冠心病辨证与冠脉病变、血管内皮功能的相关性及黄芪的内皮保护作用研究-中西医结合内科学专业论文.docxVIP

提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 提要 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小时嬲Ⅱ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(P0．05．0．01)；(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(Po 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(Po．01)；(4)对照组冠脉造影后vWF、ET血中含量升高， NO含量降低(PO．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(P0．05)结论(】)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。 关键词 冠状动脉疾病；辨证；内皮功能；冠状血管造影 Study Study of The Relationship between Coronary Artery Disease Symdrome Differentiation Type of TCM and Coronary Artery Lesion，Endothelial Function and the Endothelial Proieetion of Huangqi Speciality：Internal Medicine of TCM and Western Medicine Author：Zhang Zengtang Tutor：Zhang Wengao Abstract Objective：To investigate the relationship between the Traditional Chinese Medicine(TCMl Syndrome Differentiation—type(TCM-SDT)and degree of coronary atery lesion and endothelial funetion，in order to provide the evidence of the externalization of TCM—SD下Methods 96 CHD patients TCM-STD were differentiated，Vasodilation following reactive byperemia 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，N0 and vWF were detected also．Plasma ET,NO and vWF were detected befo『e and after coronaD angiography(CAGJ immediately，4 hours and 24 hours in 1 6 Patients undergoing CAG selected randoml斗Another 45 patients undergoing CAG were divided into Huangqi group and control group Huangqi enjection was dripped 30ml everydayin Huangqi group from 5-7 days before to 1day after CAG，but not in the control group，Plasma ET,NO and vWF wer