目的 探讨心脑舒通片联合替格瑞洛治疗冠心病心绞痛的临床疗效。方法 纳入2023年9月—2025年8月首都医科大学附属北京康复医院收治的136例冠心病心绞痛患者，使用随机数字表法分为对照组和治疗组。每组各68例。对照组口服替格瑞洛片，90 mg/次，2次/d。在对照组基础上，治疗组饭后口服心脑舒通片，2片/次，3次/d。两组患者疗程均为4周。观察两组临床疗效，比较治疗前后两组心电图ST-T改善率、硝酸甘油停减率，以及治疗前后心绞痛发作频率、持续时间、血瘀证评分、心绞痛数字评定量表（NRS）评分、心绞痛生活质量问卷（APQLQ）评分，血小板功能指标血小板聚集率（PAgT）、血小板粘附率（PAdT）、血小板分布宽度（PDW），全身免疫炎症指数（SII）和血清超敏肌钙蛋白Ⅰ（hs-cTnI）、亲环素A（CyPA）、Ⅰ型胶原交联羧基末端肽（ICTP）水平。结果 治疗后，治疗组总有效率（94.12%）明显高于对照组（79.41%）（P＜0.05）。治疗组心电图ST-T改善率（89.71%）和硝酸甘油停减率（82.35%）均高于对照组（73.53%、66.18%，P＜0.05）。治疗后，两组心绞痛发作频率、持续时间、血瘀证评分和心绞痛NRS、APQLQ评分都低于同组治疗前（P＜0.05）；且较之对照组，治疗组更低（P＜0.05）。治疗后，两组PAgT、PAdT、PDW、SII和血清hs-cTnI、CyPA、ICTP水平都显著降低（P＜0.05）；且较之对照组，治疗组均更低（P＜0.05）。结论 采用心脑舒通片联合替格瑞洛治疗冠心病心绞痛，能更有效地缓解心绞痛症状、改善心肌缺血及血瘀状态，通过抑制血小板活化、抗炎、减轻心肌微损伤及延缓血管重塑等多重机制发挥综合心脏保护效应，提升患者生活质量，且未增加不良反应风险。

Objective To evaluate the clinical efficacy of Xinnao Shutong Tablets combined with ticagrelor in the treatment of angina pectoris in patients with coronary heart disease. Methods A total of 136 patients with coronary heart disease and angina pectoris admitted to Beijing Rehabilitation Hospital, Capital Medical University, from September 2023 to August 2025 were enrolled and randomly divided into control group and treatment group using a random number table, with 68 patients in each group. The control group received oral ticagrelor 90 mg twice daily. On the basis of the control treatment, the treatment group was additionally administered Xinnao Shutong Tablets orally after meals at a dose of two tablets three times daily, with a treatment course of four weeks for both groups. The overall clinical efficacy, electrocardiographic ST-T improvement rate, and nitroglycerin discontinuation/reduction rate were compared. Pre- and post-treatment assessments included angina attack frequency and duration, blood stasis syndrome score, Numerical Rating Scale (NRS) score for angina, Angina Pectoris Quality of Life Questionnaire (APQLQ) score, platelet functional indicators platelet aggregation rate (PAgT), platelet adhesion rate (PAdT), and platelet distribution width (PDW), systemic immune-inflammation index (SII), and serum levels of high-sensitivity cardiac troponin I (hs-cTnI), cyclophilin A (CyPA), and type I collagen cross-linked carboxyterminal telopeptide (ICTP).Results The treatment group achieved a significantly higher total effective rate than the control group (94.12% vs 79.41%, P< 0.05). Meanwhile, the treatment group exhibited superior ST-T segment improvement (89.71% vs 73.53%) and a higher nitroglycerin discontinuation/reduction rate (82.35% vs 66.18%, P < 0.05). After treatment, both groups presented significant reductions in angina frequency, attack duration, blood stasis scores, NRS scores, and APQLQ scores (P< 0.05), with more substantial improvements observed in the treatment group (P < 0.05). Furthermore, levels of PAgT, PAdT, PDW, SII, hs-cTnI, CyPA, and ICTP were markedly decreased in both groups post-treatment, and the treatment group demonstrated significantly lower levels of all these biomarkers than the control group (P < 0.05). Conclusion The combination of Xinnao Shutong Tablets and ticagrelor yields prominent therapeutic effects in coronary heart disease-related angina pectoris. This synergistic therapy effectively alleviates angina symptoms, ameliorates myocardial ischemia and blood stasis status, and provides comprehensive cardioprotective benefits by inhibiting platelet activation, mitigating systemic inflammation, reducing subtle myocardial injury, and delaying vascular remodeling. This combinatorial strategy improves patients’ quality of life without increasing the risk of adverse reactions.

R972

首都医科大学附属北京康复医院科研发展专项资助项目（2021-069）