目的 探討杏芎氯化鈉注射液聯(lián)合替格瑞洛片治療不穩(wěn)定型心絞痛的臨床療效。方法 選擇2019年6月-2020年6月在鄭州市第七人民醫(yī)院治療的不穩(wěn)定型心絞痛患者104例，根據(jù)就診順序分成對(duì)照組（52例）和治療組（52例）。對(duì)照組口服替格瑞洛片，起始劑量180 mg/次，此后每次90 mg/次，2次/d。治療組在對(duì)照組的基礎(chǔ)上靜脈滴注杏芎氯化鈉注射液，250 mL/次，1次/d。兩組患者均治療2周。觀察兩組患者心絞痛和心電圖療效，同時(shí)比較治療前后兩組患者心絞痛發(fā)作次數(shù)和持續(xù)時(shí)間，SAQ和GRACE評(píng)分，血清白三烯B4（LTB4）、基質(zhì)金屬蛋白酶-2（MMP-2）、明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白（NGAL）、凝集素樣氧化低密度脂蛋白受體（Lox-1）、1型組織纖溶酶原激活物抑制劑（tPAI-1）和凋亡相關(guān)分子細(xì)胞淋巴瘤（Bcl-2）水平及血管內(nèi)皮功能。結(jié)果 治療后，對(duì)照組心絞痛和心電圖有效率分別為80.77%和82.69%，均顯著低于治療組的96.15%和98.08%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者心絞痛發(fā)作次數(shù)、每次持續(xù)時(shí)間均顯著減少（P<0.05），且治療組減少更明顯（P<0.05）。治療后，兩組患者SAQ評(píng)分均升高，GRACE評(píng)分均下降（P<0.05），且治療組患者改善更顯著（P<0.05）。治療后，兩組患者血清LTB4、MMP-2、NGAL、Lox-1、tPAI-1水平均顯著下降，而B(niǎo)cl-2明顯升高（P<0.05），且治療組患者改善更顯著（P<0.05）。治療后，兩組患者NO和VEGF顯著升高，而ET和TXB2顯著降低（P<0.05），且治療組患者改善更顯著（P<0.05）。結(jié)論 杏芎氯化鈉注射液聯(lián)合替格瑞洛片治療不穩(wěn)定型心絞痛可有效改善患心絞痛癥狀，促進(jìn)血管內(nèi)皮功能改善，一定程度上抑制心肌細(xì)胞凋亡，有利于維持患者斑塊穩(wěn)定性。

Objective To investigate the clinical efficacy of Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride combined with ticagrelor in treatment of unstable angina pectoris. Methods Patients (104 cases) with unstable angina pectoris in the 7th People's Hospital of Zhengzhou from June 2019 to June 2020 were divided into control (52 cases) and treatment (52 cases) groups based on visiting sequence. Patients in the control group were po administered with Ticagrelor Tablets, and the initial dose was 180 mg/time, then 90 mg/time, twice daily. Patients in the treatment group were iv administered with Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride on the basis of the control group, 250 mL/time, once daily. Patients in two groups were treated for 2 weeks. After treatment, the angina pectoris and ECG efficacies were evaluated, and the frequency and duration of angina pectoris, SAQ and GRACE scores, the serum levels of LTB4, MMP-2, NGAL, Lox-1, tPAI-1, and Bcl-2, and the vascular endothelial function in two groups before and after treatment were compared. Results After treatment, the angina pectoris and ECG efficacies in the control group were 80.77% and 82.69%, which were significantly lower than 96.15% and 98.08% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the frequency and duration of angina pectoris in two groups were significantly decreased (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the SAQ scores in two groups were significantly increased, but the GRACE scores were significantly decreased (P<0.05), and the improvement of these scores in the treatment group were significantly better than that in the control group (P<0.05). After treatment, the serum levels of LTB4, MMP-2, NGAL, Lox-1 and tPAI-1 in two groups were significantly decreased, but the Bcl-2 levels were significantly increased (P<0.05), and the improvement of these serological indexes in the treatment group were significantly better than that in the control group (P<0.05). After treatment, the levels of NO and VEGF in two groups were significantly increased, but the ET and TXB2 levels were significantly decreased (P<0.05), and the improvement of the vascular endothelial function in the treatment group were significantly better than that in the control group (P<0.05). Conclusion Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride combined with ticagrelor can effectively improve the symptoms in treatment of unstable angina pectoris, promote the improvement of vascular endothelial function, inhibit myocardial cell apoptosis, which is conducive to maintaining the stability of plaque.

R972

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目（LHGJ20191116）