补阳还五汤加减合血府逐瘀胶囊对急性心肌梗死PCI术后患者血小板聚集及NT-proBNP的影响*

作者：曹淑玲，尹淑利，宋光伟

单位：河北省第七人民医院，河北 保定 073000

引用：引用：曹淑玲，尹淑利，宋光伟.补阳还五汤加减合血府逐瘀胶囊对急性心肌梗死PCI术后患者血小板聚集及NT-proBNP的影响[J].中医药导报,2026,32(5):88-94.

DOI：10.13862/j.cn43-1446/r.2026.05.014

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摘要：

目的：探究补阳还五汤加减合血府逐瘀胶囊对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者血小板聚集及N末端B型利钠肽原（NT-proBNP）的影响。方法：将120例急性心肌梗死患者按照就诊顺序分为对照组和研究组，每组60例。对照组患者采用PCI及术后常规西药治疗，研究组患者在对照组基础上术后再加补阳还五汤加减合血府逐瘀胶囊治疗，两组均连续治疗4周。两组均于术前、术后即刻、术后12 h、术后24 h、术后3 d、术后7 d测定心肌损伤标志物水平，于术前、术后1周、术后4周测定血小板聚集率。于术前、术后4周统计中医证候积分，完善血清炎症因子、血管内皮功能和心脏超声检查，并于术后4周评估两组临床疗效。术后随访3个月，统计主要不良心血管事件（MACE）发生情况。结果：对照组脱落6例，纳入研究54例；研究组脱落5例，纳入研究55例。治疗4周后，研究组患者临床总有效率为92.73%（51/55），明显高于对照组的75.93%（41/54）（P＜0.05）；研究组患者主症积分、次症积分及中医证候总积分均低于对照组，差异均有统计学意义（P＜0.05）。两组患者心肌肌钙蛋白I（cTnI）在PCI术后24 h达峰，肌酸激酶同工酶（CK-MB）在PCI术后12 h达峰，NT-proBNP在PCI术后即刻达峰，随后随着时间推移均呈下降趋势。研究组cTnI、CK-MB在达峰时、达峰后水平明显低于同时间对照组水平；研究组术后24 h后NT-proBNP水平明显低于同时间对照组，差异均有统计学意义（P＜0.05）。术后1周、4周，两组患者血小板聚集率较术前均降低，且研究组低于对照组，差异均有统计学意义（P＜0.05）。术后4周，研究组患者超敏C反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）、内皮素（ET）-1均低于对照组，研究组一氧化氮（NO）、血管内皮生长因子（VEGF）高于对照组，差异均有统计学意义（P＜0.05）；研究组患者左室舒张末期内径（LVEDd）小于对照组，左室射血分数（LVEF）、心脏每搏输出量（SV）大于对照组，差异均有统计学意义（P＜0.05）。术后随访3个月，两组患者MACE发生率比较，差异无统计学意义（P＞0.05）。结论：补阳还五汤加减合血府逐瘀胶囊对于急性心肌梗死患者PCI术后具有一定疗效，能够有效降低患者炎症因子水平，保护血管内皮，抑制血小板聚集，改善患者心肌损伤程度，有利于心功能恢复。

关键词：急性心肌梗死；PCI术；补阳还五汤加减；血府逐瘀胶囊；血小板聚集；NT-proBNP

Abstract：

Objective: To investigate the effects of modified Buyang Huanwu Decoction (补阳还五汤) combined with Xuefu Zhuyu Capsules (血府逐瘀胶囊) on platelet aggregation and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: A total of 120 AMI patients were divided into a control group and a study group according to the order of consultation, with 60 cases in each group. The control group received PCI and postoperative conventional Western medicine treatment, while the study group received modified Buyang Huanwu Decoction combined with Xuefu Zhuyu Capsules in addition to the treatment of the control group. Both groups were treated for 4 weeks. Myocardial injury marker levels were measured before surgery, immediately after surgery, and at 12 h, 24 h, 3 d, and 7 d postoperatively. Platelet aggregation rates were measured before surgery and at 1 week and 4 weeks postoperatively. Before surgery and at 4 weeks postoperatively, TCM syndrome scores, serum inflammatory factors, vascular endothelial function, and echocardiographic parameters were assessed, and clinical efficacy was evaluated. Major adverse cardiovascular events (MACE) were recorded during a 3-month follow-up. Results: Six cases dropped out from the control group (54 cases included), and five cases dropped out from the study group (55 cases included). After 4 weeks of treatment, the total clinical effective rate in the study group was 92.73% (51/55), significantly higher than that in the control group (75.93%, 41/54) (P<0.05). The main syndrome scores, secondary syndrome scores, and total TCM syndrome scores in the study group were significantly lower than those in the control group (P<0.05). Cardiac troponin I (cTnI) peaked at 24 hours after PCI, creatine kinase-MB (CK-MB) peaked at 12 hours, and NT-proBNP peaked immediately postoperatively, all decreasing gradually over time. The levels of cTnI and CK-MB at and after peak in the study group were significantly lower than those in the control group at the same time points (P<0.05). The NT-proBNP level in the study group was significantly lower than that in the control group at 24 h after PCI and thereafter (P<0.05). At 1 week and 4 weeks postoperatively, the platelet aggregation rates in both groups decreased compared with preoperative levels, and the study group showed lower rates than the control group (P<0.05). At 4 weeks postoperatively, the study group exhibited lower levels of high-sensitivity C-reactive protein (hs-CRP), homocysteine (Hcy), and endothelin-1 (ET-1), and higher levels of nitric oxide (NO) and vascular endothelial growth factor (VEGF) than the control group (P<0.05). The left ventricular end-diastolic dimension (LVEDd) was lower, while left ventricular ejection fraction (LVEF) and stroke volume (SV) were higher in the study group than in the control group (P<0.05). No significant difference was found in the incidence of MACE between the two groups during the 3-month follow-up (P>0.05). Conclusion: Modified Buyang Huanwu Decoction combined with Xuefu Zhuyu Capsules exerts favorable therapeutic effects on AMI patients after PCI by reducing inflammatory factors, protecting vascular endothelium, inhibiting platelet aggregation, mitigating myocardial injury, and promoting cardiac function recovery.

Key words：acute myocardial infarction; PCI; Modified Buyang Huanwu Decoction; Xuefu Zhuyu Capsules; platelet aggregation; NT-proBNP

发布时间：2026-05-23

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