1.天津中医药大学第一附属医院/国家中医针灸临床医学研究中心,天津市西青区昌凌路88号,300381
2.天津中医药大学中医学院
通信作者:tjzhtcm@163.com
收稿:2025-08-31,
修回:2025-09-30,
纸质出版:2025-12-02
移动端阅览
耿小飞,杨颖溪,严志鹏等.活血解毒法方药辅助治疗急性心肌梗死术后易损期瘀毒互结证患者的前瞻性真实世界研究[J].中医杂志,2025,66(23):2467-2474.
GENG Xiaofei,YANG Yingxi,YAN Zhipeng,et al.Huoxue Jiedu Formulas (活血解毒方药) as an Adjunctive Therapy for Patients with Binding of Stasis and Toxin Syndrome during the Vulnerable Period after Myocardial Infarction:A Prospective Real-World Study[J].Journal of Traditional Chinese Medicine,2025,66(23):2467-2474.
耿小飞,杨颖溪,严志鹏等.活血解毒法方药辅助治疗急性心肌梗死术后易损期瘀毒互结证患者的前瞻性真实世界研究[J].中医杂志,2025,66(23):2467-2474. DOI: 10.13288/j.11-2166/r.2025.23.013.
GENG Xiaofei,YANG Yingxi,YAN Zhipeng,et al.Huoxue Jiedu Formulas (活血解毒方药) as an Adjunctive Therapy for Patients with Binding of Stasis and Toxin Syndrome during the Vulnerable Period after Myocardial Infarction:A Prospective Real-World Study[J].Journal of Traditional Chinese Medicine,2025,66(23):2467-2474. DOI: 10.13288/j.11-2166/r.2025.23.013.
目的
2
观察活血解毒法方药辅助治疗急性心肌梗死经皮冠脉介入术后易损期瘀毒互结证的临床疗效,并从血清中性粒细胞胞外诱捕网(NETs)角度探讨可能作用机制。
方法
2
纳入129例急性心肌梗死经皮冠脉介入治疗术后6个月内瘀毒互结证患者,根据患者是否愿意服用中药分为治疗组和对照组,其中治疗组65例,对照组64例。对照组患者予以西医常规治疗;治疗组在对照组的基础上联用活血解毒法方药,每日1剂。两组疗程均为4周。比较治疗前后两组患者中医证候积分,应用西雅图心绞痛量表记录心绞痛稳定状态积分、心绞痛发作情况积分,采用简明生活质量量表(SF-36)评价生活质量(包括生理机能、生理职能、躯体疼痛、总体健康、精力、社会功能、情感职能、精神健康8个维度),采用匹兹堡睡眠质量指数量表(PSQI)评价睡眠质量,采用患者健康问卷-躯体化症状群量表(PHQ-15)评价精神心理,采用Duke活动状态指数问卷评价日常体力活动,检测治疗组20例患者血清NETs标志物髓过氧化物酶-DNA复合物(MPO-DNA)、中性粒细胞弹性蛋白酶-DNA复合物(NE-DNA)、瓜氨酸化组蛋白H3(Cith3)水平。
结果
2
与本组治疗前比较,治疗后两组患者中医证候积分、PSQI积分、PHQ-15积分均较本组治疗前明显降低,Duke活动状态指数积分、心绞痛稳定程度积分、心绞痛发作情况积分均较本组治疗前明显升高,SF-36量表各维度积分均较本组治疗前明显升高(
P
<0.05)。治疗后组间比较,治疗组中医证候积分明显低于对照组,Duke活动状态指数积分、心绞痛稳定程度积分、心绞痛发作情况积分明显高于对照组(
P
<0.05);治疗组生理机能、生理职能、社会功能、躯体疼痛、精力维度积分明显高于对照组(
P
<0.05)。治疗后治疗组患者血清MPO-DNA、Cith3、NE-DNA水平均明显低于治疗前(
P
<0.05)。
结论
2
在西医常规治疗基础上加服活血解毒法方药可显著改善急性心肌梗死术后易损期瘀毒互结证患者心绞痛情况、中医证候及精神心理情况,提高生活质量、睡眠质量和日常体力活动,其机制可能与抑制血清NETs水平有关。
Objective
2
To observe the efficacy of
Huoxue Jiedu Formulas
(活血解毒方药, HJF) as an adjunctive treatement for patients with binding of stasis and toxin syndrome during the vulnerable period after acute myocardial infarction (AMI) percutaneous coronary intervention (PCI) surgery, and to explore its potential mechanism from the perspective of serum neutrophil extracellular traps (NETs).
Methods
2
A total of 129 patients with binding of stasis and toxin syndrome within 6 months after PCI for AMI were enrolled and divided into a treatment group (65 cases) and a control group (64 cases) based on patients' willingness to take Chinese herbal medicine. The control group received standard western medical therapy alone, while the treatment group additionally received HJF, one dose daily. Both groups were treated for four weeks. Before and after treatment, TCM syndrome scores were assessed. Seattle angina questionnaire (SAQ) was used to record angina stability and frequency scores, while the short form-36 health survey (SF-36) was employed to assess quality of life across eight dimensions, including physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. The Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality, and the patient health questionnaire-15 (PHQ-15) was used to assess psychosomatic symptoms; Duke activity status index (DASI) was used to measure daily physical activity. Serum levels of neutrophil extracellular traps (NET) markers including myeloperoxidase-DNA (MPO-DNA), neutrophil elastase-DNA (NE-DNA), and citrullinated histone H3 (CitH3) were measured in 20 patients from the treatment group.
Results
2
After treatment, TCM syndrome score, PSQI score and PHQ-15 score in both groups significantly decreased, while DASI score, angina stability and frequency scores, and all eight dimensions of the SF-36 scale significantly increased (
P
<0.05). Compared to the control group, the treatment group had significantly lower TCM syndrome scores and significantly higher DASI, angina stability and frequency scores (
P
<0.05), as well as higher scores in the SF-36 dimensions of physical functioning, role-physical, social functioning, bodily pain, and vitality (
P
<0.05). After treatment, serum levels of MPO-DNA, CitH3, and NE-DNA in the treatment group were significantly reduced (
P
<0.05).
Conclusion
2
HJF combined with conventional therapy can significantly improve angina symptoms, TCM syndrome scores, and psychosomatic conditions in patients with binding of stasis and toxin syndrome during the vulnerable period after AMI. It also enhances quality of life, sleep quality, and daily physical activity. The underlying mechanism may be associated with the inhibition of serum NETs level.
中国心血管健康与疾病报告编写组 . 中国心血管健康与疾病报告2022概要 [J]. 中国循环杂志 , 2023 , 38 ( 6 ): 583 - 612 .
李宪伦 , 王显 , 吴永健 , 等 . 经皮冠状动脉介入术后中西医结合心脏康复专家共识 [J]. 中国康复医学杂志 , 2022 , 37 ( 11 ): 1517 - 1528 .
SONG J , MURUGIAH K , HU S , et al . Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China [J]. Heart , 2020 , 107 ( 4 ): 313 - 318 .
UEDA Y , ASAKURA M , YAMAGUCHI O , et al . The healing process of infarct-related plaques. Insights from 18 months of serial angioscopic follow-up [J]. J Am Coll Cardiol , 2001 , 38 ( 7 ): 1916 - 1922 .
ARNOLD N , KOENIG W . Lipid lowering drugs in acute coronary syndromes (ACS) [J]. Curr Atheroscler Rep , 2023 , 25 ( 12 ): 939 - 946 .
耿小飞 , 范新彪 , 严志鹏 , 等 . 病证结合分阶段辨治冠心病临证思考 [J]. 中国中西医结合杂志 , 2024 , 44 ( 5 ): 603 - 607 .
LI YW , CHEN SX , YANG Y , et al . Colchicine inhibits NETs and alleviates cardiac remodeling after acute myocardial infarction [J]. Cardiovasc Drugs Ther , 2024 , 38 ( 1 ): 31 - 41 .
KNUUTI J , WIJNS W , SARASTE A , et al . 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes [J]. Eur Heart J , 2020 , 41 ( 3 ): 407 - 477 .
中华中医药学会 . 中医内科常见病诊疗指南:中医病证部分 [M]. 北京 : 中国中医药出版社 , 2008 : 39 .
杨颖溪 . “血-脉-心-神”一体观指导下的活血解毒法干预心梗后心肌损伤的临床及实验研究 [D]. 天津 : 天津中医药大学 , 2020 .
武雪萍 , 范红 , 刘超峰 , 等 . 加味瓜蒌薤白半夏汤治疗冠心病痰瘀毒互结证的临床观察 [J]. 世界中西医结合杂志 , 2012 , 7 ( 9 ): 800 - 801 .
郑筱萸 . 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 : 70 - 73 .
THOMAS M , JONES PG , ARNOLD SV , et al . Interpretation of the Seattle angina questionnaire as an outcome measure in clinical trials and clinical care: a review [J]. JAMA Cardiol , 2021 , 6 ( 5 ): 593 - 599 .
BRAZIER JE , HARPER R , JONES NM , et al . Validating the SF-36 health survey questionnaire: new outcome measure for primary care [J]. BMJ , 1992 , 305 ( 6846 ): 160 - 164 .
中华医学会 , 中华医学会杂志社 , 中华医学会全科医学分会 , 等 . 冠心病心脏康复基层指南(2020年) [J]. 中华全科医师杂志 , 2021 , 20 ( 2 ): 150 - 165 .
CHONG B , JAYABASKARAN J , JAUHARI SM , et al . Global burden of cardiovascular diseases: projections from 2025 to 2050 [J]. Eur J Prev Cardiol , 2025 , 32 ( 11 ): 1001 - 1015 .
沈迎 , 张奇 , 张瑞岩 , 等 . 优化急性冠脉综合征后残余风险管理 [J]. 中华心血管病杂志 , 2025 , 53 ( 3 ): 211 - 215 .
HOFBAUER TM , MANGOLD A , SCHERZ T , et al . Neutrophil extracellular traps and fibrocytes in ST-segment elevation myocardial infarction [J]. Basic Res Cardiol , 2019 , 114 ( 5 ): 33 - 48 .
耿小飞 . 活血解毒法方药调节中性粒细胞外诱捕网干预心梗后心肌损伤的临床及实验研究 [D]. 天津 : 天津中医药大学 , 2025 .
崔志洁 , 杜天依 , 彭菊琴 , 等 . 冠心病瘀毒证与患者外周血中性粒细胞胞外诱捕网水平相关性研究 [J]. 陕西中医 , 2025 , 46 ( 7 ): 903 - 907 .
0
浏览量
0
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构
京公网安备11010102007558号