目的 探讨杏芎氯化钠注射液联合替格瑞洛片治疗不稳定型心绞痛的临床疗效。方法 选择2019年6月-2020年6月在郑州市第七人民医院治疗的不稳定型心绞痛患者104例，根据就诊顺序分成对照组（52例）和治疗组（52例）。对照组口服替格瑞洛片，起始剂量180 mg/次，此后每次90 mg/次，2次/d。治疗组在对照组的基础上静脉滴注杏芎氯化钠注射液，250 mL/次，1次/d。两组患者均治疗2周。观察两组患者心绞痛和心电图疗效，同时比较治疗前后两组患者心绞痛发作次数和持续时间，SAQ和GRACE评分，血清白三烯B4（LTB4）、基质金属蛋白酶-2（MMP-2）、明胶酶相关脂质运载蛋白（NGAL）、凝集素样氧化低密度脂蛋白受体（Lox-1）、1型组织纤溶酶原激活物抑制剂（tPAI-1）和凋亡相关分子细胞淋巴瘤（Bcl-2）水平及血管内皮功能。结果 治疗后，对照组心绞痛和心电图有效率分别为80.77%和82.69%，均显著低于治疗组的96.15%和98.08%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者心绞痛发作次数、每次持续时间均显著减少（P<0.05），且治疗组减少更明显（P<0.05）。治疗后，两组患者SAQ评分均升高，GRACE评分均下降（P<0.05），且治疗组患者改善更显著（P<0.05）。治疗后，两组患者血清LTB4、MMP-2、NGAL、Lox-1、tPAI-1水平均显著下降，而Bcl-2明显升高（P<0.05），且治疗组患者改善更显著（P<0.05）。治疗后，两组患者NO和VEGF显著升高，而ET和TXB2显著降低（P<0.05），且治疗组患者改善更显著（P<0.05）。结论 杏芎氯化钠注射液联合替格瑞洛片治疗不稳定型心绞痛可有效改善患心绞痛症状，促进血管内皮功能改善，一定程度上抑制心肌细胞凋亡，有利于维持患者斑块稳定性。

Objective To investigate the clinical efficacy of Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride combined with ticagrelor in treatment of unstable angina pectoris. Methods Patients (104 cases) with unstable angina pectoris in the 7th People's Hospital of Zhengzhou from June 2019 to June 2020 were divided into control (52 cases) and treatment (52 cases) groups based on visiting sequence. Patients in the control group were po administered with Ticagrelor Tablets, and the initial dose was 180 mg/time, then 90 mg/time, twice daily. Patients in the treatment group were iv administered with Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride on the basis of the control group, 250 mL/time, once daily. Patients in two groups were treated for 2 weeks. After treatment, the angina pectoris and ECG efficacies were evaluated, and the frequency and duration of angina pectoris, SAQ and GRACE scores, the serum levels of LTB4, MMP-2, NGAL, Lox-1, tPAI-1, and Bcl-2, and the vascular endothelial function in two groups before and after treatment were compared. Results After treatment, the angina pectoris and ECG efficacies in the control group were 80.77% and 82.69%, which were significantly lower than 96.15% and 98.08% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the frequency and duration of angina pectoris in two groups were significantly decreased (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the SAQ scores in two groups were significantly increased, but the GRACE scores were significantly decreased (P<0.05), and the improvement of these scores in the treatment group were significantly better than that in the control group (P<0.05). After treatment, the serum levels of LTB4, MMP-2, NGAL, Lox-1 and tPAI-1 in two groups were significantly decreased, but the Bcl-2 levels were significantly increased (P<0.05), and the improvement of these serological indexes in the treatment group were significantly better than that in the control group (P<0.05). After treatment, the levels of NO and VEGF in two groups were significantly increased, but the ET and TXB2 levels were significantly decreased (P<0.05), and the improvement of the vascular endothelial function in the treatment group were significantly better than that in the control group (P<0.05). Conclusion Floium Ginkgo Extract and Tertram Ethypyrazine Sodium Chloride combined with ticagrelor can effectively improve the symptoms in treatment of unstable angina pectoris, promote the improvement of vascular endothelial function, inhibit myocardial cell apoptosis, which is conducive to maintaining the stability of plaque.

R972

河南省医学科技攻关计划联合共建项目（LHGJ20191116）