冠心病不稳定型心绞痛痰瘀互结证临床生化指标研究

目的 观察与冠心病不稳定型心绞痛痰瘀互结证病机衍变相关临床生化指标的特征性改变.方法 120例冠心病不稳定型心绞痛患者辨证分为痰瘀互结组65例、气虚血瘀组55例,另设健康对照组23例.分别检测两组患者血压、血糖、血脂、甲状腺功能、凝血功能、血管紧张素Ⅰ、高敏C反应蛋白、同型半胱氨酸,以及3组受试者的炎症介质指标.结果 痰瘀互结组患者糖化血红蛋白、总胆固醇、低密度脂蛋白、凝血酶原时间、纤维蛋白原反应时间均明显高于气虚血瘀组(P＜0.05),面活化部分凝血活酶时间明显低于气虚血瘀组(P＜0.05),两组患者血脂和凝血功能其他指标以及血糖、血压、甲状腺功能及炎症介质各项指标、血管紧张素Ⅰ、高敏C反应蛋白、同型半胱氨酸等方面比较差异均无统计学意义(P＞0.05).两组患者血清肿瘤坏死因子-α和层黏蛋白含量均明显高于健康对照组(P＜0.05),血清分泌型免疫球蛋白A含量明显低于健康对照组(P＜0.05).结论 由血糖、血脂变化最终引起机体凝血系统的异常可能是冠心病不稳定型心绞痛痰瘀互结证的重要病理过程,而机体的炎性免疫反应可能在血瘀证病理环节中起重要作用.

The Biochemical Indicators in Coronary Heart Disease Patients with Unstable Angina of Phlegm-Stasis Binding Syndrome

Objective To observe the characteristic changes of the biochemical indicators related to the pathogenetic process in coronary heart disease(CHD)patients with unstable angina(UA)of phlegm-stasis binding syndrome.Methods Totally 120CHD patients with UA were divided into the phlegm-stasis binding group(65cases)and the qi deficiency with blood stasis group(55cases)according to syndrome differentiation.Twenty three healthy persons were chosen as the control group.The blood pressure,blood Glucose,blood lipid,thyroid function,coagulant function,angiotensinⅠ(AngⅠ),high sensitivity Creactive protein(hs-CRP),homocysteic acid(HCA)and inflammation mediators were observed.Results Comparing with the qi deficiency with blood stasis group,glycosylated hemoglobin(GHb),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),prothrombin time(PT)and fibrinogen reaction time significantly increased in the phlegm-stasis binding group(P<0.05),but the activated partial thromboplastin time significantly decreased(P<0.05).There was no significant difference in blood lipid,coagulant function,blood Glucose,blood pressure,thyroid function,mediators of inflammation,AngⅠ,hs-CRP and HCA between the two groups(P>0.05).Comparing with the control group,the contents of tumor necrosis factor-α(TNF-α)and laminin in other groups increased significantly(P<0.05),but secreted immunoglobulin A(sIGA)decreased significantly(P<0.05).Conclusion The disturbance of blood coagulation induced by hyperglycemia and hyperlipidemia may be an important pathogenetic process of UA with phlegm-stasis blinding syndrome.Inflammation immune reaction may play an important role in the pathogenetic process of blood-stasis syndrome.