温阳活血化痰方干预颈动脉斑块临床研究

曹赤颖++李相述++王志刚

摘要：目的 观察温阳活血化痰方对颈动脉粥样硬化斑块患者颈动脉内膜中层厚度（IMT）、斑块Crouse积分、血脂相关指标及疗效的影响。方法 将114例颈动脉粥样硬化斑块患者随机分为治疗组和对照组各57例。治疗组给予他汀类药物及温阳活血化痰方口服，对照组单纯给予他汀类药物口服，连续治疗12周。分别于治疗前后检测IMT及血脂指标，计算斑块Crouse积分，评价中医证候疗效，并观察药物不良反应。结果 与本组治疗前及对照组治疗后比较，治疗组治疗后IMT、斑块Crouse积分、总胆固醇、低密度脂蛋白胆固醇均降低（P<0.05）；治疗组治疗后高密度脂蛋白胆固醇高于对照组（P<0.05）；治疗组中医证候疗效优于对照组（P<0.05）；治疗组总有效率高于对照组（P<0.05）。治疗过程中，2组均未出现明显不良反应。结论 温阳活血化痰方联合他汀类药物治疗颈动脉硬化斑块临床疗效确切，并且在降低IMT、斑块Crouse积分及调节血脂方面具有优势。

关键词：温阳活血化痰方；辨证论治；颈动脉斑块

DOI：10.3969/j.issn.1005-5304.2016.12.006

中图分类号：R259.435 文献标识码：A 文章编号：1005-5304（2016）12-0022-04

Clinical Study on Traditional Chinese Medicinal Herbs with the Efficacy of Warming Yang and Promoting Blood Circulation and Resolving Phlegm in Treatment of Carotid Atherosclerotic Plaque CAO Chi-ying1， LI Xiang-shu2， WANG Zhi-gang2 （1. First Affiliated Hospital of Chongqing Medical University， Chongqing 400016， China； 2. Second Affiliated Hospital of Chongqing Medical University， Chongqing 400010， China）

Abstract： Objective To observe the effects of traditional Chinese medicinal herbs with the efficacy of warming yang and promoting blood circulation and resolving phlegm on carotid artery intima media thickness （IMT）， Crouse score and blood lipid in patients with carotid atherosclerotic plaque. Methods Toally 114 patients were randomly divided into the treatment group and the control group， with 57 cases in each group. The treatment group was given medicinal herbs with the efficacy of warming yang and promoting blood circulation and resolving phlegm combined with statin drugs， while the control group was given statin drugs only. Course of treatment was 12 weeks. Before treatment and after treatment， IMT and lipid indexes were detected， Crouse score was calculated， TCM syndrome scores were evaluated， and adverse reactions were observed. Results After treatment， IMT， Crouse score， total cholesterol and low density lipoprotein cholesterol in the treatment group decreased， and were lower than the control group （P<0.05）； high density lipoprotein cholesterol of the treatment group was higher than the control group （P<0.05）； TCM syndrome scores and total effective rate in the treatment group were better than those in the control group （P<0.05）. During the treatment， there were no significant adverse reactions were found in the two groups. Conclusion Traditional Chinese medicinal herbs with the efficacy of warming yang and promoting blood circulation and resolving phlegm combined with statin drugs have definite efficacy in the treatment of patients with carotid atherosclerosis plaque and has advantages in reducing IMT， Crouse scores and regulating blood fat.

基金项目：国家自然科学基金（81471713）

通讯作者：王志刚，E-mail：lixiangshuok@126.com

Key words： traditional Chinese medicinal herbs with the efficacy of warming yang and promoting blood circulation and resolving phlegm； treatment based on syndrome differentiation； carotid atherosclerotic plaque

动脉粥样硬化是累及大型肌弹力型至中型肌弹力型动脉内膜的全身性疾病，是多种因素共同作用的结果，颈动脉粥样硬化是其局部病变表现之一[1]。随着经济水平快速发展和饮食习惯的改变，本病的患病率逐年上升。研究表明，颈动脉斑块所致狭窄的形成是脑卒中独立的危险因素[2]，其与缺血性脑血管病密切相关，颈动脉内膜中层厚度（IMT）在评价心脑血管风险中起着重要的作用[3-4]。目前，颈动脉粥样硬化斑块的治疗以调脂、抗血小板为主[5]，前者药物毒性、不良反应大，需要长期监测肝肾功能及肌酸激酶等变化，疾病易反复或进行性加重。中医学根据颈动脉粥样硬化斑块的特点将其归属于“痰证”及“血瘀证”等范畴，其在防治粥样硬化斑块方面具有优势。……