目的 觀察葛根素注射液輔助治療不穩(wěn)定型心絞痛的臨床療效，并探討其代謝組學(xué)作用機(jī)制。方法 選取2015年1月-2016年1月天津市第五中心醫(yī)院收治的不穩(wěn)定型心絞痛患者148例，隨機(jī)分為對照組（68例）和治療組（80例）。對照組給予常規(guī)治療，包括口服拜阿司匹林腸溶片，100 mg/次，1次/d；口服阿托伐他汀鈣片，20 mg/次，1次/d；口服酒石酸美托洛爾片，25 mg/次，2次/d；口服單硝酸異山梨酯片，20 mg/次，1次/d。治療組在常規(guī)治療基礎(chǔ)上靜脈滴注葛根素注射液，500 mg加入到5%葡萄糖或生理鹽水250 mL中，1次/d。兩組均治療2周。觀察兩組的臨床療效，比較兩組的一氧化氮（NO）、內(nèi)皮素-1（ET-1）、白細(xì)胞介素-6（IL-6）、白細(xì)胞介素-10（IL-10）、C反應(yīng)蛋白（CRP）、腫瘤壞死因子α（TNF-α）、內(nèi)脂素水平和代謝生物標(biāo)記物分析。結(jié)果 治療后，對照組和治療組的臨床癥狀療效總有效率分別為59.7%、87.5%，心電圖療效總有效率分別為54.41%、81.25%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組ET-1、IL-6、TNF-α和內(nèi)脂素水平均顯著下降，而NO、IL-10水平均顯著升高，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)的改善程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組正、負(fù)離子模式下代謝色譜圖和血清樣本比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組色氨酸明顯高于對照，而溶血磷脂1、溶血磷脂2、花生四烯酸和次黃嘌呤明顯低于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 葛根素注射液可從舒張血管、減輕炎癥反應(yīng)、穩(wěn)定斑塊及保護(hù)心肌細(xì)胞等多個方面起到輔助治療不穩(wěn)定型心絞痛的作用。

Objective To observe the clinical effect of Puerarin Injection in treatment of unstable angina pectoris, and explore its mechanisms. Methods Patients (148 cases) with unstable angina pectoris in Tianjin Fifth Central Hospital from January 2015 to January 2016 were randomly divided into the control group (68 cases) and the treatment group (80 cases). Patients in the control group were given conventional therapy, including oral administration of Aspirin Enteric-coated Tablets, 100 mg/time, once daily; oral administration of Atorvastatin Calcium Tablets, 20 mg/time, once daily; oral administration of Metoprolol Tartrate Tablets, 25 mg/time, twice daily; oral administration of Isosorbide Mononitrate Tablets, 20 mg/time, once daily. Patients in the treatment group were iv administered with Puerarin Injection on the basis of the control group, 500 mg added into 5% glucose solution or normal saline 250 mL, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and NO, ET-1, IL-6, IL-10, CRP, TNF-α, visfatin, and metabolic biomarker analysis in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 59.7% and 87.5%, respectively, the electrocardiogram curative effects in the control and treatment groups were 54.41% and 81.25%, respectively, and there was difference between two groups (P<0.05). After treatment, the levels of ET-1, IL-6, TNF-α, and visfatin in two groups were significantly decreased, but the levels of NO and IL-10 in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, metabolic chromatograms and serum samples at positive and negative ion modes were significant difference between two groups (P<0.05). After treatment, tryptophan in the treatment group was significantly higher than that in the control group, but lysophosphatidic 1, lysophosphatidic 2, arachidonic acid, and hypoxanthine in two groups in the treatment group were lower than those in the control group, and there was difference between two groups (P<0.05). Conclusion Puerarin Injection can play an important role in adjuvant therapy of unstable angina pectoris by relaxing blood vessels, reducing inflammation reaction, stabilizing plaques and protecting cardiomyocytes.