1.山东中医药大学第二附属医院,山东省济南市经八路1号,250001
2.河南中医药大学第三附属医院
3.新疆维吾尔自治区中医医院
4.河南省漯河市中医院
5.河南省周口市中医院
6.河南省南阳市中医院
7.陕西中医药大学第二附属医院
8.辽宁省丹东市第一医院
9.河南省洛阳市中医院
10.新疆维吾尔自治区维吾尔医医院
11.湖北省十堰市人民医院
12.河南省洛阳市第二中医院
13.河南省阜外华中心血管病医院
14.河南省驻马店市中医院
15.河南省平顶山市第二人民医院
16.浙江省温州市中医院
17.河南省新乡市中心医院
18.中国中医科学院广安门医院
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收稿:2024-04-12,
修回:2024-07-20,
纸质出版:2024-11-02
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姜丙华,范立华,王晓峰等.维药养心达瓦依米西克蜜膏治疗稳定型心绞痛气滞血瘀证279例——一项随机、双盲、阳性药对照、多中心临床研究[J].中医杂志,2024,65(21):2225-2233.
JIANG Binghua,FAN Lihua,WANG Xiaofeng,et al.Uyghur Medicine Yangxin Dawayimixike Honey Paste (养心达瓦依米西克蜜膏) in Treatment of 279 Cases Stable Angina Pectoris Patients with Qi Stagnation and Blood Stasis Syndrome:A Multi-center,Double-blind,Positive-controlled Randomized Clinical Trial[J].Journal of Traditional Chinese Medicine,2024,65(21):2225-2233.
姜丙华,范立华,王晓峰等.维药养心达瓦依米西克蜜膏治疗稳定型心绞痛气滞血瘀证279例——一项随机、双盲、阳性药对照、多中心临床研究[J].中医杂志,2024,65(21):2225-2233. DOI: 10.13288/j.11-2166/r.2024.21.010.
JIANG Binghua,FAN Lihua,WANG Xiaofeng,et al.Uyghur Medicine Yangxin Dawayimixike Honey Paste (养心达瓦依米西克蜜膏) in Treatment of 279 Cases Stable Angina Pectoris Patients with Qi Stagnation and Blood Stasis Syndrome:A Multi-center,Double-blind,Positive-controlled Randomized Clinical Trial[J].Journal of Traditional Chinese Medicine,2024,65(21):2225-2233. DOI: 10.13288/j.11-2166/r.2024.21.010.
目的
2
观察维药养心达瓦依米西克蜜膏治疗稳定型心绞痛气滞血瘀证的临床疗效和安全性。
方法
2
采用随机、双盲、阳性药对照、多中心的临床研究方法,将370例稳定型心绞痛气滞血瘀证患者按照3∶1比例分为治疗组279例,对照组91例。治疗组给予养心达瓦依米西克蜜膏(每次3 g)和血府逐瘀胶囊模拟剂(每次2.4 g)口服,对照组给予血府逐瘀胶囊(每次2.4 g)和养心达瓦依米西克蜜膏模拟剂(每次3 g)口服,均每天2次,疗程为12周。两组主要疗效指标为心绞痛症状疗效,次要疗效指标包括治疗前后心绞痛单项症状评分(发作次数、发作持续时间、疼痛程度及硝酸甘油服用量评分)和心绞痛症状总积分,硝酸甘油服用量,平板运动试验的运动持续时间及DUKE(杜克)评分的患者分布情况,西雅图心绞痛量表评分(包括躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度5个维度),并观察治疗后中医证候疗效和中医单项症状疗效,通过血常规、尿常规、肝功能、肾功能、空腹血糖、心电图、不良事件发生情况等评估安全性。
结果
2
治疗组心绞痛症状疗效总有效率为71.68%(200/279),明显高于对照组的总有效率51.65%(47/91,
P
<0.01);治疗组中医证候疗效愈显率为53.05%(148/279),明显高于对照组的愈显率25.27%(23/91,
P
<0.01)。与本组治疗前比较,治疗后两组心绞痛发作次数评分、发作持续时间评分及疼痛程度评分,心绞痛症状总积分,硝酸甘油服用量均降低,且治疗组治疗后上述指标改善程度均优于对照组;治疗后两组躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度评分均升高,且治疗组治疗后在升高心绞痛稳定状态、心绞痛发作情况、治疗满意程度评分方面优于对照组(
P
<0.05或
P
<0.01)。治疗后治疗组中医单项症状胸痛、胸闷、心悸、气短、神疲乏力有效率均高于对照组(
P
<0.05或
P
<0.01)。两组治疗前后平板运动试验的运动持续时间和DUKE评分的患者分布情况比较差异均无统计学意义(
P
>0.05)。治疗组有66例(23.66%)不良事件发生,对照组有16例(17.58%)不良事件发生,两组比较差异无统计学意义(
P
>0.05)。
结论
2
维药养心达瓦依米西克蜜膏治疗稳定型心绞痛气滞血瘀证患者能有效改善心绞痛症状,降低心绞痛的发作次数、发作持续时间、疼痛程度,减少硝酸甘油使用量,改善中医临床症状,且安全性较好。
Objective
2
To observe the efficacy and safety of Uyghur medicine
Yangxin Dawayimixike Honey Paste
(养心达瓦依米西克蜜膏, YDMHP) in the treatment of stable angina pectoris (SAP) of
qi
stagnation and blood stasis syndrome.
Methods
2
A randomized , double-blind, positive-controlled,multi-center clinical trial was conducted, in which 370 patients with SAP of
qi
stagnation and blood stasis syndrome were randomly divided into treatment group(279 cases)and control group(91cases)at a ratio of 3∶1. The treatment group was orally administered with YDMHP, 3 g each time, and placebo of
Xuefu Zhuyu Capsule
(血府逐瘀胶囊), 2.4 g each time, while the control group was treated with
Xuefu Zhuyu Capsule
, 2.4 g each time, and placebo of YDMHP, 3 g each time, both twice a day for a course of 12 weeks. The primary outcome was the effect of angina pectoris symptom. The secondary outcomes include single angina symptom scores such as number of attacks, duration of attacks, pain intensity and usae of nitroglycerin scores, the total angina symptom score before and after the treatment, the usage of nitroglycerin, the exercise duration in treadmill exercise test (TET) and the Duck treadmill score among patients,the scores of Seattle Angina Questionnaire (SAQ) on five dimensions including physical limitations, anginal stability, anginal frequency, treatment satisfaction, and disease perception, and efficacy of TCM syndrome and of each single TCM symptom after treatment. The safety were evaluated by examine blood routine, urine routine, liver and kidney function, fasting blood sugar, electrocardiogram, adverse events.
Results
2
The total effective rate of angina symptom in the treatment group was 71.69% (200/279), significantly higher than 51.64% (47/91) in the control group (
P
<0.01). The curative and markedly effective rate
of TCM syndrome in the treatment group was 53.05% (148/279), which was significantly higher than 25.27% (23/91) in the control group (
P
<0.01). After treatment, scores of the number as well as duration of angina attacks and pain severity, the total score of angina symptoms, and the usage of nitroglycerin significantly decreased in both groups, and more changes were seen in the treatment group than in the control group; the scores of physical limitations, anginal stability, anginal frequency, treatment satisfaction, and disease perception in both groups significantly increased, and more improvement were shown in the experimental group regarding the anginal stability, anginal frequency and treatment satisfaction (
P
<0.05 or
P
<0.01). The effects of chest pain, chest tightness, palpitation, shortness of breath and fatigue in experimental group were significantly higher than those in control group (
P
<0.05 or
P
<0.01). There was no significant difference in the exercise duration of treadmill test and Duke score among patients between the two groups either before or after treatment (
P
>0.05). Adverse events occurred in 66 cases (23.66%) of the experimental group and 16 cases (17.58%) of the control group, with no statistical significance between the two groups (
P
>0.05).
Conclusion
2
The Uyghur medicine YDMHP can effectively improve symptoms of angina pectoris, reduce the number, duration, and intensity of attacks, decrease the dosage of nitrogly-cerin and improve the individual TCM symptoms and has good safety in the treatment of SAP patients of
qi
stagnation and blood stasis.
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