摘要
为探讨消积方对老年2型糖尿病并H型高血压病(气阴两虚夹痰瘀型)患者颈动脉易损斑块稳定性的影响,2017年1月至2019年4月,在河南中医药大学第一附属医院内分泌科门诊及病房,选择老年2型糖尿病并H型高血压病及颈动脉易损斑块(气阴两虚夹痰瘀型)患者125例,按照随机数字表法分为对照组(63例,完成56例)和消积组(62例,完成58例)。2组均给予控制饮食、降血糖、降血压及对症治疗。对照组给予瑞舒伐他汀钙片20 mg·d^-1,睡前顿服;消积组给予瑞舒伐他汀钙片10 mg·d^-1,睡前顿服,同时加用中药消积方。2组患者均连续治疗6个月,治疗前后应用彩色多普勒超声检测易损斑块数量、颈动脉内膜-中层厚度(IMT),斑块厚度,计算IMT积分及改良Crouse积分;同时检测脂代谢指标:总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和脂蛋白a(lipoprotein a,LPa);斑块稳定性指标:超敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、氧化低密度脂蛋白(ox-LDL)、Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶(ADAMTS-Ⅰ)及同型半胱氨酸(Hcy)。评价治疗6个月后中医症候疗效,随访治疗6个月内的不良心脑血管事件及药物不良反应。治疗6个月后,消积组患者的疗效优于对照组(Z=-2.600,P=0.009);消积组患者的显效率高于对照组(χ^2=6.039,P=0.014),消积组患者的总有效率高于对照组(χ2=4.564,P=0.033);2组患者的易损斑块数量及形态指标(IMT、IMT积分、斑块厚度、改良Crouse积分)、脂代谢指标(TC,TG,LDL-C,HDL-C,LPa)及斑块稳定性指标(hs-CRP,MMP-9,ox-LDL,ADAMTS-Ⅰ,Hcy)均较治疗前显著改善(P<0.01),消积组较对照组改善更显著(P<0.01);治疗6个月内消积组不良心脑血管事件发生率低于对照组(χ^2=4.566,P=0.033);消积组药物不良反应发生率低于对照组(χ^2=4.465,P=0.035)。由此可见,消积方联合小剂量(10 mg·d^-1)瑞舒伐他汀钙治疗老年2型糖尿病并H型高血压病及颈动脉易损斑块(气阴两虚夹痰瘀型)安全有效,优于单纯大剂量(20 mg·d^-1)瑞舒伐他汀钙方案,可逆转颈动脉硬化斑块,降低易损斑块的活动性,降低不良心脑血管事件发生率和药物不良反应发生率。
To explore the effect of Xiaoji Recipe on the stability of carotid artery vulnerable plaque in elderly patients with type 2 diabetes mellitus and type H hypertension(Qi-Yin deficiency with phlegm stagnation).From January 2017 to April 2019,in Endocrinology Department for Outpatients and Inpatients of the First Affiliated Hospital of Henan University of Chinese Medicine,125 elderly patients with type 2 diabetes mellitus and type H hypertension with carotid artery vulnerable plaque(Qi-Yin deficiency with phlegm stagnation)were selected.According to the numerical table method,the patients were randomly divided into the control group(63 cases,including 56 cases completed)and Xiaoji group(62 cases,including 58 cases completed).Both groups were given control diet,hypoglycemic,hypotensive and symptomatic therapies.The control group was given Rosuvastatin Calcium Tablets 20 mg·d^-1 before sleep.The Xiaojie group were given Ruisuvastatin Calcium Tablets 10 mg·d^-1 before sleep,plus Xiaoji Recipe at the same time.Both groups were treated for 6 months.The number of vulnerable plaques,carotid intima-media thickness(IMT)and plaque thickness were detected by color Doppler ultrasound before and after treatment,in order to calculate IMT integral and improved Crouse integral.Meanwhile,lipid metabolism indexes,including total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and lipoprotein a(LPa).And plaque stability indexes,including hypersensitive c-reactive protein(hs-CRP),matrix metalloproteinase-9(MMP-9),oxidized low-density lipoprotein(ox-LDL),Ⅰtype platelet depolymerization protein binding protein base sequence of metalloproteinases(ADAMTS-Ⅰ)and homocysteine(Hcy)were detected.To evaluate the 6-month curative effect on TCM syndrome,the patients were followed up for 6 months for adverse cardiovascular and cerebrovascular events and adverse drug reactions.After 6 months of treatment,the efficacy on Xiaoji group was better than that of the control group(Z=-2.600,P=0.009).The significant efficiency of the Xiaoji group was higher than that of the control group(χ^2=6.039,P=0.014).The total effective rate of the Xiaoji group was higher than that of the control group(χ^2=4.564,P=0.033).The number of vulnerable plaques form indexes(IMT,IMT integral,plaque thickness,improved Crouse integral),blood lipid metabolism indexes(TC,TG,LDL-C,HDL-C,LPa)and plaque stability indexes(hs-CRP,MMP-9,ox-LDL,ADAMTS-Ⅰ,Hcy)were significantly improved than before treatment in both groups of patients(P<0.01).Compared with the control group,the Xiaoji group showed more obvious improvement(P<0.01).The incidence of adverse cardiovascular and cerebrovascular events in the Xiaoji group was lower than that in the control group within 6 months after treatment(χ^2=4.566,P=0.033).The incidence of adverse drug reactions in the Xiaoji group was lower than that in the control group(χ^2=4.465,P=0.035).This indicated that Xiaoji Recipe combined with small-dose Rosuvastatin Calcium(10 mg·d^-1)was safe and effective in the treatment of elderly patients of type 2 diabetes mellitus with type H hypertension and vulnerable carotid artery plaque(Qi-Yin deficiency with phlegm stagnation),and superior to the single high-dose Risovastatin Calcium(20 mg·d^-1)regimen.It can reverse carotid plaque,and reduce the activity of vulnerable plaque and the incidence of adverse cardiovascular and cerebrovascular events and adverse drug reactions.
作者
韩景辉
张迪
辛珂
杨海燕
HAN Jing-hui;ZHANG Di;XIN Ke;YANG Hai-yan(the First Ward of Endocrinology,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)
出处
《中国中药杂志》
CAS
CSCD
北大核心
2020年第17期4246-4253,共8页
China Journal of Chinese Materia Medica
基金
2020—2021年度河南省中医药科学研究专项(20-21ZY2169)。
关键词
老年人
2型糖尿病
H型高血压病
颈动脉粥样硬化
易损斑块
消积方
气阴两虚夹痰瘀型
the elderly
type 2 diabetes
type H hypertension
carotid atherosclerosis
vulnerable plaque
Xiaoji Recipe
Qi-Yin deficiency and phlegm stagnation
