目的 研究脑心通胶囊联合尼可地尔治疗微血管性心绞痛的应用价值。方法 选取2020年1月—2021年12月北京中医药大学房山医院收治的106例微血管性心绞痛患者为研究对象，按照随机数字表法分为对照组和治疗组，每组各53例。对照组口服尼可地尔片，5mg/次，3次/d。治疗组在对照组基础上口服脑心通胶囊，1.2g/次，3次/d。两组患者治疗6周。观察两组患者临床疗效，比较治疗前后两组患者中医症候积分，冠脉血流动力学指标，血清学标记物过氧化物酶体增殖物激活受体α（PPAR-α）、肌红蛋白（MYO）和血友病因子（vWF）水平。结果 治疗后，治疗组总有效率为92.45%，明显高于对照组患者（75.47%，P＜0.05）。治疗后，两组胸痛胸闷、神疲乏力、头晕目弦、面色少华积分均有显著降低（P＜0.05），且治疗后治疗组中医症候积分均低于对照组（P＜0.05）。治疗后，两组患者收缩期最大流速（PSV）、舒张末期血流速度（EDV）、搏动指数（PI）水平显著升高（P＜0.05），而阻力指数（RI）水平明显降低（P＜0.05），且治疗后，治疗组冠脉血流动力学指标改善优于对照组（P＜0.05）。治疗后，两组患者PPAR-α、MYO、vWF水平均显著降低（P＜0.05），且治疗组患者各项血清学指标水平均低于对照组（P＜0.05）。结论 脑心通胶囊联合尼可地尔治疗微血管性心绞痛的临床疗效显著，能够显著降低患者中医症候，增加患者冠脉血流，抑制血清PPAR-α、MYO、vWF的水平，且不良反应发生率较低。

Objective To study the clinical efficacy of Naoxintong Capsules combined with nicorandil in treatment of microvascular angina pectoris. Methods Patients (106 cases) with microvascular angina pectoris in Fangshan Hospital Beijing University of Chinese Medicine from January 2020 to December 2021 were randomly divided into control and treatment group, and each group had 53 cases. Patients in the control group were po administered with Nicorandil Tablets, 5 mg/time, three times daily. Patients in the treatment group po administered with Naoxintong Capsules on the basis of the control group, 1.2 g/time, three times daily. Patients in two groups were treated for 6 weeks. After treatment, the clinical evaluation was evaluated, the TCM symptom scores, coronary hemodynamics, the levels of serum markers PPAR-α, MYO, and vWF in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 92.45%, which was significantly higher than that of the control group (75.47%, P<0.05). After treatment, the scores of chest pain and chest tightness, fatigue, dizziness and pale face were significantly decreased in both groups (P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group (P<0.05). After treatment, the maximum systolic flow velocity (PSV), end-diastolic flow velocity (EDV) and pulsatile index (PI) levels in both groups were significantly increased (P<0.05), while the resistance index (RI) level was significantly decreased (P<0.05). After treatment, the improvement of coronary hemodynamic indexes in the treatment group was better than that in the control group (P<0.05). After treatment, the levels of PPAR-α, MYO and vWF in two groups were significantly decreased (P<0.05), and the levels of serological indexes in the treatment group were lower than those in the control group (P<0.05). Conclusion The clinical effect of Naoxintong Capsules combined with nicorandil in treatment of microvascular angina pectoris is significant, can significantly reduce the TCM symptoms of patients, increase coronary blood flow, inhibit the expression of serum PPAR-α, MYO, vWF, and the incidence of adverse reactions is low.

R972

北京市中医药科技发展资金项目（JJ2019-25）