四逆汤防治PTCA术后再灌注损伤的作用机制及中医辨证分型的临床研究

目的：探讨不同证型患者服用四逆汤防治经皮冠状动脉内成形术（ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｌｕｍｉｎａｌｃｏｒｏｎａｒｙａｎｇｉｏｐｌａｓｔｙ，ＰＴＣＡ）后再灌注损伤的作用以及对不同证型患者的影响。方法：对４０例做ＰＴＣＡ术患者随机分为四逆汤组和对照组，均有实证、虚证各１０例。四逆汤组于术前３天开始服用四逆汤２５ｍｌ，每天１次；服至术后第３天。检测两组各型ＰＴＣＡ术前后血超氧化物歧化酶（ＳＯＤ）活性、丙二醛（ＭＤＡ）含量及一氧化氮（ＮＯ）含量并进行比较。结果：术前虚证型ＳＯＤ活性显著低于实证型（Ｐ＜００５），术前实证型ＭＤＡ含量显著高于虚证型（Ｐ＜００５），服用四逆汤能减轻两组术后ＳＯＤ活性和ＮＯ浓度的下降及ＭＤＡ含量的升高（Ｐ＜００５），其中提高虚证型ＳＯＤ活性的幅度显著高于实证型（Ｐ＜００５）。结论：四逆汤具有抗ＰＴＣＡ术后再灌注损伤的作用，对虚证型效果尤好。

Clinical Study on Therapeutic Mechanism of Sini Decoction in Treating Post Percutaneous Transluminal Coronary Angioplasty Ischemia Reperfusion Injury in Terms of Syndrome Typing of TCM

Objective: To study the mechanism of Sini Decoction (SND) in prevention and treatment of post percutaneous transluminal coronary angioplasty (PTCA) ischemia reperfusion injury with different Syndrome typing of TCM. Methods: Fourty patients received PTCA were randomly divided equally into the SND group and the control group, in each group, there were 10 of Excess Syndrome (ES) and 10 of Deficiency Syndrome (DS). Twenty five ml of SND was given daily to the SND group from 3 days before operation to the third day after operation. The blood superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) content of patients were determined before PTCA, and 1hrs, 12 hrs, 24 hrs, 48 hrs and 72 hrs after PTCA. Results: Before PTCA, the cases of DS were characterized by low SOD activity and high MDA content, as compared with the patients of ES, P<0 05. SND could relieve the post PTCA deprivation of SOD activity and NO content and the elevation of MDA level of both ES and DS patients, the amplitude of elevation of SOD activity in DS patients was higher than that in ES patients (P<0 05). Conclusion: SND has antagonisting effect on post PTCA ischemia reperfusion injury, which is more effective in treating patients with DS.