【作者】 张增堂；

【导师】 张文高；

【作者基本信息】 山东中医药大学 ， 中西医结合内科学， 2003， 硕士

【摘要】 目的 研究冠心病中医辨证分型与冠状动脉病变、血管内皮功能的相关性及黄芪的血管内皮保护作用，为冠心病中医辨证客观化及动脉粥样硬化的防治提供依据。方法 根据临床征状及冠脉造影结果，对96例冠心病患者进行中医辨证分型，同时对冠心病患者、35例冠脉斑块者及20例健康对照者用超声法测定肱动脉内皮依赖性舒张功能，并检测血液vWF、ET、NO；随机抽取16例行冠脉造影者于造影前、造影后即刻、造影后4小时、24小时分别检测vWF、ET、NO。根据检测结果，对45例冠脉造影者随机分为黄芪组(23例)和对照组(22例)，黄芪组在术前5-7天静脉滴注黄芪注射液，术后至少滴注1天；于造影前、造影后4小时检测血vWF、ET、NO含量。结果 (1)冠心病组由气虚、阴虚至阳虚冠脉病变依次加重，内皮依赖性舒张功能损害依次加重；由气滞血瘀、痰阻血瘀至寒凝血瘀冠脉病变及内皮依赖性舒张功能损害依次加重(P＜0.05-0.01)；(2)冠脉病变程度与内皮依赖性舒张功能损害有显著相关性(P＜0.01)(3)肱动脉内皮依赖性舒张功能与血管内皮源性舒张因子及收缩因子含量有显著相关性(P＜0.01)；(4)对照组冠脉造影后vWF、ET血中含量升高，NO含量降低(P＜0.01)，至术后24小时基本恢复正常；(5)黄芪组冠脉造影前后血vWF、ET、NO含量无显着变化(P＞0.05)结论 (1)冠心病中医辨证分型与冠脉病变程度、内皮依赖性舒张功能损害程度密切相关；(2)冠脉造影可造成一过性血管内皮功能损害，黄芪有显著的内皮保护作用。更多还原

【Abstract】 Objective: To investigate the relationship between the Traditional Chinese Medicine(TCM) Syndrome Differentiation-type(TCM-SDT) and degree of coronary atery lesion and endothelial function ,in order to provide the evidence of the externalization of TCM-SDT. Methods 96 CHD patients TCM-STD were differentiated .Vasodilation following reactive hyperemia and after sublingual nitroglycerin(NTG) was assessed in the brachial artery using B-mode high resolution ultrasound in the patients with CHD ,35 patients with coronary clot and 20 controls.Their plasma ET,NO and vWF were detected also. Plasma ET,NO and vWF were detected before and after coronary angiography (CAG) immediately,4 hours and 24 hours in 16 Patients undergoing CAG selected randomly.Another 45 patients undergoing CAG were divided into Huangqi group and control group. Huangqi enjection was dripped 30ml everyday in Huangqi group from 5-7 days before to 1day after CAG.but not in the control group. Plasma ET,NO and vWF were detected before and 4 hours after CAG in the 45 patients. Resoluts (l)The degrees of coronary lesion reflected by CAG and endothelium dependent dilation were more and more serious from Qi-Deficiency syndrome,Yin-Deficiency syndrome to Yang-Deficiency syndrome in patients with CHD;The same results can be found from Qi stagnation-blood stasis,Phlegm turbid-blood stasis to Cold condensation-blood stasis(P<0.05-0.01).(2)The degree of coronary artery lesion significantly correlated with endothelium dependent dilation (P<0.01);(3) The endothelium dependent dilation in brachial artery was related to the levels of plasma ET,NO and vWF(P<0.01);(4)The levels of plasma ET, vWF increased ,while the level of NO decreased significantly after CAG(P<0.01),and they were all recovered 24 hours after CAG.(5)The levels of plasma ET,NO and vWF didn’t change significantly after CAG(P>0.05) in Huangqi group. Conclusion (1) TCM-SDT are closely related to the degrees and extent of coronary artery lesion and the impairment of endothelium dependent dilation;(2)Endothelial function can be impaired by CAG,and Huangqi can protect endothelium.更多还原