【摘要】：目的：(1)探討冠心病中醫(yī)證型與冠脈狹窄程度、冠脈狹窄程度積分(Gensini積分法)、病變支數(shù)之間的相關(guān)性。(2)觀察蛭龍活血通瘀膠囊對氣虛痰瘀型冠心病患者血管內(nèi)皮功能的影響。方法：(1)收集2013年5月到2015年4月在西南醫(yī)科大學(xué)附屬中醫(yī)醫(yī)院心腦病科行冠脈造影確診為冠心病患者371例。(2)記錄基本信息、冠脈造影結(jié)果、中醫(yī)辨證、計(jì)算Gensini積分、填寫CRF表、建立數(shù)據(jù)庫等。(3)將2015年5月到2015年9月本科室住院經(jīng)冠脈造影確診為冠心病且中醫(yī)辨證屬于氣虛血瘀合痰阻心脈型(簡稱氣虛痰瘀型)的患者60例,隨機(jī)分成對照組和治療組,并選取同期門診體檢的健康人20例作為健康組。兩組在冠心病西醫(yī)規(guī)范化治療基礎(chǔ)上,治療組加用蛭龍活血通瘀膠囊1.2tid服用一個月,通過檢測三組血中一氧化氮(NO)、內(nèi)皮素(ET)、6一酮前列腺素(6-Keto-PGF1 a).血栓素B2(TXB_2),觀察冠心病組與健康組及冠心病治療組與對照組血管內(nèi)皮功能的變化。(4)統(tǒng)計(jì)軟件SPSS 20.0用于相關(guān)數(shù)據(jù)的統(tǒng)計(jì)描述與分析。結(jié)果：第一部分：(1)在371例冠心病患者中不同的中醫(yī)證型基礎(chǔ)疾病史(高血壓病、糖尿病)和危險因素(吸煙史、飲酒史)差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。陽氣虛衰患者最大,痰阻心脈患者年齡最小,差異具有統(tǒng)計(jì)學(xué)意義。(2)入組的371例冠心病患者中醫(yī)證型分布：氣虛血瘀型110例(29.65%)、痰阻心脈型101例(27,22%)、氣滯血瘀型患者99例(26.68%)、氣陰兩虛型患者46例(12.40%)、陽氣虛衰型15例(4.04%)。不同中醫(yī)證型之間的冠脈病變支數(shù)存在差異(P0.05),陽氣虛衰型患者的冠脈病變平均支數(shù)(2.13±0.92)最多,氣滯血瘀型冠脈病變平均支數(shù)最少(1.41±0.67),與其他型患者進(jìn)行兩兩比較時,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。中醫(yī)證型在冠脈病變支數(shù)分布上也存在差異(P＜O.05),氣滯血瘀型(68.7%)、氣虛血瘀型(37.3%)多見于單支病變,痰阻心脈型(50.5%)及氣陰兩虛型(45.7%)多見于雙支病變,陽氣虛衰型(46.7%)多見于多支病變。不同中醫(yī)證型之間Gensini積分比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05),陽氣虛衰型Gensini積分最高42.00 [30.00,90.00],氣滯血瘀型患者Gensini積分最低14.00[8.00,22.00]。第二部分：(1)氣虛痰瘀型冠心病組與健康組,性別比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),耐心病組(64.73±9.41歲)較健康組(27.25±3.07歲)平均年齡大(P0.05)。冠心病組治療前后ET(ng/L)、 TXB_2(ng/L)較健康組高,NO(umol/L)、6酮前列腺素(ng/L)均較健康組低,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.001)。(2)冠心病組內(nèi)對照組和治療組：年齡,性別構(gòu)成比,病史(高血壓病、糖尿病、高脂血癥、腦血管意外),生活史(吸煙史、飲酒史)比較差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。(3)對照組與治療組治療前兩組患者的NO、ET、TXB_2、 6-Keto-PGF1α差異無統(tǒng)計(jì)學(xué)意義(P0.05),治療后兩組的NO,6-Keto-PGF1 α均較前升高,ET,TXB_2均較治療前降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。治療后對照組NO比值較治療組低,對照組ET、TXB_2較治療組高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),兩組6-Keto-PGFla的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(4)治療組與對照組兩組治療前后的差值比較結(jié)果：NO、ET、 TXB_2治療組治療前后的差值均較對照組大(P0.05)；6-Keto-PGF1 α治療組與對照組的差值,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論：冠心病不同中醫(yī)證型主要分布以氣虛血瘀型、痰阻心脈型、氣滯血瘀型為主,以陽氣虛衰型平均年齡最大；其中氣滯血瘀型病變平均支數(shù)最少、Gensini積分最低,陽氣虛衰型病變平均支數(shù)最多、Gensini積分最高。氣滯血瘀型、氣虛血瘀型,多見于單支病變；痰阻心脈型、氣陰兩虛型,多見于雙支病變；陽氣虛衰型多見于多支病變。所以冠脈病變、Gensini積分與冠心病中醫(yī)證型有關(guān)聯(lián)。氣虛痰瘀型冠心病患者治療組和對照組相對于健康組而言,內(nèi)皮功能均有損害。經(jīng)治療后對照組、治療組的NO、ET、TXB_2、6-Keto-PGF1 α較治療前均有改變。治療后治療組NO,ET,TXB_2療效差值差異更大,說明服用蛭龍活血通瘀膠囊的患者比單純西醫(yī)規(guī)范化治療的療效更顯著,內(nèi)皮功能改善效果更好。
[Abstract]:Objective: (1) To study the correlation between the TCM syndromes of coronary heart disease and the degree of coronary stenosis, the degree of coronary stenosis (Gensini's integral method) and the number of lesions. (2) To observe the effect of the Huoxue Huoxue Tongyu capsule on the vascular endothelial function of the patients with qi deficiency and blood stasis type coronary heart disease. Methods: (1)371 patients with coronary heart disease were diagnosed by coronary angiography from May 2013 to April 2015 in the center of the heart disease of the Affiliated Chinese Medicine Hospital of Southwest Medical University. (2) the basic information, the results of the coronary angiography, the syndrome differentiation of the traditional Chinese medicine, the calculation of Gensini integration, the filling of the CRF table, the establishment of a database, and the like are recorded. (3) The patients with coronary heart disease diagnosed by coronary angiography from May 2015 to September 2015 were divided into the control group and the treatment group. In the same period,20 healthy controls were selected as the healthy group. On the basis of the standardized treatment of the western medicine of the coronary heart disease, the two groups were given the treatment group with the treatment group, and the treatment group was taken for one month by the treatment group, and the nitric oxide (NO), the endothelin (ET) and the 6-one prostaglandin (6-Keto-PGF1 a) in the three groups of blood were detected. Thromboxane B2 (TXB _ 2) was used to observe the changes of vascular endothelial function in the treatment group and the control group of the coronary heart disease group and the healthy group and the control group. (4) The statistical software SPSS 20.0 is used to describe and analyze the relevant data. Results: The first part: (1) There was no significant difference in the basic disease history (hypertension, diabetes) and risk factors (smoking history and alcohol history) in 371 patients with coronary heart disease (P> 0.05). The maximum and phlegm-resistance of the patients with the deficiency of the yang-qi were the smallest and the difference was of statistical significance. (2) The distribution of TCM syndromes in 371 patients with coronary heart disease:110 (29.65%) of Qi-deficiency and blood-stasis,101 (27,22%) of phlegm-resistance type,99 (26.68%) of patients with Qi and blood stasis,46 (12.40%) of patients with Qi-yin deficiency, and 15 (4.04%) of male-qi deficiency. There was a difference in the number of coronary artery lesions among the different types of TCM syndrome (P0.05). The mean number of coronary artery lesions (2.13% 0.92) and the minimum number of coronary artery lesions (1.41-0.67) in the patients with yang-qi and blood-stasis type, compared with those of other patients, The difference was statistically significant (p0.05). There was also a difference in the number of branch of the coronary artery (P <0.05), the stagnation of Qi and blood stasis (68.7%), the deficiency of Qi and blood stasis (37.3%), and it was found in the single-branch lesion, the phlegm-resistance type (50.5%) and the deficiency of Qi-yin (45.7%) in the double-branch lesion. The deficiency of yang-qi (46.7%) was found in multiple lesions. There was a significant difference in the Gensini score among different types of TCM syndrome (P0.05). The highest of the Gensini score was 42.00[30.00, 90.00], and that of the patients with Qi stagnation and blood stasis was 14.00[8.00, 22.00]. The second part: (1) There was no statistical significance between (1) Qi-deficiency and phlegm-stasis type coronary heart disease group and the healthy group, the difference of sex was not significant (P0.05), and the average age of the patient group (64.73-9.41 years) was greater than that in the healthy group (27.25-3.07 years) (P0.05). The levels of ET (ng/ L), TXB _ 2 (ng/ L), NO (umol/ L) and 6-keto-prostaglandin (ng/ L) in the patients with coronary heart disease were lower than those in the healthy group (P <0.001). (2) The control group and the treatment group in the coronary heart disease group: age, sex composition ratio, medical history (hypertension, diabetes, hyperlipidemia, cerebrovascular accident), life history (history of smoking, history of alcohol consumption) were not statistically significant (P> 0.05). (3) The difference of NO, ET, TXB _ 2 and 6-Keto-PGF1 in the control group and the treatment group was not significant (P0.05). The NO ratio in the control group was lower than that in the treatment group. The difference of ET and TXB _ 2 in the control group was higher than that in the control group (P0.05). The difference of 6-Keto-PGFla in the two groups was not statistically significant (P0.05). (4) The difference between the treatment group and the control group was higher than that in the control group (P0.05). The difference between the treatment group and the control group of the 6-Keto-PGF1 treatment group was not significant (P0.05). Conclusion: The main distribution of TCM syndromes of coronary heart disease is the main distribution of Qi-deficiency and blood-stasis type, phlegm-resistance heart-vein type, qi-stagnation and blood-stasis type, and the average age of the male-qi and blood-stasis type is the largest, among which, the average number of patients with qi-stagnation and blood-stasis type is the least, Gensini score is the lowest, and the average branch of the male-qi deficiency-type lesion is the largest. The Gensini score is the highest. Qi-stagnation and blood-stasis type, qi-deficiency and blood-stasis type, frequently found in single-branch disease, phlegm-resistance heart-vein type, qi-yin two-deficiency type, more commonly seen in double-branch lesion; the deficiency of yang-qi is more common in the multiple-vessel disease. So coronary artery disease, Gensini integration is associated with the TCM syndrome of coronary heart disease. The endothelial function was impaired in both the treatment group and the control group of the patients with Qi-deficiency and phlegm-stasis type coronary heart disease compared with the healthy group. The contents of NO, ET, TXB _ 2,6-Keto-PGF1 in the treatment group were changed after treatment. The difference of the curative effect of NO, ET and TXB _ 2 in the treatment group after treatment was greater, and it was indicated that the patients taking the capsule of Huoxue Huoxue Tongyu Capsule were more effective than that of the traditional Chinese medicine, and the effect of endothelial function was better.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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