【目的】 观察疏肝温胆汤（由柴胡疏肝散和温胆汤化裁而成）治疗冠心病稳定型心绞痛（SAP）合并焦虑抑郁患者的临床 疗效及其作用机制。【方法】 选取 2023年 1月至 2024年 6月广州市南沙区中医医院收治的 SAP合并焦虑抑郁气滞痰瘀证患者 130例，采用随机数字表法将患者随机分为观察组和对照组，每组各65例。对照组给予常规西医治疗，观察组在对照组基础 上加用疏肝温胆汤治疗，疗程为12周。观察2组患者治疗前后心绞痛发作情况、西雅图心绞痛量表（SAQ）评分、广泛性焦虑 障碍量表（GAD-7）评分、患者健康问卷抑郁量表（PHQ-9）评分、中医证候积分、血脂指标[总胆固醇（TC）、甘油三酯（TG）、 高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]及血清单胺类神经递质[多巴胺（DA）、5-羟色胺（5-HT）、去 甲肾上腺素（NE）]、炎症因子[白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）]及内皮功能指标[一氧 化氮（NO）、内皮素1（ET-1）]的变化情况，并评价2组患者的中医证候疗效。【结果】（1）疗效方面，治疗12周后，观察组的总 有效率为 93.85%（61/65），对照组为 78.46%（51/65），组间比较（χ2检验），观察组的中医证候疗效明显优于对照组（P＜ 0.05）。（2）心绞痛发作情况方面，治疗后，2组患者的心绞痛发作次数和疼痛持续时间均较治疗前改善（P＜0.05），且观察组 的改善幅度均明显优于对照组（P＜0.05）。（3）血脂指标方面，治疗后，2组患者的TC、TG、LDL-C水平均较治疗前降低（P＜ 0.05），HDL-C水平均较治疗前升高（P＜0.05），且观察组对TC、TG、LDL-C水平的降低幅度及对HDL-C水平的升高幅度均 明显优于对照组（P＜0.05）。（4）量表评分方面，治疗后，2组患者的SAQ评分均较治疗前升高（P＜0.05），GAD-7、PHQ-9评 分和中医证候积分均较治疗前降低（P＜0.05），且观察组对SAQ评分的升高幅度及对GAD-7、PHQ-9评分和中医证候积分的 降低幅度均明显优于对照组（P＜0.05）。（5）单胺类神经递质方面，治疗后，2组患者血清DA、5-HT、NE水平均较治疗前升 高（P＜0.05），且观察组的升高幅度均明显优于对照组（P＜0.05）。（6）炎症因子方面，治疗后，2 组患者血清 IL-1β、IL-6、 TNF-α水平均较治疗前降低（P＜0.05），且观察组的降低幅度均明显优于对照组（P＜0.05）。（7）内皮功能方面，治疗后，2组 患者血清NO水平均较治疗前升高（P＜0.05），血清ET-1水平均较治疗前降低（P＜0.05），且观察组对血清NO水平的升高幅 度及对血清ET-1水平的降低幅度均明显优于对照组（P＜0.05）。【结论】 疏肝温胆汤联合常规西医治疗冠心病稳定型心绞痛 合并焦虑抑郁气滞痰瘀证患者疗效确切，可有效改善患者的心绞痛症状、焦虑抑郁状态和生活质量，其机制可能与调节单 胺类神经递质、抑制炎症反应、改善血管内皮功能等有关。

Objective To observe the clinical efficacy and mechanism of Shugan Wendan Decoction （SGWDD， modified from Chaihu Shugan San and Wendan Decoction） in treating patients with stable angina pectoris （SAP） of coronary heart disease complicated by anxiety and depression. Methods A total of 130 patients with SAP complicated by anxiety and depression， presenting with the TCM syndrome of qi stagnation and phlegm-blood stasis，admitted to Guangzhou Nansha Hospital of Traditional Chinese Medicine between January 2023 and June 2024 were selected. Patients were randomly divided into an observation group and a control group using a random number table，with 65 patients in each group. The control group received conventional western medicine treatment， while the observation group received SGWDD in addition to the conventional treatment for 12 weeks. The following parameters were observed before and after treatment in both groups： angina attack frequency， Seattle Angina Questionnaire （SAQ） scores，Generalized Anxiety Disorder-7（GAD-7） scores，Patient Health Questionnaire-9 （PHQ-9） scores， TCM syndrome scores， lipid profiles [total cholesterol （TC）， triglycerides （TG）， highdensity lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）]， serum monoamine neurotransmitters [dopamine （DA），5-hydroxytryptamine （5-HT），norepinephrine （NE）]，inflammatory factors [interleukin-1β（IL-1β），interleukin-6（IL-6），tumor necrosis factor-α（TNF-α）]，and endothelial function indicators [nitric oxide （NO）， endothelin-1（ET-1）]. The TCM syndrome efficacy was also evaluated in both groups. Results（1） Therapeutic effect：After 12 weeks of treatment，the total effective rate was 93.85% （61/65） in the observation group and 78.46% （51/65） in the control group. The intergroup comparison （by chi-square test） showed that the TCM syndrome efficacy in the observation group was significantly superior to that in the control group （P＜0.05）.（2） Angina attacks： After treatment， both groups showed improvement in the frequency of angina attacks and pain duration compared to before treatment （P＜0.05），and the improvement in the observation group was significantly greater than that in the control group （P＜0.05）.（3） Lipid profiles：After treatment，TC， TG，and LDL-C levels decreased （P＜0.05），while HDL-C levels increased （P＜0.05） in both groups compared to before treatment； the reductions in TC， TG， and LDL-C levels and the increase in HDL-C level were significantly greater in the observation group than in the control group （P＜0.05）.（4） Scale scores：After treatment， SAQ scores increased （P＜0.05），while GAD-7，PHQ-9 scores，and TCM syndrome scores decreased （P＜ 0.05） in both groups compared to before treatment；the increase in SAQ scores and the reductions in GAD-7， PHQ-9 scores，and TCM syndrome scores were significantly greater in the observation group than in the control group （P＜0.05）.（5） Monoamine neurotransmitters： After treatment， serum levels of DA， 5-HT， and NE increased in both groups compared to before treatment （P＜0.05），and the increases were significantly greater in the observation group than in the control group （P＜0.05）.（6） Inflammatory factors： After treatment， serum levels of IL-1β，IL-6，and TNF-α decreased in both groups compared to before treatment （P＜0.05），and the decreases were significantly greater in the observation group than in the control group （P＜0.05）.（7） Endothelial function：After treatment，serum NO levels increased （P＜0.05） and ET-1 levels decreased （P＜0.05） in both groups compared to before treatment；the increase in serum NO level and the decrease in serum ET-1 level were significantly greater in the observation group than in the control group （P＜0.05）. Conclusion SGWDD combined with conventional western medicine demonstrates definite efficacy in treating patients with SAP complicated by anxiety and depression of qi stagnation and phlegm-blood stasis syndrome. It effectively alleviates angina symptoms，improves anxiety and depression status，and enhances quality of life. The mechanism may be related to regulating monoamine neurotransmitters，inhibiting inflammatory responses，and improving vascular endothelial function.

R259.414

国家自然科学基金面上项目（编号：82074342）；广州市科技计划项目（编号：2024A04J3302）；广东省中医药局科研项目（编号： 20251135）；广州市南沙区民生科技计划项目（编号：2023MS014）