摘要
目的观察加味黄连温胆汤联合利伐沙班冠心病合并阵发性房颤(AF)(痰火扰心证)的临床疗效及对炎症因子和血栓形成风险的影响。方法选择84例符合要求患者作为观察对象,随机分为对照组与观察组各42例。对照组给予西医常规治疗措施,观察组在对照组治疗的基础上采用加味黄连温胆汤内服,两组治疗4周。进行治疗前后动态心电图检查记录P波离散度(Pd)、最大P波时限(Pmax)、24 h发作次数和房颤持续时间、NN间期的标准差(SDNN)、相邻R-R间隔差值>50 ms数目占所有R-R间隔总数百分比(PNN50)、低频功率/高频功率值(LF/HF)、全部相邻NN间期之差的均方根(RMSSD);进行治疗前后西雅图心绞痛量表(SAQ)和中医证候评分;检测治疗前后炎症趋化因子CXCL10、CXCL1、肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)水平;纤维蛋白原(FIB)和D-二聚体(D-D)水平,比较两组临床疗效。结果治疗后,两组患者Pd、Pmax、24 h发作次数和房颤持续时间均较治疗前减少,且观察组少于对照组(P<0.05);治疗后,两组患者SDNN、PNN50、RMSSD增加,LF/HF减少,且均以观察组为显著(P<0.05);治疗后,两组患者SAQ评分升高(P<0.05),且观察组更高(P<0.05);治疗后,两组患者CXCL10、CXCL1、TNF-α、IL-4、IL-10下降(P<0.05),且观察组更低(P<0.05);治疗后,两组患FIB和D-D下降(P<0.05),且观察组更低(P<0.05);治疗后,两组中医证候评分下降(P<0.05),且观察组更低(P<0.05);观察组总有效率为90.48%,高于对照组的71.43%(P<0.05)。结论加味黄连温胆汤联合利伐沙班治疗CHD合并阵发性AF(痰火扰心证)患者,能有效控制AF发作情况,降低心房颤负荷,具有抗炎作用,降低血栓形成风险,临床疗效显著。
Objective:To evaluate the clinical efficacy of Modified Huanglian Wendan Decoction combined with rivaroxaban in treating patients with coronary heart disease(CHD)complicated with paroxysmal atrial fibrillation(AF)and syndrome of phlegm-fire disturbing heart,and to assess its effects on inflammatory factors and thrombosis risk.Methods:84 eligible patients were randomly divided into a control group(n=42)and an observation group(n=42).The control group received standard western treatments.On the basis of this regimen,the observation group was additionally treated with oral administration of Modified Huanglian Wendan Decoction.Both groups were treated for 4 weeks.Before and after treatment,Holter monitoring was used to record P-wave dispersion(Pd),maximum P-wave duration(Pmax),number of AF episodes within 24 hours,AF duration,standard deviation of NN intervals(SDNN),percentage of adjacent RR intervals differing by>50 ms(PNN50),low-frequency/high-frequency power ratio(LF/HF),and root mean square of successive differences(RMSSD).The Seattle Angina Questionnaire(SAQ)and TCM syndrome scores were assessed before and after treatment.Serum levels of inflammatory chemokines CXCL10,CXCL1,tumor necrosis factor-alpha(TNF-α),interleukin-4(IL-4),and IL-10,as well as coagulation markers fibrinogen(FIB)and D-dimer(D-D)were also measured.Clinical efficacy was compared between the two groups.Results:After treatment,both groups showed significant reductions in Pd,Pmax,daily AF episode frequency,and AF duration,with more significant improvements in the observation group(P<0.05).SDNN,PNN50,and RMSSD increased while LF/HF decreased in both groups,with greater changes in the observation group(P<0.05).After treatment,SAQ scores improved in both groups,especially in the observation group(P<0.05).Levels of CXCL10,CXCL1,TNF-α,IL-4,and IL-10 were significantly reduced in both groups,with greater reductions observed in the observation group(P<0.05).Similarly,FIB and D-D levels decreased significantly in both groups,with more favorable outcomes in the observation group(P<0.05).Symptom scores were significantly lower after treatment,particularly in the observation group(P<0.05).The total effective rate in the observation group was 90.48%,which was significantly higher than 71.43% of the control group(P<0.05).Conclusion:Modified Huanglian Wendan Decoction combined with rivaroxaban can effectively reduce AF episodes,alleviate atrial fibrillation burden,suppress inflammation,and lower the risk of thrombosis in CHD patients with paroxysmal AF and syndrome of phlegm-fire disturbing heart,showing significant clinical efficacy.
作者
梁怀珍
李志文
陈相春
封晓娟
Liang Huaizhen;Li Zhiwen;Chen Xiangchun;Feng Xiaojuan(Shijiazhuang Medical College,Hebei,Shijiazhuang 050000,China)
出处
《中国中医急症》
2025年第6期1046-1050,共5页
Journal of Emergency in Traditional Chinese Medicine
基金
河北省医学科学研究课题计划(20231291)
河北省人力资源和社会保障课题(JRSJY-2024-1167)。
关键词
冠心病
阵发性心房颤动
痰火扰心证
黄连温胆汤
利伐沙班
炎症因子
Coronary heart disease
Paroxysmal atrial fibrillation
Syndrome of phlegm-fire disturbing heart
Huanglian Wendan Decoction
Rivaroxaban
Inflammatory factors
作者简介
通信作者:李志文。
