益气凉血生肌方干预冠心病介入术远期预后的临床与机制研究

发布时间：2018-05-21 10:25

  本文选题：创伤修复 + 冠心病　； 参考：《北京中医药大学》2015年博士论文

【摘要】：本文包括文献综述及课题研究两部分；综述分为中医综述和西医综述,课题研究分为临床观察和基础实验研究。一、文献综述文献综述从中医和西医两方面详细的论述了对冠心病介入治疗远期预后的现有研究和认识,为更科学的防治冠心病的进展及各种并发症提供理论支持。二、临床研究目的：观察益气凉血生肌方对冠心病介入术后患者远期心血管事件及生存质量的影响。方法：采用临床随访的方法,将国家中医药管理局中医药科研专项课题(2005)97例冠心病介入治疗后7.5～9.1年的患者,分为51例中药治疗组和46例对照组,观察7.5-9.1年后远期心血管事件发生情况、二级预防情况、远期心血管事件干预因素、生存曲线情况,对两组间数据进行统计比较分析。结果：①与对照组相比中药治疗组的远期复发心绞痛、心肌梗死、心衰和心源性死亡的单独心血管事件发病率无明显统计学差异(P0.05),但是所有心血管事件发病率与对照组比较具有统计学差异(P0.05)；②两组在规律治疗及良好生活习惯等冠心病二级预防方面无统计学差异；③中药干预(服用益气凉血生肌方)和定期门诊复查进入了Logistic回归(P0.05),两者对心血管事件有保护作用；与对照组相比中药治疗组远期生存曲线有更好趋势,但没有统计学上的差异(P0.05)结论：①早期服用益气凉血生肌方可降低冠心病介入治疗后远期心血管事件的发生率。②益气凉血生肌方改善冠心病介入治疗的远期预后。三、基础实验研究目的：基于中医创伤修复理论,观察益气凉血生肌方对血管内皮细胞增殖迁移及损伤修复的作用,探讨益气凉血生肌方改善冠心病介入术后远期预后的作用机制。方法：采用体外实验的方法,对人脐静脉内皮细胞(HUVECs)损伤造模,分为益气凉血生肌中药组、ARB西药组、中西医结合组、模型组、对照组；采用CCK-8法检测细胞增殖率、透射电镜观察细胞超微结构变化、活细胞工作站检测细胞迁移率、硝酸还原法检测一氧化氮(NO)浓度、荧光探针法检测活性氧自由基(ROS)含量、酶联免疫吸附法检测内皮素(ET-1)浓度、RT-PCR检测ET-1蛋白基因表达水平等；并对组间数据进行统计分析比较。结果：①与模型组相比,益气凉血生肌方组和ARB西药组均对损伤后的内皮细胞具有增殖作用且细胞增殖率50%,两者增殖率相比无统计学差异(P0.05),中西医结合治疗组与中药组和西药组两者相比均有统计学差异(P0.05)；②与模型组比较,中药组、ARB西药组和中西医结合组透射电镜下损伤内皮细胞的细胞核边界清楚、内质网增多增密、线粒体数目增加,中药组和中西医结合组的内质网折叠更明显,线粒体饱满、数目较西药组增多;③与模型组相比ARB西药组和中西医结合组细胞迁移显著加快(P0.05),中西医结合组优于ARB西药组,中药组整体迁移曲线优于模型组,但未表现出明显的差异(P0.05)；④与模型组相比,进行药物干预后N0含量上升(P0.05),ROS无明显差异、ET-1含量下降(P0.05),中西医结合组的促NO释放、抑制ET-1释放作用与中药组和ARB西药组相比有统计学差异(P0.05)；⑤ RT-PCR示模型组的Ct均值高于对照组,药物干预后Ct均值下降,中药组和中西医结合组均值低于西药组,治疗后血管内皮细胞的ET-1基因表达含量降低,但没有统计学显著性差异(P0.05)结论：①益气凉血生肌方对损伤性血管内皮细胞有促进增殖的作用；②益气凉血生肌方减轻血管内皮细胞的超微结构的损伤；③益气凉血生肌方对血管内皮细胞损伤划痕模型有促迁移的作用；④益气凉血生肌方增加血管活性物质N0的释放、减轻细胞损伤因子ET-1的浓度,并影响ET-1蛋白基因表达水平。⑤中西医结合治疗对血管内皮细胞的增殖、迁移、细胞超微结构、细胞因子浓度及基因表达的损伤修复作用优于单纯中药治疗或西药治疗。
[Abstract]:This paper includes two parts : literature review and subject research .
This review is divided into a review of TCM and a review of western medicine . The study is divided into clinical observation and basic experiment research . The clinical research aim : To observe the effect of Yiqi Liangxue Shengji on the long - term cardiovascular events and the quality of life of coronary heart disease after interventional therapy .
( 2 ) There was no statistical difference between the two groups in the secondary prevention of coronary heart disease , such as regular treatment and good living habits ;
( 3 ) Logistic regression ( P0.05 ) was entered into the traditional Chinese medicine intervention ( taking Yiqi Liangxue Shengji Fang ) and regular clinic examination , both had protective effect on cardiovascular events ;
Objective : To observe the effect of Yiqi Liangxue Shengji on the long - term prognosis of coronary heart disease after percutaneous coronary intervention .
CCK - 8 method was used to detect the cell proliferation rate , the ultrastructural changes of the cells were observed by transmission electron microscope , the concentration of nitric oxide ( NO ) was detected by the living cell workstation , the concentration of nitric oxide ( NO ) was detected by nitrate reduction method , the concentration of reactive oxygen free radical ( ROS ) was detected by fluorescence probe method , the concentration of ET - 1 was detected by enzyme linked immunosorbent assay , and the expression level of ET - 1 protein gene was detected by RT - PCR .
Results : 鈶，

本文编号：1918823