目的 探讨麝香保心丸对冠心病患者胰岛素抵抗（IR）影响及机制。方法 2016年1月—2017年3月选择在南阳市第二人民医院诊治的冠心病患者82例作为研究对象，根据随机信封抽签原则分为观察组与对照组各41例，对照组给予常规治疗，观察组在对照组治疗的基础上给予麝香保心丸治疗，2丸/次，3次/d，两组治疗观察周期为3个月。比较两组的临床疗效、IR指数及C反应蛋白（CRP）水平，同时采用超声进行冠状动脉重构指数（RI）的测定。结果 观察组与对照组的总有效率分别为97.6%和82.9%，观察组好于对照组，差异有统计学意义（P<0.05）。观察组与对照组治疗后的IR指数分别为（1.79±0.45）和（2.44±0.51），都明显低于治疗前的（4.01±0.44）和（4.00±0.56），同组治疗前后比较差异有统计学意义（P<0.05）；且观察组治疗后的IR指数明显低于对照组，组间比较差异有统计学意义（P<0.05）。观察组与对照组治疗后的血清CRP水平都明显低于治疗前，同组治疗前后比较差异有统计学意义（P<0.05）；同时治疗后观察组的血清CRP水平也明显低于对照组，组间比较差异有统计学意义（P<0.05）。治疗后观察组的冠状动脉正性重构、无重构与负性重构分别为4例、25例与12例，而对照组分别为15例、10例和16例，组间对比差异都有统计学意义（P<0.05）。结论 麝香保心丸治疗冠心病患者能提高治疗疗效，改善IR状况，其作用机制可能与抑制炎症因子表达、改善冠状动脉重构有关。

Objective To investigate the effects and mechanism of Shexiang Baoxin Pills on insulin resistance (IR) in patients with coronary heart disease.Methods From January 2016 to March 2017, 82 patients with coronary heart disease in The Second People’s Hospital of Nanyang were selected as the research object. All the patients were divided into observation group and control group with 41 cases in each group according to the principle of random envelope drawing. The control group was given conventional treatment, and the observation group was treated with Shexiang Baoxin Pills on the basis of the treatment of the control group. The observation periods of the two groups were 3 months.Results The total effective rates of the observation group and control group were 97.6% and 82.9%, respectively, and the observation group was better than that of the control group (P<0.05). The IR indexes of the observation group and control group after treatment were (1.79 ±0.45) and (2.44 ±0.51), respectively, which were significantly lower than before treatment of (4.01 ±0.44) and (4.00 ±0.56) (P<0.05), and the IR index in the observation group after treatment was significantly higher than that in the control group (P<0.05). The serum CRP levels of the observation group and control group were significantly lower than those before treatment (P<0.05), and the level of serum CRP in the observation group after treatment was also significantly lower than that in the control group (P<0.05). After treatment, the coronary artery remodeling, no reconstruction and negative reconstruction in the observation group were 4 cases, 25 cases and 13 cases, while the control group were 15 cases, 10 cases and 16 cases, the difference between the two groups was statistically significant (P<0.05).Conclusion Shexiang Baoxin Pill can improve the therapeutic effect and improve the IR status in patients with coronary heart disease, and its mechanism may be related to inhibiting the expression of inflammatory factors and improving coronary artery remodeling.