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Article(id=1322923851595784464, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.06.013, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339224956, onlineDateStr=2026-10-30, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339224956, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339224956, creator=13701087609, updateTime=1793339224956, updator=13701087609, issue=Issue{id=1322923782029062261, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='6', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1749484800000', pubDateStr='2025-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339208371, creator='13701087609', updateTime=1793340556755, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929437859258468, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929437859258469, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923782029062261, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=75, endPage=78, ext={EN=ArticleExt(id=1322923852380119313, articleId=1322923851595784464, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effects of Jianpi Ziyin Decoction（健脾滋阴汤）Combined with Atorvastatin on Improvement of Traditional Chinese Medicine Syndrome Characteristics，Blood Rheology and Electrocardiogram in Patients with Coronary Heart Disease Microcirculation Disorder, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the effect of Jianpi Ziyin Decoction（健脾滋阴汤）combined with atorvastatin on the improvement of traditional Chinese medicine syndrome characteristics，hemorrheology and electrocardiogram in patients with coronary heart disease microcirculation disorders.

Methods

A hundred patients with coronary heart disease microcirculatory disorder of Qi deficiency and blood stasis syndrome were enrolled in the hospital，and the patients were randomly divided into an observation group and a control group according to the random number table method，50 cases in each.The control group was given atorvastatin calcium tablets，and the observation group was given Jianpi Ziyin Decoction on the basis of the treatment plan of the control group.After treatment，the clinical efficacy，TCM clinical symptom scores，microcirculatory function，hemorrheology，blood lipid levels and electrocardiogram efficacy of the two groups were observed before and after treatment.

Results

After treatment，the total effective rate of the observation group was 92.00%，which was significantly higher than that（74.00%）in the control group（P<0.05）.After treatment，the TCM clinical symptom scores of the two groups were significantly improved compared with those before treatment（P<0.05）.The symptom scores of the observation group in terms of chest tightness，chest pain，fatigue，palpitations，shortness of breath，insomnia and night sweats were significantly better than those in the control group（P<0.05）.The coronary flow reserve（CFR）of the two groups after treatment was higher than that before treatment.There was a significant improvement（P<0.05），and the CFR improvement of the observation group was significantly better than that the control group（P<0.05）.After treatment，the index of microcirculatory（IMR）of both groups decreased significantly compared with those be-fore treatment（P<0.05）and the index of the observation group was significantly better than that of the control group（P<0.05）.After treatment，the blood rheology indexes of both groups were significantly lower than those before treatment（P<0.05）.The whole blood viscosity high shear，whole blood viscosity low shear，platelet aggregation rate and red blood cell aggregation index in the observation group were significantly better than those in the control group（P<0.05）.The blood lipid levels in both groups after treatment were significantly improved compared with those before treatment（P<0.05）.The observation group had lower levels of total cholesterol（TC），triglycerides（TG），low-density lipoprotein cholesterol（LDL-C）and highdensity lipoprotein cholesterol（HDL-C）than the control group（P<0.05）.After treatment，the total ST segment effective rate of the observation group was 92.00%，which was significantly higher than that（70.00%）in the control group（P<0.05）.After treatment，the total effective rate of T-band in the observation group was 90.00%，which was significantly higher than that in the control group（78.00%）（P<0.05）.

Conclusion

Jianpi Ziyin Decoction combined with atorvastatin can effectively improve the clinical treatment effect，the clinical symptoms and microcirculation function，reduce the blood rheology and blood lipid levels and improve the electrocardiogram of patients with coronary heart disease.

, authors=Lu GUI, Wei WANG, Shasha ZHANG, authorsList=Lu GUI, Wei WANG, Shasha ZHANG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923853537747224, articleId=1322923851595784464, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

旨在探究健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响。

方法

纳入医院100例冠心病微循环障碍气虚血瘀证患者，按随机数字表法将患者随机分为观察组及对照组各50例。对照组给予阿托伐他汀钙片，观察组在对照组治疗方案上给予健脾滋阴汤。治疗结束后观察两组治疗前后临床疗效、中医临床症状积分、微循环功能、血液流变学、血脂水平及心电图疗效。

结果

治疗后观察组总有效率为92.00%，显著高于对照组总有效率74.00%（P<0.05）；治疗后两组中医临床症状积分较治疗前均有显著改善（P<0.05），观察组胸闷、胸痛、乏力疲惫、心悸气短、失眠盗汗的症状积分均显著优于对照组（P<0.05）；治疗后两组冠状动脉流量储备（coronary flow reserve，CFR）较治疗前均有显著提升（P<0.05），其中观察组显著优于对照组（P<0.05）；治疗后两组微循环阻力指数（index of microcirculatory resistance，IMR）较治疗前均有显著下降（P<0.05），其中观察组显著优于对照组（P<0.05）；治疗后两组血液流变学指标均较治疗前有显著下降（P<0.05），观察组全血黏度高切、全血黏度低切、血小板聚集率及红细胞聚集指数均显著优于对照组（P<0.05）；治疗后两组患者血脂水平变化均较治疗前显著改善（P<0.05），观察组总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）及高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）均显著优于对照组（P<0.05）；治疗后观察组ST段总有效率为92.00%，显著高于对照组总有效率70.00%（P<0.05）；治疗后观察组T波段总有效率为90.00%，显著高于对照组78.00%（P<0.05）。

结论

健脾滋阴汤联合阿托伐他汀治疗冠心病微循环障碍能有效提高临床治疗效果，改善患者临床症状、微循环功能，降低患者血液流变学及血脂水平并改善患者心电图情况。

, authors=桂璐, 王巍, 张莎莎, authorsList=桂璐, 王巍, 张莎莎, authorCompany=null, correspAuthors=null, authorNote=

桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

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桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

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桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

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组别例数显效有效无效总有效
观察组5026（52.00）20（40.00）4（8.00）46（92.00）
对照组5015（30.00）22（44.00）13（26.00）37（74.00）
χ2值5.740 6
P值0.016 6
), ArticleFig(id=1322923857635582263, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表1, caption=

两组冠心病微循环障碍患者治疗后临床疗效对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效有效无效总有效
观察组5026（52.00）20（40.00）4（8.00）46（92.00）
对照组5015（30.00）22（44.00）13（26.00）37（74.00）
χ2值5.740 6
P值0.016 6
), ArticleFig(id=1322923857698496824, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间胸闷胸痛乏力疲惫心悸气短失眠盗汗
观察组50治疗前10.62±2.418.72±2.912.15±0.201.92±0.523.22±0.74
治疗后4.56±1.15*#3.37±1.96*#0.12±0.64*#0.32±0.83*1.25±0.11*#
对照组50治疗前11.63±2.928.12±2.262.18±0.581.98±0.633.68±0.82
治疗后6.21±1.91*5.49±1.34*1.62±0.13*0.35±0.68*2.93±0.83*
), ArticleFig(id=1322923857761411385, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表2, caption=

两组冠心病微循环障碍患者中医临床症状积分对比（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间胸闷胸痛乏力疲惫心悸气短失眠盗汗
观察组50治疗前10.62±2.418.72±2.912.15±0.201.92±0.523.22±0.74
治疗后4.56±1.15*#3.37±1.96*#0.12±0.64*#0.32±0.83*1.25±0.11*#
对照组50治疗前11.63±2.928.12±2.262.18±0.581.98±0.633.68±0.82
治疗后6.21±1.91*5.49±1.34*1.62±0.13*0.35±0.68*2.93±0.83*
), ArticleFig(id=1322923857841103162, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间CFRIMR
观察组50治疗前1.34±0.4336.76±3.55
治疗后2.98±0.55*#21.83±4.73*#
对照组50治疗前1.38±0.4236.63±3.83
治疗后1.81±0.51*30.02±4.34*
), ArticleFig(id=1322923857904017723, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表3, caption=

两组冠心病微循环障碍患者微循环功能对比（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间CFRIMR
观察组50治疗前1.34±0.4336.76±3.55
治疗后2.98±0.55*#21.83±4.73*#
对照组50治疗前1.38±0.4236.63±3.83
治疗后1.81±0.51*30.02±4.34*
), ArticleFig(id=1322923857979515196, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间全血黏度高切/（mPa·a）全血黏度低切/（mPa·a）血小板聚集率/（%）红细胞聚集指数/（%）
观察组50治疗前5.52±0.4112.25±1.5748.13±7.419.10±1.46
治疗后4.17±0.26*#8.47±1.36*#30.46±5.64*#6.32±0.98*
对照组50治疗前5.55±0.4212.28±1.6648.18±7.589.14±1.53
治疗后4.87±0.38*10.22±1.54*41.74±6.11*8.24±1.45*
), ArticleFig(id=1322923858042429757, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表4, caption=

两组冠心病微循环障碍患者血液流变学对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间全血黏度高切/（mPa·a）全血黏度低切/（mPa·a）血小板聚集率/（%）红细胞聚集指数/（%）
观察组50治疗前5.52±0.4112.25±1.5748.13±7.419.10±1.46
治疗后4.17±0.26*#8.47±1.36*#30.46±5.64*#6.32±0.98*
对照组50治疗前5.55±0.4212.28±1.6648.18±7.589.14±1.53
治疗后4.87±0.38*10.22±1.54*41.74±6.11*8.24±1.45*
), ArticleFig(id=1322923858096955711, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TCTGLDL-CHDL-C
观察组50治疗前7.64±0.532.85±0.563.79±1.461.35±0.21
治疗后4.11±0.30*#1.04±0.41*#1.24±0.63*#1.98±0.33*#
对照组50治疗前7.68±0.512.89±0.573.75±1.491.32±0.23
治疗后5.25±0.37*1.62±0.35*2.56±0.90*1.51±0.46*
), ArticleFig(id=1322923858168258880, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表5, caption=

两组冠心病微循环障碍患者治疗前后血脂水平对比（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TCTGLDL-CHDL-C
观察组50治疗前7.64±0.532.85±0.563.79±1.461.35±0.21
治疗后4.11±0.30*#1.04±0.41*#1.24±0.63*#1.98±0.33*#
对照组50治疗前7.68±0.512.89±0.573.75±1.491.32±0.23
治疗后5.25±0.37*1.62±0.35*2.56±0.90*1.51±0.46*
), ArticleFig(id=1322923858243756353, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数ST段T波段
显效有效无效总有效显效有效无效总有效
观察组5028（56.00）18（36.00）4（8.00）46（92.00）26（52.00）19（38.00）5（10.00）45（90.00）
对照组5025（50.00）10（20.00）15（30.00）35（70.00）15（30.00）24（48.00）11（22.00）39（78.00）
χ2值7.862 22.678 6
P值0.005 00.101 7
), ArticleFig(id=1322923858369585474, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, language=CN, label=表6, caption=

两组冠心病微循环障碍患者心电图对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数ST段T波段
显效有效无效总有效显效有效无效总有效
观察组5028（56.00）18（36.00）4（8.00）46（92.00）26（52.00）19（38.00）5（10.00）45（90.00）
对照组5025（50.00）10（20.00）15（30.00）35（70.00）15（30.00）24（48.00）11（22.00）39（78.00）
χ2值7.862 22.678 6
P值0.005 00.101 7
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健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响
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桂璐 , 王巍 , 张莎莎
中华中医药学刊 | 国家项目点击 2025,43(6): 75-78
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中华中医药学刊 |国家项目点击 2025 , 43 (6) : 75 -78
健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响
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[Author(id=1322923854045258013, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322923854145921311, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, authorId=1322923854045258013, language=EN, stringName=Lu GUI, firstName=Lu, middleName=null, lastName=GUI, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=The First People's Hospital of Huzhou，Huzhou 313000，Zhejiang，China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322923854271750432, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923851595784464, authorId=1322923854045258013, language=CN, stringName=桂璐, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=湖州市第一人民医院，浙江 湖州 313000, bio={"content":"

桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

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桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

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桂璐, 王巍, 张莎莎
作者信息
  • 湖州市第一人民医院，浙江 湖州 313000
作者简介:

桂璐（1989-），女，浙江湖州人，主管技师，学士，研究方向：临床心电学技术。

Effects of Jianpi Ziyin Decoction（健脾滋阴汤）Combined with Atorvastatin on Improvement of Traditional Chinese Medicine Syndrome Characteristics，Blood Rheology and Electrocardiogram in Patients with Coronary Heart Disease Microcirculation Disorder
Lu GUI, Wei WANG, Shasha ZHANG
Affiliations
  • The First People's Hospital of Huzhou，Huzhou 313000，Zhejiang，China
出版时间: 2025-06-10 doi: 10.13193/j.issn.1673-7717.2025.06.013
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摘要
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目的

旨在探究健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响。

方法

纳入医院100例冠心病微循环障碍气虚血瘀证患者，按随机数字表法将患者随机分为观察组及对照组各50例。对照组给予阿托伐他汀钙片，观察组在对照组治疗方案上给予健脾滋阴汤。治疗结束后观察两组治疗前后临床疗效、中医临床症状积分、微循环功能、血液流变学、血脂水平及心电图疗效。

结果

治疗后观察组总有效率为92.00%，显著高于对照组总有效率74.00%（P<0.05）；治疗后两组中医临床症状积分较治疗前均有显著改善（P<0.05），观察组胸闷、胸痛、乏力疲惫、心悸气短、失眠盗汗的症状积分均显著优于对照组（P<0.05）；治疗后两组冠状动脉流量储备（coronary flow reserve，CFR）较治疗前均有显著提升（P<0.05），其中观察组显著优于对照组（P<0.05）；治疗后两组微循环阻力指数（index of microcirculatory resistance，IMR）较治疗前均有显著下降（P<0.05），其中观察组显著优于对照组（P<0.05）；治疗后两组血液流变学指标均较治疗前有显著下降（P<0.05），观察组全血黏度高切、全血黏度低切、血小板聚集率及红细胞聚集指数均显著优于对照组（P<0.05）；治疗后两组患者血脂水平变化均较治疗前显著改善（P<0.05），观察组总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）及高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）均显著优于对照组（P<0.05）；治疗后观察组ST段总有效率为92.00%，显著高于对照组总有效率70.00%（P<0.05）；治疗后观察组T波段总有效率为90.00%，显著高于对照组78.00%（P<0.05）。

结论

健脾滋阴汤联合阿托伐他汀治疗冠心病微循环障碍能有效提高临床治疗效果，改善患者临床症状、微循环功能，降低患者血液流变学及血脂水平并改善患者心电图情况。

健脾滋阴汤  /  阿托伐他汀  /  冠心病微循环障碍  /  血液流变学  /  心电图
Objective

To explore the effect of Jianpi Ziyin Decoction（健脾滋阴汤）combined with atorvastatin on the improvement of traditional Chinese medicine syndrome characteristics，hemorrheology and electrocardiogram in patients with coronary heart disease microcirculation disorders.

Methods

A hundred patients with coronary heart disease microcirculatory disorder of Qi deficiency and blood stasis syndrome were enrolled in the hospital，and the patients were randomly divided into an observation group and a control group according to the random number table method，50 cases in each.The control group was given atorvastatin calcium tablets，and the observation group was given Jianpi Ziyin Decoction on the basis of the treatment plan of the control group.After treatment，the clinical efficacy，TCM clinical symptom scores，microcirculatory function，hemorrheology，blood lipid levels and electrocardiogram efficacy of the two groups were observed before and after treatment.

Results

After treatment，the total effective rate of the observation group was 92.00%，which was significantly higher than that（74.00%）in the control group（P<0.05）.After treatment，the TCM clinical symptom scores of the two groups were significantly improved compared with those before treatment（P<0.05）.The symptom scores of the observation group in terms of chest tightness，chest pain，fatigue，palpitations，shortness of breath，insomnia and night sweats were significantly better than those in the control group（P<0.05）.The coronary flow reserve（CFR）of the two groups after treatment was higher than that before treatment.There was a significant improvement（P<0.05），and the CFR improvement of the observation group was significantly better than that the control group（P<0.05）.After treatment，the index of microcirculatory（IMR）of both groups decreased significantly compared with those be-fore treatment（P<0.05）and the index of the observation group was significantly better than that of the control group（P<0.05）.After treatment，the blood rheology indexes of both groups were significantly lower than those before treatment（P<0.05）.The whole blood viscosity high shear，whole blood viscosity low shear，platelet aggregation rate and red blood cell aggregation index in the observation group were significantly better than those in the control group（P<0.05）.The blood lipid levels in both groups after treatment were significantly improved compared with those before treatment（P<0.05）.The observation group had lower levels of total cholesterol（TC），triglycerides（TG），low-density lipoprotein cholesterol（LDL-C）and highdensity lipoprotein cholesterol（HDL-C）than the control group（P<0.05）.After treatment，the total ST segment effective rate of the observation group was 92.00%，which was significantly higher than that（70.00%）in the control group（P<0.05）.After treatment，the total effective rate of T-band in the observation group was 90.00%，which was significantly higher than that in the control group（78.00%）（P<0.05）.

Conclusion

Jianpi Ziyin Decoction combined with atorvastatin can effectively improve the clinical treatment effect，the clinical symptoms and microcirculation function，reduce the blood rheology and blood lipid levels and improve the electrocardiogram of patients with coronary heart disease.

Jianpi Ziyin Decoction（健脾滋阴汤）  /  atorvastatin  /  coronary heart disease microcirculation disorder  /  hemorrheology  /  electrocardiogram
桂璐, 王巍, 张莎莎. 健脾滋阴汤联合阿托伐他汀对冠心病微循环障碍患者中医证候特征、血液流变学及心电图改善的影响. 中华中医药学刊, 2025 , 43 (6) : 75 -78 . DOI: 10.13193/j.issn.1673-7717.2025.06.013
Lu GUI, Wei WANG, Shasha ZHANG. Effects of Jianpi Ziyin Decoction（健脾滋阴汤）Combined with Atorvastatin on Improvement of Traditional Chinese Medicine Syndrome Characteristics，Blood Rheology and Electrocardiogram in Patients with Coronary Heart Disease Microcirculation Disorder[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (6) : 75 -78 . DOI: 10.13193/j.issn.1673-7717.2025.06.013
正文
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冠心病微循环障碍是一种涉及冠状动脉系统微小血管的心脏疾病，其流行病学数据表明，这一病症不仅在老年人中高发，还在年轻人中逐渐增多，尤其在女性和那些具有心血管危险因素的人群中[1]。然而，冠心病微循环障碍的确切病因病机尚不为人所明了，尽管存在多种可能的因素，如内皮功能异常、炎症反应、氧化应激等[2]。本病主要症状包括胸痛、心悸、疲劳和气短，这些症状不仅严重影响了患者的生活质量，还增加了心肌梗死等严重心血管事件的风险[3]。目前，治疗冠心病微循环障碍的方法主要包括药物治疗、生活方式干预和心理支持[4]。然而，一些患者对这些治疗方法的反应有限，而且长期使用某些药物可能引发不良反应。在这一背景下，中医药作为中国传统医学，具备丰富的经验和独特的治疗方法，其可以通过改善心脏血液供应、调节内皮功能、减轻炎症反应等多种途径，对患者产生积极影响[5]。因此，引入中医药治疗的原因和必要性在于提供一种多元化的治疗选择，有望为冠心病微循环障碍患者带来更好的临床疗效和生活质量。本研究旨在评估在目前常用的临床治疗方案基础上，联合使用健脾滋阴汤来治疗冠心病微循环障碍患者的效果，现报道如下。
1　资料与方法
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1.1　一般资料
选取本院2020年6月—2022年12月收治的100例冠心病微循环障碍患者，按照随机数字表法将患者分为对照组及观察组各50例。其中观察组男26例，女24例；年龄39～72岁，平均（59.15±4.62）岁；病程为1～12年，平均（6.34±1.03）年。对照组患者男28例，女22例；年龄40～73岁，平均（60.66±3.96）岁；病程1～13年，平均（6.71±1.12）年。两组患者的性别、年龄、病程一般资料相比，差异均无统计学意义（P>0.05）。本研究经医院伦理委员会审核通过。
1.2　诊断标准
冠心病微循环障碍诊断标准参照《稳定性冠心病诊断与治疗指南》[6]，根据患者症状并依据病史、体格检查、相关的无创检查及有创检查结果作出诊断。气虚血瘀证诊断标准按《冠心病稳定型心绞痛中医诊疗指南》[7]制定，证候诊断：气虚：胸闷或胸痛劳则诱发（4分），神疲（3分），乏力（3分），气短（3分），自汗（3分），脉弱（2分），舌淡胖或有齿痕（2分），心悸（1分）；血瘀：固定性胸痛（4分），舌质紫黯或舌体有瘀斑瘀点（4分），舌下静脉紫黯（3分），面色紫黯（3分），身体有瘀点或瘀斑（3分），肢体麻木（2分），口唇紫黯或黯红（2分），脉涩（2分）。单一证候要素得分相加≥8分，同时满足气虚、血瘀证候要素即可诊断。
1.3　纳入及排除标准
1.3.1　纳入标准
①年龄在35～85岁；②符合本研究中西医诊断标准；③美国纽约心脏学会心功能分级≤Ⅲ级；④自愿参加本研究并签署知情同意书。
1.3.2　排除标准
①合并有心肌、瓣膜病等其他心脏疾病患者；②合并有严重肝、肾功能障碍，免疫性疾病，血液系统疾病或恶性肿瘤，糖尿病等患者；③急/慢性感染者；④非自愿参与本研究或未签署知情同意书。
1.4　方法
对照组给予阿托伐他汀钙片（辉瑞制药有限公司，国药准字H20051407）10 mg/次，1次/d。观察组在对照组治疗方案上给予健脾滋阴汤：黄芪30 g，丹参25 g，麦冬25 g，酸枣仁10 g，茯苓15 g，川芎10 g，五味子10 g，五灵脂10 g，薏苡仁10 g，山楂10 g，以上药物共水煎服，每日1剂，早晚分服。两组均以4周为1个疗程，治疗2个疗程即8周后观察临床疗效。
1.5　观察指标
1.5.1　临床疗效评价
参考《中药新药临床研究指导原则（试行）》[8]根据中医证候积分情况进行评定。显效：中医证候积分减少大于等于70%；有效：中医证候积分减少大于等于30%，小于70%；无效：中医证候积分减少小于30%。总有效率＝（显效+有效）/总例数×100%。
1.5.2　中医临床症状积分
依据《中药新药临床研究指导原则（试行）》[8]对患者临床症状胸闷、胸痛、乏力疲惫、心悸气短、失眠盗汗进行评估，由无、轻、中、重分别计0、1、2、3分，累计证候积分越低患者临床症状越轻。
1.5.3　微循环功能
分别于治疗前后采用多普勒超声检测CFR及IMR。
1.5.4　血液流变学
使用自动血流变分析仪检测患者全血高切黏度、全血低切黏度、红细胞聚集指数和血小板聚集率。
1.5.5　血脂水平
取患者外周静脉血，测定患者血清中总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）及高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）水平。
1.5.6　心电图疗效标准
分为ST段及T波段疗效[9]。ST段疗效标准：显效：静息时心电图显示正常；有效：静息时心电图显示缺血性ST段降低，治疗后回升在0.05 mv以上后达正常；无效：治疗前后静息时心电图显示无变化。T波段疗效：显效：静息时心电图显示正常；有效：静息时心电图显示缺血性T波倒置情况减轻25%以上，T波平坦变直；无效：治疗前后静息时心电图显示无变化。总有效率＝（显效+有效）/（无效）×100%。
1.6　统计学分析
应用SPSS 22.0软件进行数据处理，计数资料进行χ2检验，计量资料进行t检验，P<0.05表示差异具有统计学意义。
2　结果
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2.1　两组患者临床疗效对比
治疗后观察组总有效率为92.00%，显著高于对照组总有效率74.00%（P<0.05）。见表1。
2.2　两组患者中医临床症状积分对比
治疗后两组中医临床症状积分较治疗前均有显著改善（P<0.05）；观察组胸闷、胸痛、乏力疲惫、心悸气短、失眠盗汗的症状积分均显著优于对照组（P<0.05）。见表2。
2.3　两组患者微循环功能对比
治疗后两组CFR较治疗前均有显著提升（P<0.05），其中观察组显著优于对照组（P<0.05）；治疗后两组IMR较治疗前均有显著下降（P<0.05），其中观察组显著优于对照组（P<0.05）。见表3。
2.4　两组患者血液流变学对比
治疗后两组血液流变学指标均较治疗前有显著下降，（P<0.05）；观察组全血黏度高切、全血黏度低切、血小板聚集率及红细胞聚集指数均显著优于对照组（P<0.05）。见表4。
2.5　两组患者血脂水平对比
治疗后两组患者血脂水平变化均较治疗前显著改善（P<0.05）；观察组TC、TG、LDL-C及HDL-C均显著优于对照组（P<0.05）。见表5。
2.6　两组患者心电图疗效对比
治疗后观察组ST段总有效率为92.00%，显著高于对照组总有效率70.00%（P<0.05）；治疗后观察组T波段总有效率为90.00%，显著高于对照组78.00%（P<0.05）。见表6。
3　讨论
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在治疗冠心病的临床实践及研究中，许多患者在经冠脉造影检查后未显示其有明显的冠脉狭窄或病变[10]。同时在经皮冠状动脉介入治疗后，患者的症状仍可能会再次出现[11]。这一类的患者多数被发现有冠脉微循环障碍，而这一状态对于冠心病的发展、治疗效果和预后起着重要作用[12]。冠状动脉微循环是由直径小于150μm的微动脉、毛细血管和微小静脉组成的，是确保心肌正常功能活动的关键通道[13]。微循环障碍通常表现为患者血液流速的改变，进而致使管腔狭窄或血栓形成，最终导致局部组织功能减退或坏死。但其病因和病理学基础至今尚未完全阐明[14]。有关冠心病微循环障碍的主要假设包括内皮功能异常、炎症反应、代谢紊乱、神经调节失常等[15-16]。因其隐匿性常常容易被忽视或误诊，给患者带来不适和健康隐患[17]。目前的常规治疗方案主要集中在改善症状和提高患者的生活质量，包括使用硝酸酯类药物、钙通道拮抗剂等药物来缓解症状[18]。然而，这些治疗方法并不直接针对微循环障碍的病因，因此在一些患者中可能效果不佳。此外，这些治疗也存在一些限制，如药物耐受性和不良反应[19]。
中医对冠心病微循环障碍的具体认识在不断发展，本病属于“胸痹”“心痛”等范畴，其发生与外邪内侵、饮食不节、情志失调、劳倦内伤等因素有关。本病病位在心，涉及脾等多个脏腑。本病病机实质为本虚标实，因患者自身禀赋不足，导致气虚；气为血之帅，气虚无以推动血液运行，停滞于脉管中，引起血瘀、痰浊等阻痹，故气虚血瘀证为常见证候，常使用益气养阴、活血通络的方法进行治疗。本研究使用健脾滋阴汤进行治疗，其组方为黄芪、丹参、麦冬、酸枣仁、茯苓、川芎、五味子、五灵脂、薏苡仁、山楂，其中以黄芪为君药，益气固表、补中行气，纠正患者气虚状态，推动血液运行；其有效成分黄芪皂苷、黄酮类等，能有效扩张毛细血管，改善缺血状态[20]；丹参、川芎、五灵脂活血散瘀、通络行气；麦冬、酸枣仁、茯苓、五味子、薏苡仁、山楂养阴生津、健脾宁心、化脂降浊，全方十味药，组方攻补兼施，共奏益气养阴、活血散瘀之效。现代药理学研究证明了本药中含有的多种皂苷类、黄酮类有效物质，确可起到抗氧化应激、抗炎、改善微循环等作用[21-22]。
CFR及IMR这两个指标在微循环中的意义非常重要，CFR是用来衡量冠状动脉血流的指标，反映了心脏微循环的功能，它表示在心脏的冠状动脉中血流的增加能力[23]；IMR是用来评估冠状动脉微循环的指标，它反映了微小血管中的血液流动情况，高IMR值表示微循环中存在阻力，这可能导致冠状动脉疾病患者的心肌供血不足[24]；本研究结果表明，使用健脾滋阴汤联合阿托伐他汀能有效改善患者CFR及IMR指标。同时血脂异常也是冠心病患者常出现的代谢异常，TC、TG、LDL-C的异常能导致不同程度的血管内皮损伤，使炎性因子升高，加速动脉粥样硬化的进度，改变血液流变学指标，增加心肌负担及发病风险[25]。在使用本研究方案后，患者无论血脂水平或血液流变学指标均有所下降。心电图的改变对于冠心病患者的诊断、疾病的严重程度评估以及治疗方案的制定都有着非常重要的意义，尤其ST段及T波的改变，往往预示着心肌供血不足甚至心肌梗死的发生[26]；使用本研究方案后，患者在心电图疗效方面也有所提升。
综上所述，对于气虚血瘀证冠心病微循环障碍患者，使用健脾滋阴汤联合阿托伐他汀能显著提高临床治疗效果，改善患者临床症状、微循环功能，降低患者血液流变学及血脂水平并改善患者心电图情况。
基金
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  • 国家中医药管理局中医药古籍文献和特色技术传承专项(GYZ-KJS-2020-353)
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doi: 10.13193/j.issn.1673-7717.2025.06.013
  • 首发时间：2026-10-30
  • 出版时间：2025-06-10
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国家中医药管理局中医药古籍文献和特色技术传承专项(GYZ-KJS-2020-353)
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    湖州市第一人民医院，浙江 湖州 313000
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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