Abstract: Objective　To observe the clinical efficacy of panax notoginseng saponins (PNS) for elderly patients with unstable angina pectoris (UAP) and its effect on cytokines secreted by T helper (Th) cells. Methods　A total of 70 elderly patients with UAP in The Second Affiliated Hospital of Guangzhou Medical University from June 2014 to June 2018 were divided into a routine treatment group and a PNS group with 35 cases in each group, with 30 elderly persons of healthy examination as a control group. In the routine treatment group, there were 21 males and 14 females, aged (70.5±8.1) years; in the PNS group, there were 20 males and 15 females, aged (71.7±10.2) years; in the control group, there were 18 males and 12 females, aged (70.7±8.8) years. The patients in the routine treatment group received the routine treatment regimen, and the patients in the PNS group were additionally given PNS. All objects of study were detected for serum alanine transaminase, creatinine, and some other biochemical indices. The expression levels of interferon γ (IFN-γ) secreted by Th1 cells and interleukin-4 (IL-4) secreted by Th2 cells in plasma were detected by the enzyme-linked immunosorbent assay (ELISA) kit, and the ratio of IFN-γ and IL-4 was calculated as the functional balance index of Th1/Th2 cells. The clinical efficacy was observed for patients both in the routine treatment group and the PNS group. χ² test or rank sum test was used for the count data, independent sample t test was used for inter-group comparison of the measurement data, and paired t test was used for intra-group comparison of the measurement data. Results　Compared with those in the control group, the levels of IFN-γ and Th1/Th2 in elderly UAP patients significantly increased before treatment (both P<0.05), while the level of IL-4 significantly decreased (P<0.05). Compared with those before treatment, the levels of IFN-γ and Th1/Th2 in elderly UAP patients significantly decreased after treatment (both P<0.05), while the level of IL-4 significantly increased (P<0.05). The levels of plasma IFN-γ and Th1/Th2 in the PNS group were significantly lower than those in the routine treatment group (both P<0.05), but there was no statistically significant difference in the level of IL-4 between the two groups (P>0.05). The total effective rate in the PNS group was significantly higher than that in the routine treatment group [91.4% (32/35) vs. 80.0% (28/35)] (P<0.05). Conclusion　PNS can increase clinical efficacy for elderly patients with UAP, which may be due to its inactivation of Th1 cells and improvement of Th1/Th2 cell functional imbalance.

Key words: Panax notoginseng saponins, Unstable angina pectoris, Clinical efficacy, T helper cells, Cytokines

摘要： 目的　观察三七总皂甙（PNS）对老年不稳定型心绞痛（UAP）患者的临床疗效和对辅助性T细胞（Th）分泌细胞因子的影响。方法　2014年6月至2018年6月期间广州医科大学附属第二医院老年UAP患者70例按照治疗方案的不同分为常规治疗组和PNS组各35例，另以30例老年体检者作为对照组。常规治疗组男/女为21/14，年龄（70.5±8.1）岁；PNS组男/女为20/15，年龄（71.7±10.2）岁；对照组男/女为18/12，年龄（70.7±8.8）岁。常规治疗组患者接受常规治疗方案，PNS组患者在此基础上加用PNS。检测研究对象的血清谷丙转氨酶、肌酐等生化指标。采用酶联免疫吸附法（ELISA）检测研究对象血浆中Th1细胞分泌的γ-干扰素（IFN-γ）和Th2细胞分泌的白介素-4（IL-4）表达水平，计算IFN-γ和IL-4比率作为Th1/Th2细胞功能平衡指数。观察常规治疗组和PNS组患者的临床疗效。计数资料采用χ²检验或秩和检验，计量资料组间比较采用独立样本t检验，组内比较采用配对t检验。结果　与对照组相比，老年UAP患者治疗前血浆IFN-γ水平和Th1/Th2明显升高（均P<0.05），而IL-4水平明显降低（P<0.05）。与治疗前相比，老年UAP患者治疗后血浆IFN-γ水平和Th1/Th2明显降低（均P<0.05），而IL-4水平明显升高（P<0.05）。PNS组患者血浆IFN-γ水平及Th1/Th2明显低于常规治疗组（均P<0.05），而两组IL-4水平差异无统计学意义（P>0.05）。PNS组治疗总有效率明显高于常规治疗组［91.4%（32/35）比80.0%（28/35）］（P<0.05）。结论　PNS用于治疗老年UAP患者能够提高临床疗效，可能与其抑制Th1细胞活化并改善Th1/Th2细胞功能失衡相关。

关键词: 三七总皂甙, 不稳定型心绞痛, 临床疗效, 辅助性T细胞, 细胞因子