Abstract: Background　The origin of coronary heart disease（CHD）is not completely clear，and it is treated mostly by standardized western pharmaceutical therapies such as antiplatelet drugs，beta-blockers，and nitrate preparations.Traditional Chinese medicine（TCM）classifies coronary heart disease as thoracic obstruction and true heart pain，and has a complete system of syndrome differentiation and treatment.Clinical evidence shows that，kidney deficiency，and phlegm and blood stasis play an important role in the occurrence and development of CHD.Objective　To observe the effects of Tongmaihuaban decoction on myocardial perfusion volume and serum levels of von willebrand factor（vWF）and matrixmetalloproteinase-9（MMP-9）in patients with CHD.Methods　A total of 196 patients with CHD were divided into conventional group（n=98）and  Tongmaihuaban decoction group（n=98）by using a visit order from 2015 to 2017，treated with conventional therapy plus rosuvastatin（10 mg/time，once a day），conventional therapy plus rosuvastatin and Tongmaihuaban decoction（decocting 1 dose/2 times，200 ml/time），respectively.Both groups were treated continuously for 6 months.Treatment outcomes were evaluated by myocardial perfusion conditions（perfusion defect size and abnormal radiotracer distribution integrals showed by SPECT），serum levels of vWF and MMP-9，and oxidative stress indicators〔malondialdehyde（MDA），and superoxide dismutase（SOD）〕，and main TCM symptom scores.Self-controlled and intergroup comparisons were made in terms of changes in the aforementioned parameters from baseline to the end of a 6-month treatment.Results　After 6 months of treatment，the average perfusion defect size and abnormal radiotracer distribution integrals，serum levels of vWF，MMP-9 and MDA，and main TCM symptoms scores were decreased significantly in both groups compared with baseline（P<0.05），and they were much lower in Tongmaihuaban decoction group compared with conventional group（P<0.05）.Average serum SOD level increased significantly in both groups（P<0.05），and it was much higher in Tongmaihuaban decoction group than that in conventional group（P<0.05）.Conclusion　Conventional therapy plus rosuvastatin and Tongmaihuaban decoction，can effectively improve myocardial perfusion and vascular endothelial function，inhibit the formation of unstable atherosclerotic plaques，reduce oxidative stress response，improve TCM symptoms，and promote the recovery in CHD patients.

Key words: Tongmaihuaban decoction；Coronary heart disease；Myocardial perfusion imaging；Endothelium, vascular；Unstable plaque；Oxidative stress；TCM symptoms

摘要： 背景　冠心病病因尚未完全阐明，目前西医多采用抗血小板药物、β-受体阻滞剂、硝酸酯制剂等标准药物治疗。中医将其归为“胸痹”“真心痛”等范畴，有完整的辨证施治体系，临床实践中发现肾虚、痰瘀互结在冠心病的发生、发展过程中发挥重要作用。目的　观察通脉化斑汤对冠心病患者心肌灌注量和血清血管性假血友病因子（vWF）、基质金属蛋白酶-9（MMP-9）水平的影响。方法　2015—2017年，按就诊顺序将196例冠心病患者分为常规组（n=98）和通脉化斑汤组（n=98）。常规组予以瑞舒伐他汀口服，10 mg/次，1次/d；通脉化斑汤组在常规组基础上予以通脉化斑汤口服，水煎煮1剂/2次，200 ml/次。2组均持续治疗6个月。于治疗前、治疗6个月后观察2组患者心肌灌注情况〔心肌放射性缺损面积（MIA）、放射性分布异常积分〕，检测血清vWF、MMP-9和氧化应激指标〔丙二醛（MDA）、超氧化物歧化酶（SOD）〕水平，比较2组治疗前、治疗6个月后主要中医症状积分差异。结果　治疗6个月后，2组MIA、放射性分布异常积分及血清vWF、MMP-9、MDA水平、主要中医症状积分均较治疗前降低，且通脉化斑汤组低于常规组，差异有统计学意义（P<0.05）；血清SOD水平均较治疗前升高，且通脉化斑汤组高于常规组，差异均有统计学意义（P<0.05）。结论　在常规治疗基础上予以通脉化斑汤治疗冠心病可有效改善患者心肌灌注情况和血管内皮功能，抑制不稳定斑块形成，减轻氧化应激反应，改善中医症状，促进患者恢复。

关键词: 通脉化斑汤；冠心病；心肌灌注显像；内皮, 血管；不稳定斑块；氧化应激；中医症状