冠心宁对不稳定型心绞痛患者心肺功能保护作用的研究

Study on the Protective Effect of Guanxinning on the Cardiopulmonary Function of Patients with Unstable Angina Pectoris

摘要: 目的：探索冠心宁片对不稳定型心绞痛患者心肺功能的保护作用及其可能涉及的相关机制。方法：选取2019年6月至2020年5月我院80例因不稳定型心绞痛入院，拟行择期冠脉介入(PCI)治疗的患者，随机分为对照组和干预组。对照组术前行常规抗凝及调脂治疗，干预组在常规治疗基础上辅以冠心宁片4片每日三次治疗3个月。住院期间监测患者心律失常、心绞痛的发作频率；收集患者入院时、PCI术后及3个月后心功能指标：左心射血分数(LVEF)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)、超敏C反应蛋白(hs-CRP)、B型脑钠肽(BNP)及肾功能指标：肾小球滤过率(eGFR)、肌酐(SCr)；出院前及3个月后行6分钟步行试验、心肺运动试验。结果：冠心宁组患者心律失常、心绞痛等事件发生频率低于对照组(P < 0.05)。PCI术后及治疗3个月后，两组心功能指标均较治疗前改善，且冠心宁组的改善程度优于对照组(P < 0.05)。PCI术后，两组患者肾功能下降，但冠心宁组患者肾功能损害程度小于对照组(P < 0.05)，治疗3个月后，冠心宁组患者肾功能改善程度优于对照组(P < 0.01)。此外，治疗3月后两组患者6分钟步行距离、最大摄氧量(VO2max)、无氧阈值(AT)、代谢当量(MET)等心肺功能指标均有明显改善(P < 0.05)，且冠心宁组的改善程度均优于对照组(P < 0.01)。结论：冠心宁片干预不稳定型心绞痛患者，有助于：1) 减少患者心绞痛、心律失常等不良心血管事件；2) 改善LVEF、6分钟步行距离、VO2max、AT及MET等指标，提高患者的心肺运动功能；3) 改善肾功能，降低PCI术后对比剂带来的肾功能损害；4) 降低CK-MB、cTnT、hs-CRP等，改善机体炎症反应。项目研究结果提示，冠心宁的上述保护作用可能是通过改善组织的血液循环、降低氧化应激和炎症反应等机制而实现的。

Abstract: Objective: To explore the protective effect of Guanxining Tablet on cardiopulmonary function in patients with unstable angina pectoris and its possible related mechanisms. Methods: Eighty patients with unstable angina pectoris who were admitted to our hospital from June 2019 to May 2020 and planned to undergo elective coronary intervention (PCI) were randomly divided into control group and intervention group. The control group received routine anticoagulation and lipid-regulating treatment before PCI, while the intervention group was additively treated with 4 Guanxining tablets three times a day for 3 months. The attack frequency of arrhythmia and angina pectoris was monitored during hospitalization. Cardiac function indexes at admission, after PCI and 3 months after PCI were collected, including left cardiac ejection fraction (LFEF), creatine kinase isoenzyme (CK-MB), troponin (cTnT), hypersensitive C-reactive protein (hs-CRP), B-type brain natriuretic peptide (BNP), and renal function indexes: glomerular filtration rate (EGFR), creatinine (SCR). The 6-minute walking test and cardiopulmonary exercise test were performed before discharge and 3 months after discharge. Results: The frequency of arrhythmia and angina pectoris in Guanxining group was lower than that in control group (P < 0.05). After PCI and treatment of 3 months, the heart function indexes in both groups were improved compared with those before treatment (P < 0.05), and the improvement in the Guanxinning group was bigger than that in the control group (P < 0.05). After PCI, renal function of both groups was decreased (P < 0.05), but the Guanxinning group of patients with renal damage was much less than the control group (P < 0.05), after 3 months of treatment, renal function indexes of two groups were improved (P < 0.05), and the improvement of the Guanxinning group is higher than that of control group (P < 0.01). After 3 months of treatment, cardiopulmonary function indexes, such as 6-minute walking distance, VO2max, anaerobic threshold (AT), metabolic equivalent (MET) were significantly improved in the control group and Guanxinning group (P < 0.05), and the improvement degree in the Guanxinning group was better than that in the control group (P < 0.01). Conclusion: This study found that the intervention of Guanxining Tablet is helpful to: 1) Reduce the occurrence of adverse cardiovascular events such as angina pectoris and arrhythmia in patients with unstable angina pectoris; 2) Improve the indexes such as LVEF, 6-minute walking distance, VO2max, AT and MET to improve the cardiopulmonary motor function of patients; 3) Improve renal function and reduce renal function damage caused by contrast agents after PCI; 4) Reduce the level of CK-MB, cTnT, hs-CRP, etc., and improve the inflammatory response of the body. The results of this study suggest that the protective effects of Guanxinning may be achieved by improving blood circulation, reducing oxidative stress and inflammatory response.