目的 探究大柴胡湯加減聯(lián)合硫酸氫氯吡格雷片治療冠心病心絞痛的臨床療效及對患者抗菌肽（LL-37）、免疫球蛋白樣轉(zhuǎn)錄子（ILT3）水平的影響。方法 前瞻性選取2019年3月-2020年5月于北京核工業(yè)醫(yī)院治療的冠心病心絞痛患者150例為研究對象，隨機分為對照組和試驗組，每組各75例。對照組患者采用硫酸氫氯吡格雷片治療，每次75 mg，每日1次，口服。試驗組在對照組基礎上加服大柴胡湯（組方：柴胡、枳實、黃芩各15 g，白芍、丹參、茯苓、陳皮各20 g，大黃、半夏、甘草各10 g），組方藥材煎煮后取汁400 mL，分早晚2次服用，另隨癥加減。分別于治療前及治療后對兩組患者行心臟超聲檢查，評價患者左室間隔厚度（IST）、左室后壁厚度（LVPWT）、左室等容舒張時間（IVRT）、左室射血分數(shù)（LVEF）。分別于治療前后采集兩組患者血清，檢測可溶性細胞間黏附分子-1（sICAM-1）、白細胞介素-6（IL-6）、骨保護素（OPG）等炎癥因子水平以及LL-37、ILT3水平。治療前后對兩組患者進行中醫(yī)證候積分評價，同時評價患者的中醫(yī)及西醫(yī)療效。結(jié)果 治療后兩組患者心功能指標IST、LVPWT、IVRT、LVEF較治療前明顯改善（P<0.05），且試驗組好于對照組（P<0.05）；治療后兩組患者血清sICAM-1、CRP、OPG、IL-6、LL-37、ILT3水平較治療前明顯下降（P<0.05），且試驗組顯著低于對照組（P<0.05）；治療后兩組中醫(yī)證候積分均較治療前顯著降低（P<0.05），且試驗組顯著低于對照組（P<0.05）；與對照組比較，治療后試驗組中醫(yī)及西醫(yī)總有效率均顯著增加（P<0.05）；治療過程中兩組不良反應發(fā)生率差異無統(tǒng)計學意義（P>0.05）。結(jié)論 大柴胡湯加減聯(lián)合硫酸氫氯吡格雷片治療冠心病心絞痛，可明顯改善患者心功能指標，抑制患者炎癥反應，改善LL-37、ILT3水平，提高療效。

Objective To investigate the clinical efficacy of Dachaihu Decoction combined with Clopidogrel Bisulfate Tablets in the treatment of angina pectoris of coronary heart disease and its effect on the levels of antimicrobial peptide (LL-37) and immunoglobulin like transcript (ILT3). Methods A total of 150 patients with angina pectoris of coronary heart disease treated in Beijing Nuclear Industry Hospital from March 2019 to may 2020 were prospectively divided into control group and experimental group, with 75 cases in each group. The patients in the control group were treated with Clopidogrel Bisulfate Tablets, 75 mg each time, once a day, orally. On the basis of the control group, the patients in the experimental group were added with Dachaihu Decoction (the formula: Bupleuri Radix, Aurantii Fructus Immaturus and Scutellariae Radix 15 g each, Paeoniae Radix Alba,Salviae Miltiorrhizae Radix et Rhizoma, Poria and Citri Reticulatae Pericarpium 20 g each, Rhei Radix et Rhizoma, Pinelliae Rhizoma and Glycyrrhizae Radix et Rhizoma 10 g each). After decocting, take 400 mL of juice, take it twice in the morning and evening, and add or subtract according to the symptoms. Echocardiography was performed before and after treatment to evaluate the left ventricular septal thickness (IST), left ventricular posterior wall thickness (LVPWT), left ventricular isovolumic relaxation time (IVRT) and left ventricular ejection fraction (LVEF). The serum of the two groups were collected before and after treatment to detect the levels of inflammatory factors such as sICAM-1, CRP, OPG and IL-6, as well as the levels of LL-37 and ILT3. The two groups of patients were evaluated by TCM symptom score before and after treatment, and the curative effects of TCM and Western medicine were evaluated at the same time. Results After treatment, the cardiac function indexes IST, LVPWT, IVRT and LVEF of the two groups were significantly improved (P < 0.05), and the experimental group was better than the control group (P < 0.05). After treatment, the levels of serum sICAM-1, CRP, OPG, IL-6, LL-37 and ILT3 in the two groups were significantly lower than those before treatment (P < 0.05), and the levels in the experimental group were significantly lower than those in the control group (P < 0.05). After treatment, the TCM syndrome volume of the two groups was significantly lower than that before treatment (P < 0.05), and the experimental group was significantly lower than that of the control group (P < 0.05). Compared with the control group, the total effective rates of traditional Chinese medicine and Western medicine in the experimental group increased significantly after treatment (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Dachaihu Decoction combined with Clopidogrel Bisulfate Tablets in the treatment of angina pectoris of coronary heart disease can significantly improve the indexes of cardiac function, inhibit the inflammatory response, improve LL-37 and ILT3, and improve the curative effect.

R972

北京市衛(wèi)生科技發(fā)展專項基金（2019-1-148）