冠脉病变与冠心病中医证型的相关性及蛭龙活血通瘀胶囊对气虚痰瘀型冠心病患者血管内皮功能的影响

发布时间：2019-05-29 22:23

【摘要】：目的：(1)探讨冠心病中医证型与冠脉狭窄程度、冠脉狭窄程度积分(Gensini积分法)、病变支数之间的相关性。(2)观察蛭龙活血通瘀胶囊对气虚痰瘀型冠心病患者血管内皮功能的影响。方法：(1)收集2013年5月到2015年4月在西南医科大学附属中医医院心脑病科行冠脉造影确诊为冠心病患者371例。(2)记录基本信息、冠脉造影结果、中医辨证、计算Gensini积分、填写CRF表、建立数据库等。(3)将2015年5月到2015年9月本科室住院经冠脉造影确诊为冠心病且中医辨证属于气虚血瘀合痰阻心脉型(简称气虚痰瘀型)的患者60例,随机分成对照组和治疗组,并选取同期门诊体检的健康人20例作为健康组。两组在冠心病西医规范化治疗基础上,治疗组加用蛭龙活血通瘀胶囊1.2tid服用一个月,通过检测三组血中一氧化氮(NO)、内皮素(ET)、6一酮前列腺素(6-Keto-PGF1 a).血栓素B2(TXB_2),观察冠心病组与健康组及冠心病治疗组与对照组血管内皮功能的变化。(4)统计软件SPSS 20.0用于相关数据的统计描述与分析。结果：第一部分：(1)在371例冠心病患者中不同的中医证型基础疾病史(高血压病、糖尿病)和危险因素(吸烟史、饮酒史)差异无统计学意义(P＞0.05)。阳气虚衰患者最大,痰阻心脉患者年龄最小,差异具有统计学意义。(2)入组的371例冠心病患者中医证型分布：气虚血瘀型110例(29.65%)、痰阻心脉型101例(27,22%)、气滞血瘀型患者99例(26.68%)、气阴两虚型患者46例(12.40%)、阳气虚衰型15例(4.04%)。不同中医证型之间的冠脉病变支数存在差异(P0.05),阳气虚衰型患者的冠脉病变平均支数(2.13±0.92)最多,气滞血瘀型冠脉病变平均支数最少(1.41±0.67),与其他型患者进行两两比较时,差异均有统计学意义(p0.05)。中医证型在冠脉病变支数分布上也存在差异(P＜O.05),气滞血瘀型(68.7%)、气虚血瘀型(37.3%)多见于单支病变,痰阻心脉型(50.5%)及气阴两虚型(45.7%)多见于双支病变,阳气虚衰型(46.7%)多见于多支病变。不同中医证型之间Gensini积分比较差异具有统计学意义(P0.05),阳气虚衰型Gensini积分最高42.00 [30.00,90.00],气滞血瘀型患者Gensini积分最低14.00[8.00,22.00]。第二部分：(1)气虚痰瘀型冠心病组与健康组,性别比较差异无统计学意义(P0.05),耐心病组(64.73±9.41岁)较健康组(27.25±3.07岁)平均年龄大(P0.05)。冠心病组治疗前后ET(ng/L)、 TXB_2(ng/L)较健康组高,NO(umol/L)、6酮前列腺素(ng/L)均较健康组低,差异具有统计学意义(P＜0.001)。(2)冠心病组内对照组和治疗组：年龄,性别构成比,病史(高血压病、糖尿病、高脂血症、脑血管意外),生活史(吸烟史、饮酒史)比较差异无统计学意义(P＞0.05)。(3)对照组与治疗组治疗前两组患者的NO、ET、TXB_2、 6-Keto-PGF1α差异无统计学意义(P0.05),治疗后两组的NO,6-Keto-PGF1 α均较前升高,ET,TXB_2均较治疗前降低,差异具有统计学意义(P0.05)。治疗后对照组NO比值较治疗组低,对照组ET、TXB_2较治疗组高,差异均有统计学意义(P0.05),两组6-Keto-PGFla的差异无统计学意义(P0.05)。(4)治疗组与对照组两组治疗前后的差值比较结果：NO、ET、 TXB_2治疗组治疗前后的差值均较对照组大(P0.05)；6-Keto-PGF1 α治疗组与对照组的差值,差异无统计学意义(P0.05)。结论：冠心病不同中医证型主要分布以气虚血瘀型、痰阻心脉型、气滞血瘀型为主,以阳气虚衰型平均年龄最大；其中气滞血瘀型病变平均支数最少、Gensini积分最低,阳气虚衰型病变平均支数最多、Gensini积分最高。气滞血瘀型、气虚血瘀型,多见于单支病变；痰阻心脉型、气阴两虚型,多见于双支病变；阳气虚衰型多见于多支病变。所以冠脉病变、Gensini积分与冠心病中医证型有关联。气虚痰瘀型冠心病患者治疗组和对照组相对于健康组而言,内皮功能均有损害。经治疗后对照组、治疗组的NO、ET、TXB_2、6-Keto-PGF1 α较治疗前均有改变。治疗后治疗组NO,ET,TXB_2疗效差值差异更大,说明服用蛭龙活血通瘀胶囊的患者比单纯西医规范化治疗的疗效更显著,内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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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