【作者】 张双伟；

【导师】 冼绍祥；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2006， 硕士

【摘要】 冠心病是严重危害人类健康的心血管疾病之一。心肌纤维化是由于心肌间质胶原沉积增多,各型胶原比例失调所导致,可发生于多种心血管疾病。研究冠心病心肌纤维化的机制以及运用中医药来干预和治疗冠心病心肌纤维化有一定的临床价值。 1.研究目的:探讨活血化瘀法抗冠心病心血瘀阻证心肌纤维化的作用及机理 2.研究方法:采用前瞻性单盲随机对照临床研究方法,根据中医辨证诊断标准将60例冠心病心血瘀阻证患者按简单随机对照方法随机分两组,每组病例30例,分别为血府逐瘀汤组和安慰剂组,设冠心病非心血瘀阻证患者20例,同时选择健康受试者20例作为正常对照组。两组心血瘀阻证患者均服用拜阿司匹林0.1 qd、雅施达4mgqd,倍他乐克12.5mg bid,立普妥10mg qd,心绞痛急性发作者可予硝酸甘油0.5mg舌下含服。在此治疗的基础上,血府逐瘀汤组以血府逐瘀汤煎剂口服,安慰剂组服用由麦芽、谷芽和甘草组成的汤剂,日一剂,共3周。3周后观察治疗前后患者的临床症状改善情况、血清Ⅲ型前胶原(PCⅢ)、层粘蛋白(LN)和透明质酸(HA)、内皮素(ET)和一氧化氮(NO)等指标的变化。 3.研究结果:治疗后血府逐瘀汤和安慰剂组的总有效率分别为90%和76.67%,血府逐瘀汤组的疗效高于安慰剂组,两组比较有显著性差异(P<0.05),并且在症状改善上,血府逐瘀汤组优于安慰剂组,差异具有显著性(P<0.05)。血府逐瘀汤明显改善心血瘀阻证患者血瘀症状,治疗后心血瘀阻证宏观计量得分与安慰剂组比较差异具有高度显著性(P<0.01)。治疗后两组PCⅢ、LN、HA、ET值均下降(P<0.05),并且血府逐瘀汤组较安慰剂组下降更为明显(P<0.05),NO水平血府逐瘀汤组高于安慰剂组(P<0.05)。心血瘀阻组与非心血瘀阻组比较,其PCⅢ、LN、HA、ET水平均高于非心血瘀阻组,具有显著性差异或高度显著性差异(P<0.05或P<0.01),而NO水平两组无明显差异(P>0.05)。 4.结论:(1)心肌纤维化是一种严重影响心血管疾病预后的病理状态,冠心病心血瘀阻证较其它证型与心肌纤维化有比较密切的关系,可能“血瘀”是导致心肌纤维化的主要病机,可以活血化瘀为主要治法。(2)血府逐瘀汤在治疗冠心病心血瘀阻证的同时,亦明显改善心肌纤维化的程度。此外血府逐瘀汤具有保护血管内皮细胞的作用,可以使NO升高,ET降低,从另一方面说明可以抑制心肌纤维化。更多还原

【Abstract】 Coronary heart disease (CHD) is one kind of heart diseases that severely hazards human health. Myocardial fibrosis is caused by overdeposition of myocardial interstitial collagen and proportion disorder of all kinds of collagen, and it occurs in many heart diseases. So making research on myocardial fibrosis of coronary heart disease and treating it by traditional Chinese medicine is much valuable.Objective:The aim is to observe the effect and mechanism about myocardial fibrosis of CHD with blood stasis syndrome treated by activating blood and removing stasis.Method:According to prospective single blind method, 60 patients diagnosed as CHD with blood stasis syndrome were rangdomly divided into two groups:Group A (the observing group) and Group B( the control group). Each group had 30 cases. Additionally, 20 patients without blood stasis syndrome were chose as Group C, and 20 normal person were chose as Group D. Group A and Group B took the same basic treatment:Asprine 100mg qd, acertil 4mg qd , betaloc 12. 5mg bid and lipitor 10mg qd. when angina pectoris happened, nitroglycerin 0. 5mg could be put under the tougne. Furthermore, Group A was treated with XueFuZhuYu decoction for 3 weeks, while Group B was treated with placebo composed of rice sprout, malt and liguorice. Between pre and post-treating , clinical symptoms、 serum procollagen III(PCIII)、 Lamins(LN)、 Hyaluronic acid (HA) 、 endothelin (ET)、 nitric oxide (NO) were compared.Results:The effective rates of Group A and Group B were 90% and 76.67% respectively, and the difference was significant (P<0.05) .Blood stasis syndrome of patients in Group A was more relieved than Group B, for aftertherapy the comparison of microscopic quantitative score in the two groups made difference significant (P<0. 01) . The level of PCIIK LN> HA and ET in two groups declined respectively, the degree of which was more obvious in Group A(P<0. 05), while the level of NO was much higher in Group A (P<0. 05). Compared to Group C, the level of PCIII> LN.. HA and ET were higher in the blood stasis group with difference significant (P<0. 05 nJc P<0. 01) , but there was no distinct difference of NO level between two groups (P>0. 05) .Conclusion: (l)Myocardial fibrosis is one pathologic state that severely influences the progosis of heart diseases.As compared with other syndromes, heart blood stasis syndrome is more relevant to myocardial fibrosis, so maybe blood stasis syndrome is the primary pathogenesis causing myocardial fibrosis. It can be treated by activating blood and removing stasis. (2)XueFuZhuYu decoction can not only treat CHD with blood stasis syndrome, but also restrain and reverse myocardial fibrosis. Besides, it can protect vascular endotheliocyte, make NO increase and ET decrease. From the other hand, it proves the effect on restraining myocardial fibrosis.更多还原