加味柴胡桂枝汤治疗气滞血瘀型冠心病稳定性心绞痛伴焦虑/抑郁的临床研究

皇甫海全; 黄慧春; 于海睿; 商晓明; 廖蔚茜

doi:10.14148/j.issn.1672-0482.2023.1122

加味柴胡桂枝汤治疗气滞血瘀型冠心病稳定性心绞痛伴焦虑/抑郁的临床研究

doi: 10.14148/j.issn.1672-0482.2023.1122

1.
上海中医药大学深圳医院/深圳市罗湖区中医院, 广东深圳 518000
2.
广州中医药大学第七临床医学院, 广东广州 510006

基金项目:

广东省中医药局中医药科研项目 20222197

深圳市宝安区基础研究(医疗卫生类)项目 2021JD301

深圳市宝安区基础研究(医疗卫生类)项目 2021JD157

深圳市罗湖区软科学研究计划项目 LX202302068

深圳市罗湖区软科学研究计划项目 LX202302082

详细信息

作者简介:
皇甫海全, 男, 主治医师, E-mail: ss300155@shutcm.edu.cn

通讯作者:
廖蔚茜, 女, 教授, 主任医师, 主要从事中医药防治心血管系统疾病研究, E-mail: reesee@126.com

中图分类号: R256.21
计量
- 文章访问数: 143
- HTML全文浏览量: 15
- PDF下载量: 30
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-05
- 网络出版日期: 2023-11-24
- 发布日期: 2023-11-10

Clinical Study of Modified Chaihu Guizhi Decoction in Treating Stable Angina Pectoris of Coronary Heart Disease with Anxiety/Depression of Qi Stagnation and Blood Stasis Type

1.
Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine/Shenzhen Luohu District Traditional Chinese Medicine Hospital, Shenzhen 518000, China
2.
The Seventh Clinical Medical College, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510006, China

摘要

摘要: 目的观察加味柴胡桂枝汤治疗气滞血瘀型冠心病稳定性心绞痛伴焦虑/抑郁的临床疗效。方法纳入气滞血瘀型冠心病稳定性心绞痛伴焦虑/抑郁患者60例, 随机分为对照组、治疗组各30例, 2组患者均予健康宣教、心理疏导及冠心病心绞痛常规治疗等基础治疗, 对照组加服氟哌噻吨美利曲辛片, 治疗组加服加味柴胡桂枝汤, 疗程均4周。治疗前后评估2组患者中医证候积分及疗效、心绞痛症状积分、心电图平板运动试验、硝酸甘油停减率、焦虑自评量表(SAS)、抑郁自评量表(SDS)及西雅图心绞痛调查量表(SAQ)评分, 检测血脂(TC、TG、LDL-C、HDL-C)及血清IL-6表达水平。结果治疗后, 2组患者中医证候积分、心绞痛症状积分、SAS、SDS评分均显著降低(P < 0.01), SAQ各维度积分明显增加(P < 0.01), 平板运动试验ST段压低1 mm出现时间及心绞痛出现时间均显著延长(P < 0.01)、ST段恢复时间明显缩短(P < 0.01), TC、TG、LDL-C、IL-6水平均明显降低(P < 0.05, P < 0.01);且治疗组改善中医证候积分、心绞痛症状积分、SAS、SDS评分、SAQ中PL及TS积分、中医证候显效率、硝酸甘油停减率、血脂(TC、LDL-C)及血清IL-6均优于对照组(P < 0.05, P < 0.01)。结论加味柴胡桂枝汤能明显改善气滞血瘀型冠心病稳定性心绞痛伴焦虑/抑郁患者临床症状、焦虑抑郁状态, 提高生存质量, 同时降低血脂及血清IL-6水平。
- 加味柴胡桂枝汤 /
- 冠心病稳定性心绞痛 /
- 焦虑抑郁 /
- 气滞血瘀型
Abstract: OBJECTIVE To observe the clinical efficacy of modified Chaihu Guizhi Decoction in treating stable angina pectoris with anxiety/depression in patients with coronary heart disease of qi stagnation and blood stasis type. METHODS 60 patients with stable angina pectoris and anxiety/depression caused by qi stagnation and blood stasis type of coronary heart disease were included in the study. They were randomly divided into a control group (n=30) and a treatment group (n=30). Both groups of patients received health education, psychological counseling, and routine treatment for coronary heart disease angina pectoris. The control group received droperidol melitracin tablets in addition to basic treatment, while the treatment group received modified Chaihu Guizhi Decoction in addition to basic treatment for 4 weeks. The efficacy of traditional Chinese medicine (TCM) syndrome, total score of traditional Chinese medicine syndrome, angina symptom score, electrocardiogram treadmill exercise test, nitroglycerin withdrawal rate, self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Seattle angina questionnaire (SAQ) scores between the two groups of patients were compared before and after treatment. At the same time, peripheral blood lipids and IL-6 levels were measured. RESULTS After treatment, the TCM syndrome score, angina symptom score, SAS, SDS score of both groups of patients decreased (P < 0.01), and the scores of various dimensions of SAQ increased (P < 0.01). The occurrence time of ST segment depression of 1mm in treadmill exercise test was prolonged, the occurrence time of angina was prolonged, and the recovery time of ST segment was shortened (P < 0.01), and TC, TG, LDL-C, IL-6 were significantly reduced (P < 0.05, P < 0.01). Moreover, the treatment group was superior to the control group in improving TCM syndrome scores, angina symptom scores, SAS, SDS scores, PL and TS scores in SAQ, apparent effective rate of TCM syndrome, nitroglycerin cessation rate, blood lipids (TC, LDL-C), and serum IL-6 (P < 0.05, P < 0.01). CONCLUSION Modified Chaihu Guizhi Decoction can significantly improve the clinical symptoms, anxiety and depression status of patients with stable angina pectoris and anxiety/depression of qi stagnation and blood stasis type of coronary heart disease, improve quality of life, reduce blood lipids and IL-6 levels.
- modified Chaihu Guizhi Decoction /
- stable angina pectoris of coronary heart disease /
- anxiety and depression /
- qi stagnation and blood stasis type

HTML全文

表 1 2组患者基线资料比较(x±s, n=30)

Table 1. Comparison of baseline data between the two groups of patients(x±s, n=30)

组别	年龄/岁	病程/a	男	女
治疗组	58.53±7.76	2.60±1.26	20	10
对照组	57.40±8.84	2.69±1.13	22	8

下载: 导出CSV

表 2 2组患者治疗前后中医证候积分比较[M(P₂₅, P₇₅), n=30]

Table 2. Comparison of TCM syndrome scores before and after treatment between the two groups of patients [M(P₂₅, P₇₅), n=30]

组别	时间	胸闷痛	胸胁胀痛	情绪抑郁	心悸	善太息	易怒	失眠	咽干口苦	总积分
治疗组	治疗前	4.00(4.00, 6.00)	4.00(2.00, 4.00)	4.00(4.00, 6.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	22.00(20.00, 24.25)
	治疗后	2.00(2.00, 4.00)^**#	2.00(0, 2.00)^**#	2.00(1.50, 2.00)^**#	1.00(0, 1.00)^**#	1.00(0, 1.00)^**#	0.00(0.00, 1.00)^**#	1.00(0.00, 1.00)^**#	1.00(0.00, 1.00)^**#	8.50(6.75, 12.00)^**##
对照组	治疗前	4.00(4.00, 6.00)	4.00(3.50, 4.00)	4.00(4.00, 6.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	2.00(1.00, 2.00)	22.00(20.00, 24.00)
	治疗后	4.00(2.00, 4.00)^**	2.00(2.00, 4.00)^**	2.00(2.00, 4.00)^**	1.00(1.00, 1.00)^**	1.00(1.00, 2.00)^**	1.00(0.75, 1.00)^**	1.00(1.00, 1.00)^**	1.00(1.00, 1.00)^**	13.00(11.00, 15.25)^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

下载: 导出CSV

表 3 2组患者中医证候疗效比较(n=30)

Table 3. Comparison of TCM syndrome curative effects between two groups of patients (n=30)

组别	显效	有效	无效	显效率/%	总有效率/%
治疗组	7	20	3	23.33^#	90.00
对照组	1	24	5	3.33	83.33
注: 组间比较, χ_显效率²=5.19, ^#P < 0.05。

下载: 导出CSV

表 4 2组患者治疗前后心绞痛症状积分比较[M(P₂₅, P₇₅), n=30]

Table 4. Comparison of angina symptoms scores before and after treatment between the two groups of patients [M(P₂₅, P₇₅), n=30]

组别	时间	发作次数	持续时间/min	疼痛程度	硝酸甘油用量/mg
治疗组	治疗前	4.00(4.00, 6.00)	4.00(4.00, 4.00)	4.00(4.00, 6.00)	2.00(1.00, 2.00)
	治疗后	2.00(0.00, 2.00)^**#	2.00(0.00, 2.00)^**#	2.00(0.00, 2.00)^**#	0.00(0.00, 1.00)^**#
对照组	治疗前	4.00(4.00, 4.00)	4.00(4.00, 4.00)	4.00(4.00, 4.50)	2.00(1.75, 2.00)
	治疗后	4.00(1.50, 4.00)^**	2.00(1.50, 4.00)^**	3.00(0.00, 4.00)^**	1.00(0.00, 1.00)^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05。

下载: 导出CSV

表 5 2组患者硝酸甘油停减率比较(n=30)

Table 5. Comparison of nitroglycerin discontinuation and reduction rates between two groups of patients(n=30)

组别	用药	未用药	停药	减药	未停减	停减率/%
治疗组	24	6	10	12	2	91.67^#
对照组	25	5	5	14	6	76.00
注: 组间比较, χ²=10.39, ^#P < 0.05。

下载: 导出CSV

表 6 2组患者治疗前后平板运动试验比较(x±s, min, n=30)

Table 6. Comparison of treadmill exercise tests before and after treatment between two groups of patients (x±s, min, n=30)

组别	时间	ST段压低1 mm时间	心绞痛出现时间	ST段恢复时间
治疗组	治疗前	5.27±1.14	5.63±0.96	3.13±0.73
	治疗后	6.77±1.07^**#	7.07±0.98^**#	1.67±0.48^**#
对照组	治疗前	5.00±0.98	5.33±0.88	3.03±0.67
	治疗后	6.13±0.86^**	6.47±0.90^**	2.00±0.53^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05。

下载: 导出CSV

表 7 2组患者治疗前后SAS、SDS评分比较(x±s, n=30)

Table 7. Comparison of SAS and SDS scores before and after treatment between the two groups of patients(x±s, n=30)

组别	时间	SAS	SDS
治疗组	治疗前	58.33±5.03	60.27±5.38
	治疗后	36.70±9.09^**#	32.63±8.72^**#
对照组	治疗前	59.37±5.30	61.00±5.29
	治疗后	42.27±8.37^**	37.50±8.40^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05。

下载: 导出CSV

表 8 2组患者治疗前后SAQ各维度评分比较(x±s, n=30)

Table 8. Comparison of SAQ dimensions scores before and after treatment between the two groups of patients(x±s, n=30)

组别	时间	PL	AF	AS	TS	DP
治疗组	治疗前	43.73±7.98	55.63±6.44	54.77±5.69	43.47±7.69	51.83±5.25
	治疗后	60.93±6.72^**#	62.93±5.71^**	61.67±5.18^**	59.23±5.94^**#	58.50±4.70^**
对照组	治疗前	44.37±7.61	55.00±6.30	53.87±5.32	44.07±7.20	51.77±5.04
	治疗后	56.47±6.94^**	61.50±4.72^**	60.83±5.28^**	55.63±6.16^**	57.80±4.75^**
注: 组内比较, ^**P < 0.01;组间比较, ^#P < 0.05。

下载: 导出CSV

表 9 2组患者治疗前后血脂及IL-6水平比较(x±s, mmol·L^-1, n=30)

Table 9. Comparison of blood fat and IL-6 scores before and after treatment between the two groups of patients(x±s, mmol·L^-1, n=30)

组别	时间	TC	TG	HDL-C	LDL-C	IL-6
治疗组	治疗前	5.21±0.45	1.78±0.35	1.16±0.14	2.95±0.30	3.90±1.34
	治疗后	4.34±0.54^**##	1.68±0.29^*	1.17±0.10	2.45±0.36^**##	2.85±0.61^**#
对照组	治疗前	5.08±0.57	1.89±0.32	1.11±0.11	3.02±0.38	3.97±1.45
	治疗后	4.80±0.32^*	1.77±0.27^**	1.12±0.08	2.76±0.37^**	3.25±0.78^**
注: 组内比较, ^P < 0.05, ^*P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

下载: 导出CSV

参考文献(25)

[1]	WELLS A, REEVES D, CAPOBIANCO L, et al. Improving the effectiveness of psychological interventions for depression and anxiety in cardiac rehabilitation: PATHWAY-a single-blind, parallel, randomized, controlled trial of group metacognitive therapy[J]. Circulation, 2021, 144(1): 23-33. doi: 10.1161/CIRCULATIONAHA.120.052428
[2]	LICHTMAN JH, FROELICHER ES, BLUMENTHAL JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: Systematic review and recommendations: A scientific statement from the American Heart Association[J]. Circulation, 2014, 129(12): 1350-1369. doi: 10.1161/CIR.0000000000000019
[3]	王维中. 让双心服务的理念在所有心内科医生中践行[J]. 中华心血管病杂志, 2014, 42(5): 388. WANG WZ. Practice the concept of dual-heart service among all cardiologists[J]. Chin J Caidiol, 2014, 42 (5): 388.
[4]	PALACIOS J, KHONDOKER M, MANN A, et al. Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs[J]. J Psychosom Res, 2018, 104: 1-8.
[5]	中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会动脉粥样硬化与冠心病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 等. 稳定性冠心病诊断与治疗指南[J]. 中华心血管病杂志, 2018, 46(9): 680-694. doi: 10.3760/cma.j.issn.0253-3758.2018.09.004 Section of Interventional Cardiology of Chinese Society of Cardiology, Section of Atherosclerosis and Coronary Artery Disease of Chinese Society of Cardiology, Specialty Committee on Prevention and Treatment of Thrombosis of Chinese College of Cardiovascular Physicians, et al. Guidelines for diagnosis and treatment of stable coronary heart disease[J]. Chin J Cardiol, 2018, 46(9): 680-694. doi: 10.3760/cma.j.issn.0253-3758.2018.09.004
[6]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 慢性稳定性心绞痛诊断与治疗指南[J]. 中华心血管病杂志, 2007, 35(3): 195-206. doi: 10.3760/j.issn:0253-3758.2007.03.002 Chinese Society of Cardiology, Editorial Committee of the Chinese Journal of Cardiovascular Disease. Guidelines for diagnosis and treatment of chronic stable angina pectoris[J]. Chin J Cardiol, 2007, 35(3): 195-206. doi: 10.3760/j.issn:0253-3758.2007.03.002
[7]	汪向东. 心理卫生评定量表手册[J]. 中国心理卫生杂志, 1993, 7(增刊): 194-238. WANG XD. Handbook of mental health assessment scales[J]. Chin Ment Health J, 1993, 7(Suppl): 194-238.
[8]	ZUNG WW. A self-rating depression scale[J]. Arch Gen Psychiatry, 1965, 12: 63-70. doi: 10.1001/archpsyc.1965.01720310065008
[9]	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: 68-73. Guiding Principles for Clinical Research of New Chinese Medicine: Trial Implementation[M]. Beijing: China medical science press, 2002: 68-73.
[10]	中国中西医结合学会心血管病专业委员会双心学组. 双心疾病中西医结合诊治专家共识[J]. 中国全科医学, 2017, 20(14): 1659-1662. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201711100.htm Chinese Integrative Medicine Association Cardiology Committee Psychocardiology Group. Expert consensus on the diagnosis and treatment of psycho-cardiological disease with integrated traditional Chinese and western medicine[J]. Chin Gen Pract, 2017, 20(14): 1659-1662. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201711100.htm
[11]	国家食品药品监督管理局. 中药、天然药物治疗冠心病心绞痛临床研究技术指导原则[M]. 北京: 中国医药科技出版社, 2012: 370-386. State Food And Drug Administration. Technical Guidelines For Clinical Research On The Treatment of Angina Pectoris With Traditional Chinese Medicine And Natural Medicine[M]. Beijing: China medical science press, 2012: 370-386.
[12]	冠心病心绞痛及心电图疗效评定标准(中西医结合治疗冠心病心绞痛及心律失常座谈会, 1979, 上海)[J]. 中国药事, 1987, 1(2): 71. Evaluation criteria of angina pectoris of coronary heart disease and ECG curative effect (symposium on treating angina pectoris and arrhythmia of coronary heart disease with integrated traditional Chinese and western medicine, Shanghai, 1979)[J]. Chin Pharm Aff, 1987, 1(2): 71.
[13]	郭兰, 王磊, 刘遂心. 心脏运动康复[M]. 南京: 东南大学出版社, 2014. GUO L, WANG L, LIU SX. Cardiac Exercise Rehabilitation[M]. Nanjing: Southeast University press, 2014.
[14]	于鲁, 李珠, 王朔, 等. 血府逐瘀胶囊对冠心病心绞痛患者西雅图心绞痛量表评分影响的多中心前瞻性队列研究[J]. 中医杂志, 2023, 64(2): 146-152. doi: 10.3969/j.issn.0411-8421.2023.02.035 YU L, LI Z, WANG S, et al. Multi-center prospective cohort study on the effect of Xuefuzhuyu capsule on Seattle angina pectoris scale score in patients with coronary heart disease and angina pectoris[J]. J Tradit Chin Med, 2023, 64(2): 146-152. doi: 10.3969/j.issn.0411-8421.2023.02.035
[15]	《中国心血管健康与疾病报告》2021(冠心病部分内容)[J]. 心肺血管病杂志, 2022, 41(12): 1205-1211. China Cardiovascular Health and Disease Report 2021 (part of coronary heart disease)[J]. J Cardiovasc Pulm Dis, 2022, 41(12): 1205-1211.
[16]	史金玉, 王超, 黄乐曦, 等. 冠心病合并焦虑抑郁的治疗研究进展[J]. 世界中医药, 2022, 17(14): 2087-2091. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202214024.htm SHI JY, WANG C, HUANG LX, et al. Research progress in the treatment of coronary heart disease with anxiety and depression[J]. World Chin Med, 2022, 17(14): 2087-2091. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202214024.htm
[17]	陈维, 李秋冶, 王凤荣. 基于德尔菲法的冠状动脉血运重建后双心疾病辨证分型探析[J]. 中西医结合心脑血管病杂志, 2023, 21(17): 3128-3132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202317005.htm CHEN W, LI QY, WANG FR. Analysis on the syndrome differentiation of psychological heart disease after coronary artery revascularization based on Delphi method[J]. Chin J Integr Med Cardio Cerebrovasc Dis, 2023, 21(17): 3128-3132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202317005.htm
[18]	华鑫, 李成, 朱爱松, 等. 运用"形神同调"治疗冠心病伴抑郁状态[J]. 中医杂志, 2021, 62(15): 1370-1373. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202115021.htm HUA X, LI C, ZHU AS, et al. Treatment of coronary heart disease with depression based on "co-regulation of body and mind" theory[J]. J Tradit Chin Med, 2021, 62(15): 1370-1373. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202115021.htm
[19]	张晓蕾, 赵永峰, 任岩春, 等. 冠心病患者焦虑抑郁与炎症反应、血管内皮功能的关系[J]. 中国循证心血管医学杂志, 2018, 10(2): 199-202. doi: 10.3969/j.issn.1674-4055.2018.02.20 ZHANG XL, ZHAO YF, REN YC, et al. Relationship among anxiety-depression, inflammatory response and vascular endothelial function in patients with coronary heart disease[J]. Chin J Evid Based Cardiovasc Med, 2018, 10(2): 199-202. doi: 10.3969/j.issn.1674-4055.2018.02.20
[20]	BEUREL E, TOUPS M, NEMEROFF CB. The bidirectional relationship of depression and inflammation: Double trouble[J]. Neuron, 2020, 107(2): 234-256.
[21]	JANTARATNOTAI N, MOSIKANON K, LEE YN, et al. The interface of depression and obesity[J]. Obes Res Clin Pract, 2017, 11(1): 1-10.
[22]	王训强, 楼忠泽, 张庆玉, 等. 血小板功能在抑郁症与心血管疾病间作用的研究进展[J]. 浙江医学, 2016, 38(6): 440-442. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201606025.htm WANG XQ, LOU ZZ, ZHANG QY, et al. Research progress on the role of platelet function between depression and cardiovascular disease[J]. Zhejiang Med J, 2016, 38(6): 440-442. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201606025.htm
[23]	诸骏仁, 高润霖, 赵水平, 等. 中国成人血脂异常防治指南(2016年修订版)[J]. 中国循环杂志, 2016, 31(10): 937-953. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htm ZHU JR, GAO RL, ZHAO SP, et al. Guidelines for prevention and treatment of dyslipidemia in adults in China (revised in 2016)[J]. Chin Circ J, 2016, 31(10): 937-953. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htm
[24]	BOT M, MILANESCHI Y, AL-SHEHRI T, et al. Metabolomics profile in depression: A pooled analysis of 230 metabolic markers in 5283 cases with depression and 10, 145 controls[J]. Biol Psychiatry, 2020, 87(5): 409-418.
[25]	WEI YG, CAI DB, LIU J, et al. Cholesterol and triglyceride levels in first-episode patients with major depressive disorder: A meta-analysis of case-control studies[J]. J Affect Disord, 2020, 266: 465-472.