满 自汗 总积分 对照组 治疗前 4.00(4.00) 4.00(4.00) 2.00(2.00) 4.00(4.00) 14.00(4.50) 治疗后 0.00(2.00)** 2.00(4.00)** 2.00(2.00)** 2.00(2.00)** 5.00(4.00)** 研究组 治疗前 4.00(4.00) 4.00(4.00) 2.00(2.00) 4.00(4.00) 15.00(6.00) 治疗后 0.00(2.00)** 0.00(2.00)**# 0.00(2.00)**# 0.00(2.00)**# 2.00(2.00)**## 注: 组内比较, **P < 0.01;2组比较, #P < 0.05, ##P < 0.01。
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表 4 2组患者ΔIST与TIMI血流分级比较(x±s, n=30)
组别 ΔIST/mV TIMI血流分级 0级 1级 2级 3级 对照组 0.10±0.06 0 1 2 27 研究组 0.20±0.08# 0 0 3 27 注: 组间比较, #P < 0.05。
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[1] 葛均波, 徐永健. 内科学[M]. 8版. 北京: 人民卫生出版社, 2013: 242. [2] THIELE H, DESCH S, DE WAHA S. Acute myocardial infarction in patients with ST-segment elevation myocardial infarction: ESC guidelines 2017[J]. Herz, 2017, 42(8): 728-738. doi: 10.1007/s00059-017-4641-7 [3] REED GW, ROSSI JE, CANNON CP. Acute myocardial infarction[J]. Lancet, 2017, 389(10065): 197-210. doi: 10.1016/S0140-6736(16)30677-8 [4] BEKKERS SC, YAZDANI SK, VIRMANI R, et al. Microvascular obstruction: Underlying pathophysiology and clinical diagnosis[J]. J Am Coll Cardiol, 2010, 55(16): 1649-1660. doi: 10.1016/j.jacc.2009.12.037 [5] YU H, KALOGERIS T, KORTHUIS RJ. Reactive species-induced microvascular dysfunction in ischemia/reperfusion[J]. Free Radic Biol Med, 2019, 135: 182-197. doi: 10.1016/j.freeradbiomed.2019.02.031 [6] HEUSCH G, SCHULZ R, HAUDE M, et al. Coronary microembolization[J]. J Mol Cell Cardiol, 2004, 37(1): 23-31. doi: 10.1016/j.yjmcc.2004.04.011 [7] NICCOLI G, SCALONE G, LERMAN A, et al. Coronary microvascular obstruction in acute myocardial infarction[J]. Eur Heart J, 2016, 37(13): 1024-1033. doi: 10.1093/eurheartj/ehv484 [8] 陈琳, 张艳, 陈勇. 速效救心丸对心肌缺血大鼠心肌损伤相关蛋白表达的影响[J]. 中草药, 2021, 52(5): 1369-1375. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYO202105017.htm [9] 陈亚妮, 高俊杰, 朱文叶, 等. 速效救心丸干预心肌缺血/再灌注大鼠线粒体通透性转换孔及心肌细胞凋亡[J]. 中成药, 2015, 37(3): 469-473. doi: 10.3969/j.issn.1001-1528.2015.03.001 [10] CHEN C, WANG FQ, XIAO W, et al. Effect on platelet aggregation activity: Extracts from 31 traditional Chinese medicines with the property of activating blood and resolving stasis[J]. J Tradit Chin Med, 2017, 37(1): 64-75. doi: 10.1016/S0254-6272(17)30028-6 [11] HISHIKARI K, KAKUTA T, LEE T, et al. ST-segment elevation on intracoronary electrocardiogram after percutaneous coronary intervention is associated with worse outcome in patients with non-ST-segment elevation myocardial infarction[J]. Catheter Cardiovasc Interv, 2016, 87(4): e113-e121. doi: 10.1002/ccd.26072 [12] WONG DT, LEUNG MC, DAS R, et al. Intracoronary ECG during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction predicts microvascular obstruction and infarct size[J]. Int J Cardiol, 2013, 165(1): 61-66. doi: 10.1016/j.ijcard.2011.07.078 [13] VASSILEV D, DOSEV L, COLLET C, et al. Intracoronary electrocardiogram to guide percutaneous interventions in coronary bifurcations-a proof of concept: The FIESTA(Ffr vs. IcEcgSTA) study[J]. Eurointervention, 2018, 14(5): e530-e537. doi: 10.4244/EIJ-D-17-00189 [14] THYGESEN K, ALPERT JS, JAFFE AS, et al. Fourth universal definition of myocardial infarction(2018)[J]. Eur Heart J, 2019, 40(3): 237-269. doi: 10.1093/eurheartj/ehy462 [15] 中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 54-58. [16] ANTMAN EM, COHEN M, BERNINK PJ, et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making[J]. JAMA, 2000, 284(7): 835-842. doi: 10.1001/jama.284.7.835 [17] 中国医师协会急诊医师分会, 中华医学会心血管病学分会, 中华医学会检验医学分会. 急性冠脉综合征急诊快速诊疗指南[J]. 中华急诊医学杂志, 2016, 25(4): 397-404. doi: 10.3760/cma.j.issn.1671-0282.2016.04.002 [18] 华芳, 赵玉玲, 李莞, 等. 川芎及其中成药抗凝血作用测定方法的研究[J]. 中草药, 2019, 50(7): 1698-1702. [19] 景云佳. 速效救心丸对胸痹气滞血瘀证冠心病患者冠状动脉内径的影响[D]. 南京: 南京中医药大学, 2014. [20] 李迪, 刘剑雄, 徐俊波, 等. 冠状动脉内心电图ST段改变对冠心病患者PCI相关心肌损伤判断价值[J]. 四川医学, 2016, 37(4): 399-403. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX201604014.htm [21] BALIAN V, MARCASSA C, GALLI M, et al. Intracoronary electrocardiogram ST segment shift evaluation during intravenous adenosine infusion: A comparison with fractional flow reserve[J]. Cardiol J, 2011, 18(6): 662-667. doi: 10.5603/CJ.2011.0030 [22] YAJIMA J, SAITO S, HONYE J, et al. Intracoronary electrocardiogram for early detection of myocardial viability during coronary angioplasty in acute myocardial infarction[J]. Int J Cardiol, 2001, 79(2/3): 293-299. http://www.onacademic.com/detail/journal_1000035491613810_387a.html -
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