加味柴胡桂枝汤联合康复运动对冠心病PCI术后患者小而密低密度脂蛋白、脂蛋白a水平和疾病获益感的影响

Effects of modified Chaihu Guizhi decoction combined with rehabilitation exercise on sd-LDL, Lipoprotein(a) levels, and disease benefit perception following coronary heart disease PCI surgery

摘要:

目的 评估加味柴胡桂枝汤联合康复运动对冠心病经皮冠状动脉介入治疗（PCI）后患者血清小而密低密度脂蛋白（sd-LDL）和脂蛋白a水平和疾病获益感的影响。方法 选取2021年1月—2023年12月海军青岛特勤疗养中心收治的106例接受PCI术的患者。采用随机数字表法分为研究组和对照组，各53例。对照组患者给予PCI术后规范的药物及康复运动治疗，研究组在术后规范的药物基础上接受加味柴胡桂枝汤联合康复运动治疗；所有患者均给予术后12周康复干预。比较两组患者治疗前后的中医证候积分、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、sd-LDL和脂蛋白a水平；比较两组患者治疗前、治疗4、8、12周后6分钟步行试验距离；比较两组患者治疗前后的左室射血分数、西雅图心绞痛量表评分，同时评估疾病获益感的变化。结果 研究组治疗前后中医证候积分、TC、TG、LDL-C、sd-LDL和脂蛋白a水平的差值均高于对照组（P <0.05）。两组治疗前、治疗4、8、12周6分钟步行距离比较，采用重复测量设计的方差分析，结果 ①不同时间点6分钟步行距离比较，差异有统计学意义（F =1 265.726，P =0.000）；②两组6分钟步行距离比较，差异有统计学意义（F =128.596，P =0.000），研究组6分钟步行距离较长，相对治疗效果较好；③两组6分钟步行距离趋势比较，差异有统计学意义（F =19.867，P =0.000）。研究组治疗前后躯体活动受限、心绞痛稳定状态、心绞痛发作及治疗满意度评分及左室射血分数的差值均高于对照组（P < 0.05）。研究组治疗前后SAS评分、SDS评分、疾病获益感量表评分的差值均高于对照组（P < 0.05）。结论 加味柴胡桂枝汤联合康复运动能有效降低冠心病PCI术后患者的sd-LDL和脂蛋白a水平，提高患者的疾病获益感，为冠心病患者术后康复提供了一种有效的治疗方法。

Abstract:

Objective To evaluate the effect of modified Chaihu Guizhi decoction combined with rehabilitation exercise on serum small dense low-density lipoprotein (sd-LDL) and lipoprotein(a) [Lp(a)] levels, as well as disease benefit perception in patients following percutaneous coronary intervention (PCI) for coronary heart disease.Methods A total of 106 PCI patients treated at the Navy Qingdao Special Services Convalescent Center from January 2021 to December 2023 were randomly assigned to a study group and a control group, with 53 patients in each group. Patients in the control group received standard drug therapy and rehabilitation exercises following coronary intervention, while the study group received a modified Chaihu Guizhi decoction combined with rehabilitation exercises on top of the standard postoperative medication; all patients underwent a 12-week postoperative rehabilitation intervention. The treatments' effects were assessed by comparing Traditional Chinese Medicine (TCM) syndrome scores, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), sd-LDL, and Lp(a) levels, a 6-minute walk test, left ventricular ejection fraction, Seattle Angina Pectoris Scale scores, and perceived health benefit changes before and after treatment.Results The differences in TCM syndrome scores, TC, TG, LDL-C, sd-LDL, and Lp(a) levels before and after treatment were greater in the study group than in the control group (P < 0.05). Comparison of the 6-minute walk distance before treatment and at weeks 4, 8, and 12 between the study and control groups showed: (1) statistically significant differences in walk distances at different time points (F =1 265.726, P =0.000); (2) longer walk distances in the experimental group, indicating better treatment effects (F = 128.596, P = 0.000); (3) statistically significant differences in trends of walk distances between the two groups (F =19.867, P =0.000). The differences in scores for physical activity limitation, stable angina, angina attacks, treatment satisfaction, and left ventricular ejection fraction before and after treatment were also higher in the study group than in the control group (P < 0.05). Differences in SAS scores, SDS scores, and disease benefit perception scores before and after treatment were also greater in the study group (P < 0.05).Conclusion Modified Chaihu Guizhi decoction combined with rehabilitation exercise can effectively reduce sd-LDL and Lp(a) levels and improve disease benefit perception in patients after coronary heart disease PCI surgery, offering an effective treatment method for post-operative rehabilitation in coronary heart disease patients.