不稳定型心绞痛治疗的研究进展
Research Progress in the Treatment of Unstable Angina Pectoris
DOI: 10.12677/ACM.2023.1381778, PDF,   
作者: 邵 敬：内蒙古民族大学第二临床医学院，内蒙古 牙克石；孙 欣*：内蒙古林业总医院心血管内科，内蒙古 牙克石
关键词: 不稳定型心绞痛；冠心病；动脉粥样硬化；炎症反应；西医治疗；中成药治疗；Unstable Angina Pectoris； Coronary Heart Disease； Atherosclerosis； Inflammatory Reaction； Western Medicine Treatment； Chinese Patent Medicine Treatment
摘要: 不稳定型心绞痛是指位于稳定性心绞痛和急性心肌梗塞之间的一类临床症候群，它的发病机制是不稳定的粥样斑块破裂或糜烂，继而引发血小板聚集、血栓形成、冠状动脉痉挛从而引起冠状动脉血管狭窄或堵塞，导致心肌氧气供给不足和缺血加重，是临床上一种常见的急性冠脉综合征，如不及时有效地干预处理可发展演变为急性心肌梗塞或猝死。本综述概述了UA的发病机制、诊断与治疗。
Abstract: Unstable angina pectoris refers to a class of clinical syndromes between stable angina pectoris and acute myocardial infarction. Its pathogenesis is rupture or erosion of unstable atherosclerotic plaques, which in turn triggers platelet aggregation, thrombus formation, and coronary artery spasm, thus causing coronary artery stenosis or blockage, leading to insufficient supply of oxygen to the myocardium and aggravation of ischemia, and it is a common acute coronary syndrome in clinic. It is a common acute coronary syndrome in clinic, if not timely and effective intervention can de-velop into acute myocardial infarction or sudden death. This review summarizes the pathogenesis, diagnosis and treatment of unstable angina pectoris.
文章引用：邵敬, 孙欣. 不稳定型心绞痛治疗的研究进展[J]. 临床医学进展, 2023, 13(8): 12679-12686. https://doi.org/10.12677/ACM.2023.1381778

参考文献

[1] 《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2021》概述[J]. 中国心血管病研究, 2022, 20(7): 577-596.
[2] 沈迎, 张瑞岩, 沈卫峰. 稳定性冠心病血运重建策略进展——2018中国稳定性冠心病诊断与治疗指南解读[J]. 心脑血管病防治, 2019, 19(2): 107-111.
[3] 王建南, 何青. 冠心病领域诊疗进展[J]. 中国心血管杂志, 2019, 24(4): 301-303.
[4] 不稳定性心绞痛诊断和治疗建议[J]. 中华心血管病杂志, 2000(6): 8-11.
[5] Koivunen, M., Tynkkynen, J., Oksala, N., Eskola, M. and Hernesniemi, J. (2023) Incidence of Sudden Car-diac Arrest and Sudden Cardiac Death after Unstable Angina Pectoris and Myocardial Infarction. American Heart Jour-nal, 257, 9-19. [Google Scholar] [CrossRef] [PubMed]
[6] 赵连友, 孙英贤, 李玉明, 等. 高血压合并动脉粥样硬化防治中国专家共识[J]. 中华高血压杂志, 2020, 28(2): 116-123.
[7] Gimbrone JR, M.A. and García-Cardeña, G. (2016) Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis. Circulation Research, 118, 620-636. [Google Scholar] [CrossRef] 
[8] Tabas, I., Garcia-Cardena, G. and Owens, G.K. (2015) Recent Insights into the Cellular Biology of Atherosclerosis. Journal of Cell Biology, 209, 13-22. [Google Scholar] [CrossRef] [PubMed]
[9] Singh, R.K., Haka, A.S., Asmal, A., et al. (2020) TLR4 (Toll-Like Receptor 4)-Dependent Signaling Drives Extracellular Catabolism of LDL (Low-Density Lipoprotein) Aggregates. Arte-riosclerosis, Thrombosis, and Vascular Biology, 40, 86-102. [Google Scholar] [CrossRef] 
[10] Roldán-Montero, R., Pérez-Sáez, J.M., Cerro-Pardo, I., et al. (2022) Galectin-1 Prevents Pathological Vascular Remodeling in Atherosclerosis and Abdominal Aortic Aneurysm. Sci-ence Advances, 8, eabm7322. [Google Scholar] [CrossRef] [PubMed]
[11] Duque, P., Mora, L., Levy, J.H. and Schöchl, H. (2020) Pathophysi-ological Response to Trauma-Induced Coagulopathy: A Comprehensive Review. Anesthesia & Analgesia, 130, 654-664. [Google Scholar] [CrossRef] 
[12] Merino, J. (2022) A Reassessment of the Causal Effects of Dysglycemia on Atherosclerotic and Thrombotic Events. Diabetes, 71, 2075-2077. [Google Scholar] [CrossRef] [PubMed]
[13] Bosch, X. and Marrugat, J. (2001) Platelet Glycoprotein IIb/IIIa Blockers for Percutaneous Coronary Revascularization, and Unstable Angina and Non-ST-Segment Elevation Myocardial Infarc-tion. The Cochrane Database of Systematic Reviews, 4, CD002130. [Google Scholar] [CrossRef] 
[14] Bjorkegren, J.L.M. and Lusis, A.J. (2022) Atherosclerosis: Re-cent Developments. Cell, 185, 1630-1645. [Google Scholar] [CrossRef] [PubMed]
[15] Libby, P. (2021) The Changing Landscape of Atherosclerosis. Na-ture, 592, 524-533. [Google Scholar] [CrossRef] [PubMed]
[16] Kobiyama, K. and Ley, K. (2018) Atherosclerosis. Circulation Research, 123, 1118-1120. [Google Scholar] [CrossRef] 
[17] Adamo, L., Rocha-Resende, C., Prabhu, S.D. and Mann, D.L. (2020) Reappraising the Role of Inflammation in Heart Failure. Nature Reviews Cardiology, 17, 269-285. [Google Scholar] [CrossRef] [PubMed]
[18] Yoon, D.S., Lee, K.M., Choi, Y., et al. (2022) TLR4 Downregu-lation by the RNA-Binding Protein PUM1 Alleviates Cellular Aging and Osteoarthritis. Cell Death and Differentiation, 29, 1364-1378. [Google Scholar] [CrossRef] [PubMed]
[19] Saigusa, R., Winkels, H. and Ley, K. (2020) T Cell Subsets and Functions in Atherosclerosis. Nature Reviews Cardiology, 17, 387-401. [Google Scholar] [CrossRef] [PubMed]
[20] Orecchioni, M., Kobiyama, K., Winkels, H., et al. (2022) Olfac-tory Receptor 2 in Vascular Macrophages Drives Atherosclerosis by NLRP3-Dependent IL-1 Production. Science, 375, 214-221. [Google Scholar] [CrossRef] [PubMed]
[21] 国家卫生计生委合理用药专家委员会, 中国药师协会. 冠心病合理用药指南(第2版) [J]. 中国医学前沿杂志(电子版), 2018, 10(6): 1-130.
[22] Carey, R.M., Moran, A.E. and Whelton, P.K. (2022) Treatment of Hypertension: A Review. JAMA, 328, 1849-1861. [Google Scholar] [CrossRef] [PubMed]
[23] 硝酸酯类药物低反应性或耐药人群的急诊识别与处理中西医专家共识组. 硝酸酯类药物低反应性或耐药人群的急诊识别与处理中西医专家共识[J]. 中华急诊医学杂志, 2022, 31(9): 1174-1181.
[24] Münzel, T., Daiber, A. and Gori, T. (2011) Nitrate Therapy: New Aspects Concerning Molecu-lar Action and Toleranc. Circulation, 123, 2132-2144. [Google Scholar] [CrossRef] 
[25] 郭晓芳, 陈静静, 陈霞. 老年患者冠心病治疗的研究进展[J]. 医学综述, 2021, 27(11): 2189-2193.
[26] 萧雪兰, 陈远中, 梁锦裕, 等. 硝酸酯类药物治疗心血管疾病的药学应用价值分析[J]. 中国现代药物应用, 2021, 15(14): 112-114.
[27] 应用β肾上腺素能受体阻滞剂规范治疗冠心病中国专家共识组. 应用β肾上腺素能受体阻滞剂规范治疗冠心病的中国专家共识[J]. 中国循环杂志, 2020, 35(2): 108-123.
[28] Singh, J., Elton, A. and Kwa, M. (2023) Comparison of Various Calcium Antagonist on Vasospastic Angina: A Systematic Review. Open Heart, 10, e002179. [Google Scholar] [CrossRef] [PubMed]
[29] Lin, J., Guo, Q., Lu, Z., et al. (2023) Cardiovascular Outcomes of β-Blocker-Calcium Channel Blocker Initial Dual Therapy vs. Other Initial Dual Therapies in Chinese Patients with Hypertension: A Real-World Retrospective Study. Journal of Clinical Hypertension, 25, 440-452. [Google Scholar] [CrossRef] [PubMed]
[30] 北京高血压防治协会,北京糖尿病防治协会, 北京慢性病防治与健康教育研究会, 等. 基层心血管病综合管理实践指南2020[J]. 中国医学前沿杂志(电子版), 2020, 12(8): 1-73.
[31] Rood, K.M., Patel, N., Devengencie, I.M., et al. (2023) Aspirin Modulates Production of Pro-Inflammatory and Pro-Resolving Mediators in Endothelial Cells. PLOS ONE, 18, e0283163. [Google Scholar] [CrossRef] [PubMed]
[32] Ujjawal, A., Gupta, M., Ghosh, R.K., et al. (2021) Aspirin for Primary Prevention of Coronary Artery Disease. Current problems in Cardiology, 46, Article ID: 100553. [Google Scholar] [CrossRef] [PubMed]
[33] Wang, Y., Cavallari, L.H., Brown, J.D., et al. (2023) As-sessing the Clinical Treatment Dynamics of Antiplatelet Therapy following Acute Coronary Syndrome and Percutaneous Coronary Intervention in the US. JAMA Network Open, 6, e238585. [Google Scholar] [CrossRef] [PubMed]
[34] Sachdeva, A., Mutyala, R., Mantri, N., et al. (2023) P2Y12 Inhibitors in Acute Coronary Syndromes: A Real-World, Community-Based Comparison of Ischemic and Bleeding Outcomes. Journal of Interventional Cardiology, 2023, Article ID: 1147352. [Google Scholar] [CrossRef] [PubMed]
[35] Mayer, M. (2017) Anticoagulants in Ischemia-Guided Management of Non-ST-Elevation Acute Coronary Syndromes. The American Journal of Emergency Medicine, 35, 502-507. [Google Scholar] [CrossRef] [PubMed]
[36] Hirsh, J., Warkentin, T.E., Shaughnessy, S.G., et al. (2001) Hepa-rin and Low-Molecular-Weight Heparin: Mechanisms of Action, Pharmacokinetics, Dosing, Monitoring, Efficacy, and Safety. Chest, 119, 64s-94s. [Google Scholar] [CrossRef] 
[37] Wang, X., Ma, Y., Hui, X., et al. (2023) Oral Direct Thrombin Inhibitors or Oral Factor Xa Inhibitors versus Conventional Anticoagulants for the Treatment of Deep Vein Thrombosis. The Cochrane Database of Systematic Reviews, 4, CD010956. [Google Scholar] [CrossRef] 
[38] Wilkinson, M.J., Lepor, N.E. and Michos, E.D. (2023) Evolving Management of Low-Density Lipoprotein Cholesterol: A Personalized Approach to Preventing Atherosclerotic Cardiovascular Disease across the Risk Continuum. Journal of the American Heart Association, 12, e028892. [Google Scholar] [CrossRef] 
[39] Mylonas, K.S., Peroulis, M., Schizas, D. and Kapelouzou, A. (2023) MYD88 and Proinflammatory Chemokines in Aortic Atheromatosis: Exploring Novel Statin Effects. Internation-al Journal of Molecular Sciences, 24, Article 9248. [Google Scholar] [CrossRef] [PubMed]
[40] 中国高血压防治指南修订委员会, 高血压联盟(中国, 中华医学会心血管病学分会中国医师协会高血压专业委员会, 等. 中国高血压防治指南(2018年修订版) [J]. 中国心血管杂志, 2019, 24(1): 24-56.
[41] Raposeiras-Roubín, S., Abu-Assi, E., Cespón-Fernández, M., et al. (2020) Impact of Ren-in-Angiotensin System Blockade on the Prognosis of Acute Coronary Syndrome Based on Left Ventricular Ejection Fraction. Revista Española de Cardiología (English Edition), 73, 114-122. [Google Scholar] [CrossRef] [PubMed]
[42] Han, Y.L. and Li, Y. (2021) History and Development of Percuta-neous Coronary Intervention for Coronary Heart Disease in China. Chinese Journal of Cardiology, 49, 645-649.
[43] Mahmoud, S.E.S., Shahin, M., Yousif, N., et al. (2022) Cardiovascular Risk Profile, Presentation and Management Outcomes of Patients with Acute Coronary Syndromes after Coronary Artery Bypass Grafting. Current Problems in Cardiology, 47, Article ID: 101078. [Google Scholar] [CrossRef] [PubMed]
[44] 韩格平, 董莲池, 主编. 山海经译注[M]. 沈薇薇, 译注. 哈尔滨: 黑龙江人民出版社, 2003.
[45] 杨继, 张垚, 张运娇, 等. 通心络胶囊联合西医常规治疗不稳定型心绞痛疗效与安全性的Meta分析[J]. 药物评价研究, 2021, 44(4): 830-847.
[46] 赵红亮, 张明轩, 张向宇, 等. 参松养心胶囊对不稳定型心绞痛伴慢性失眠患者临床疗效的影响[J]. 世界科学技术-中医药现代化, 2020, 22(2): 511-515.
[47] 唐梅玲, 卢健棋, 余梅平, 等. 稳心颗粒联合曲美他嗪治疗不稳定型心绞痛疗效和安全性的系统评价及Meta分析[J]. 湖南中医药大学学报, 2019, 39(7): 898-906.
[48] 赵洁慧, 左君丽. 麝香保心丸治疗冠心病合并高血压获益探讨[J]. 中西医结合心脑血管病杂志, 2018, 16(16): 2329-2330.
[49] Sun, L. and Zhang, Y.N. (2022) Compound Danshen Dripping Pills in Treating with Coronary Heart Disease: A Protocol for Systematic Review and Meta-Analysis. Medicine, 101, e28927. [Google Scholar] [CrossRef] 
[50] 陈朋程, 于玲欢, 项伟忠. 冠心宁片治疗冠心病不稳定型心绞痛临床研究[J]. 新中医, 2022, 54(19): 84-87.

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