贺楠 吕海波

摘要  目的：探討冠心Ⅲ号对缺血性心肌病机体氧化应激及心肌组织纤维化的影响。方法：选取2017年11月至2019年5月广州中医药大学深圳医院收治的ICM患者100例作为研究对象，按照住院号单双分为对照组和观察组，每组50例。对照组常规西医治疗，观察组在对照组基础上加用冠心Ⅲ号治疗，均治疗4周，观察治疗前后NO、SOD、BNP和心肌纤维化指标变化。结果：1）2组患者治疗4周后ET、CRP、BNP、LVEDd、、透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、层粘连蛋白（LN）较治疗前比较均显著降低，NO、SOD、LVEF、△FS、E/A值及SV较治疗前均显著升高，组内比较差异有统计学意义（ P <0.01），且观察组显著优于对照组（ P <0.01）;2）治疗前后2组全血高切、全血中切、全血低切、血浆黏度、红细胞压积、纤维蛋白原差异无统计学意义（ P >0.05）;3）对照组不良反应率合计12%，观察组为8%，比较差异无统计学意义（ P >0.05）。结论：冠心Ⅲ号可通过提高NO、SOD，降低BNP和心肌纤维化，促进血液循环，从而改善心功能，防治ICM。

关键词  冠心Ⅲ号;缺血性心肌病;一氧化氮;超氧化物歧化酶;N端脑钠肽;心肌纤维化;心功能;血液流变学

Effect of Guanxin Ⅲ on Oxidation and Fibrosis Indexes of Ischemic Cardiomyopathy

HE Nan，LYU Haibo

（1 Guangzhou University of Traditional Chinese Medicine，Shenzhen Hospital，Emergency Department，Shenzhen 518034，China; 2 Shenzhen Pingle Orthopedic Hospital/Pingshan District TCM Hospital of Shenzhen City Emergency Department，Shenzhen 518010，China）

Abstract Objective： To investigate the effect of Guanxin Ⅲ on oxidative stress and myocardial fibrosis in patients with ischemic cardiomyopathy. Methods： A total of 100 patients with cardiomyopathy visited Guangzhou University of Traditional Chinese Medicine Shenzhen Hospital from November 2017 to May 2019 were randomly divided into control group（ n =50）and observation group（ n =50）according to odd or even admission number.The control group was treated with routine western medicine，and the observation group was treated with Guanxin Ⅲ on the basis of the control group，all for 4 weeks.The changes of NO，SOD，BNP and myocardial fibrosis indexes were observed before and after treatment. Results： 1）After 4 weeks treatment，ET，CRP，BNP，LVEDd，hyaluronic acid（HA），type Ⅲ procollagen and laminin（LN）in 2 groups were significantly lower than those before treatment，while NO，SOD，LVEF，△FS，E/A and SV were significantly higher than those before treatment，differences within the group were statistically significant（ P <0.01）.The observation group was significantly better than the control group（ P <0.01）.2）there was no difference in all the values of whole blood viscosity，plasma viscosity，hematocrit and fibrinogen between the two groups before and after treatment（ P >0.05）.3）The total adverse reaction rate was 12% in the control group and 8% in the observation group.there was no significant difference between the two groups（ P >0.05）. Conclusion： Guanxin Ⅲ can reduce BNP and myocardial fibrosis by increasing NO and SOD，promote blood circulation，improve cardiac function，prevent and treat ICM.

Keywords  Guanxin III; Ischemic cardiomyopathy; Nitric oxide; Superoxide dismutase; N-terminal brain natriuretic peptide; Myocardial fibrosis; Cardiac function; Hemorheology

中图分类号：R256.2 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.018

ICM属于冠心病一种特殊类型或晚期阶段，因冠状动脉粥样硬化致使长期心肌缺血引起弥漫性纤维化为主的心肌病变，又称为心肌硬化、心肌纤维化。ICM冠状动脉粥样硬化严重，多位多支病变，心脏逐渐扩大，左室功能缺损，左室射血分数90%以上在35%以下[1]。近些年，ICM发病率有所升高，特别是40岁以上脑力劳动者，5年病死率>50%[2]。目前西医在治疗上无特异性方法，药物治疗能减少心血管意外事件发生，但不良反应大，而介入治疗风险性高，存在术后再狭窄可能，不易被患者接受。而中医中药注重辨证论治基础上整体调节，未病先防，既病防变，有很重要的现实意义，中医理论认为，人体是有机整体，五脏六腑相互维系，能脏腑调和、阴阳平衡。肾为先……