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用于易损颈动脉斑块的C-117配方(Spchim)的安全性和有效性:一项随机双盲对照试验性研究。

Safety and Efficacy of the C-117 Formula for Vulnerable Carotid Artery Plaques (Spchim): A Randomized Double-Blind Controlled Pilot Study.

作者信息

Gong Baoying, Chen Xiuyan, Lin Rongming, Zhang Feng, Zhong Jingxin, Zhang Qixin, Zhou Yuexiang, Li Haijun, Zeng Liling, Jiang Zonghua, Guo Jianwen

机构信息

Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou, Guangdong Province 510006, China.

Guangdong Second Traditional Chinese Medicine Hospital, 60 Hengfu Road, Yuexiu District, Guangzhou, Guangdong Province 510095, China.

出版信息

Evid Based Complement Alternat Med. 2019 Jul 17;2019:9746492. doi: 10.1155/2019/9746492. eCollection 2019.

Abstract

OBJECTIVE

To investigate the safety and efficacy of the Herbal Medicine C-117 (C-117) formula in the treatment of carotid atherosclerotic vulnerable plaques.

METHODS

This was a prospective, single-centre, randomized, double-blind study. A total of 120 eligible patients were randomly divided into two groups to receive the C-117 formula or placebo. As the basic treatment, both groups were treated according to the using statins to regulate blood lipids, blood pressure lowering drugs, drugs for controlling blood sugar, and antiplatelet drugs according to the indications. The primary outcomes were the change in stability, the mean change of the plaque Crouse score, and the area and number of bilateral carotid artery plaques before and after 6 months of treatment. The secondary outcomes were the total number of cardiocerebrovascular events during the treatment and follow-up and the mean changes of lipid levels.

RESULT

After 180 days of treatment, the plaque Crouse score(95% CI, 0.39 (0.01-0.77), P=0.046) and plaque area (95% CI, 2.14 (-10.10-14.39), P=0.727) were lower in the C-117 formula group than that before treatment. The plaque Crouse score of the control group (95% CI, 0.17 (-0.24-0.57), P=0.417) was lower than that before treatment, while the plaque area (95% CI, -0.35 (-9.35-8.65), P=0.938) increased, but without statistical significance. There was no significant difference in the reduction of the intima-media thickness (IMT), plaque Crouse score, or plaque area between the two groups after treatment (P>0.05). Subgroup analysis of patients whose Lipitor medication time ≥ 20% of the 6-month treatment showed that the levels of total cholesterol, triglycerides, and low-density lipoprotein were lower in the two groups after treatment than before, and the low-density lipoprotein levels in the C-117 formula group significantly decreased (95% CI, 2.99 (-0.08-0.39), P=0.005), but there was no statistical difference between the two groups after treatment (P>0.05). No serious adverse events occurred in the two groups after 180 days of treatment.

CONCLUSION

The C-117 formula may be antiatherosclerotic by strengthening statins to reduce the low-density lipoprotein levels and reducing the carotid plaque Crouse scores. Clinical trials with large sample sizes, long-term interventions, and follow-up are needed to investigate the efficacy of the C-117 formula.

CLINICAL TRIALS REGISTRATION

This trial is registered with clinicaltrials.gov identifier: NCT03072225 (registered retrospectively on 1st March 2017).

摘要

目的

探讨中药C-117配方治疗颈动脉粥样硬化易损斑块的安全性和有效性。

方法

这是一项前瞻性、单中心、随机、双盲研究。共120例符合条件的患者被随机分为两组,分别接受C-117配方或安慰剂治疗。作为基础治疗,两组均根据指征使用他汀类药物调节血脂、降压药物、控制血糖药物和抗血小板药物。主要结局指标为治疗6个月前后斑块稳定性的变化、斑块Crouse评分的平均变化以及双侧颈动脉斑块的面积和数量。次要结局指标为治疗及随访期间心脑血管事件的总数以及血脂水平的平均变化。

结果

治疗180天后,C-117配方组的斑块Crouse评分(95%CI,0.39(0.01 - 0.77),P = 0.046)和斑块面积(95%CI,2.14(-10.10 - 14.39),P = 0.727)低于治疗前。对照组的斑块Crouse评分(95%CI,0.17(-0.24 - 0.57),P = 0.417)低于治疗前,而斑块面积(95%CI,-0.35(-9.35 - 8.65),P = 0.938)增加,但无统计学意义。治疗后两组间内膜中层厚度(IMT)、斑块Crouse评分或斑块面积的降低无显著差异(P>0.05)。对瑞舒伐他汀用药时间≥6个月治疗时间20%的患者进行亚组分析显示,两组治疗后的总胆固醇、甘油三酯和低密度脂蛋白水平均低于治疗前,且C-117配方组的低密度脂蛋白水平显著降低(95%CI,2.99(-0.08 - 0.39),P = 0.005),但治疗后两组间无统计学差异(P>0.05)。治疗180天后两组均未发生严重不良事件。

结论

C-117配方可能通过增强他汀类药物降低低密度脂蛋白水平和降低颈动脉斑块Crouse评分来抗动脉粥样硬化。需要进行大样本量、长期干预和随访的临床试验来研究C-​117配方的疗效。

临床试验注册

本试验已在clinicaltrials.gov注册,标识符为:NCT03072225(于2017年3月1日追溯注册)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3b6/6662507/4ae5aa51a724/ECAM2019-9746492.001.jpg

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