冠心病介入术前后的中医证型研究

目的:探讨冠心病患者在冠状动脉支架植入术前后中医证型的特点及演变规律。方法:对89例冠心病患者介入术前后进行中医证候分型,常见有血瘀证、气虚证、热证、痰浊证、气滞证、阳虚证、阴虚证、寒凝证等证型。结果:冠状动脉介入治疗前以血瘀证54例(60.7%),气虚证50例(56.2%),热证32例(40%),痰浊证20例(22.5%)最为常见,气滞证13例(14.6%),阳虚证8例(9%),阴虚证6例(6.7%),寒凝证3例(3.4%)。介入术后3天中医辨证中以血瘀证40例(44.9%),气虚证33例(37.1)最为常见,热证17例(19.1%),痰浊证15例(16.9%),气滞证13例(14.6%),阳虚证9例(10.1%),阴虚证6例(6.7%),寒凝证0例。结论:介入术后胸闷、胸痛及汗出临床症状较介入前均有显著改善(P<0.01);而乏力、眩晕、气短等症状在介入术前后变化不明显(P﹥0.05)。结论:①热证已成为冠心病的临床常见证型;②虽然介入手术治疗能够显著改善冠心病患者的临床症状,但并不能从根本上改变冠心病的本虚标实的病机特点。     

中医药防治绝经后冠心病实验研究进展

围绕绝经后冠心病的发病机制,对近年来中医药防治去势后动脉粥样硬化做一综述,为绝经后冠心病的防治提供一种新途径。     

Effectiveness of Integrative Medicine Therapy on Coronary Artery Disease Prognosis: A Real-World Study

Objective: To evaluate the effectiveness of integrative medicine(IM) on patients with coronary artery disease(CAD) and investigate the prognostic factors of CAD in a real-world setting. Methods: A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine(CM) plus conventional treatment, i.e., IM therapy(IM group); or conventional treatment alone(CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction(MI), and revascularization]. Results: A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4%(514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization(9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age 65 years [odds ratio(OR), 2.224], MI(OR, 2.561), diabetes mellitus(OR, 1.650), multi-vessel lesions(OR, 2.554), baseline high sensitivity C-reactive protein level 3 mg/L(OR, 1.678), and moderate or severe anxiety/depression(OR, 1.849) were negative predictors(P0.05); while anti-platelet agents(OR, 0.422), β-blockers(OR, 0.626), statins(OR, 0.318), and IM therapy(OR, 0.583) were protective predictors(P0.05). For cardiac death/MI, age 65 years(OR, 6.389) and heart failure(OR, 7.969) were negative predictors(P0.05), while statin use(OR, 0.323) was a protective predictor(P0.05) and IM therapy showed a beneficial tendency(OR, 0.587), although the difference was not statistically significant(P=0.218). Conclusion: In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI.     

冠心病中医药循证研究进展

中医药学有数千年的历史,是中国劳动人民长期同疾病作斗争的实践经验总结,并逐步形成、发展成为独特的医学体系。然而,由于其是一种典型的经验医学,疗效缺乏客观化、定量化的评价标准。中医药临床试验是20余年前才开始的,近10年来呈增长趋势,但在临床研究中仍存在不少问题,     

吸烟冠心病患者冠状动脉介入术结果分析

目的:初步探讨吸烟冠心病患者冠状动脉介入术即刻结果与吸烟之间的关系. 方法:选自2002年11月至2005年7月间我院所有冠状动脉造影者289例,按吸烟与否分为吸烟组和非吸烟组两组.吸烟组168例,131例(78.1%)接受 PCI术,非吸烟组121例,102例(84.3%)患者行 PCI术.结果:在冠脉介入术的吸烟组中32例有PCI相关血管PCI后的慢血流现象.而非吸烟组有此现象的9例,两组相比有显著差异(χ2=12.35,P＜0.05).结论:吸烟患者PCI术中相关血管慢血流现象的发生率较高.     

冠脉支架置入术与冠脉搭桥术治疗严重冠心病的对比研究——SYNTAX研究

1 文献来源 Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease [J]. N Engl J Med, 2009,360(10):961- 972.     

冠脉支架置入术与冠脉搭桥术治疗严重冠心病的对比研究——SYNTAX研究

1文献来源 Serruys PW, Morice MC, Kappetein AP, et al.Percutaneous coronary intervention versus coronaryartery bypass grafting for severe coronary artery disease [J]. N Engl J Med, 2009,360 （10） ：961 - 972.     

冠心病中医辨治述要

提出冠心病中医辨治的四项要点：心脏为发病的部位,肾虚为发病的基础;注意区分寒邪与热邪致病的不同病机,采取针对性治疗;活血化瘀与扶正补益相结合;重视疏肝解郁法的应用。并附验案两则以资佐证。     

中医中药治疗冠心病研究进展

冠心病属中医学"胸痹""心痛"范畴,是内科常见病、多发病,是目前威胁人类健康的重要疾病之一,其发病率呈逐年上升趋势。深入研究冠心病的致病机理,采取有效预防及治疗措施,对延长人口寿命、降低病死率和提高患者生存质量具有重要意义。几千年的实践证明,祖国传统医学对治疗冠心病具有副作用小、标本并治等特点,近年来随着分子生物学技术的长足进步,治疗冠心病的单味药、复方、辨证论治研究都有了长足的进展,基础研究和临床大样本循证医学研究均表明中医药对防治冠心病有着巨大的应用潜力和重要意义。     

中医药治疗妇女绝经后冠心病的研究进展

冠心病是临床常见的心血管疾病之一,临床流行病学研究表明,绝经前女性冠心病的发病率仅为男性的1/10～3/10,但绝经后妇女冠心病的发病率及死亡率比绝经前上升4～8倍,明显高于男性,绝经后妇女年龄每增加10岁,冠心病的死亡率增加7倍。随着我国人民生活水平的提高,老年人口的增加,正逐步进入老龄化社会,老年女性冠心病发生率随年龄增长而呈明显的上升趋势。因此,积极有效地防治老年女性冠心病对于增进女性健康、延长寿命具有十分重要的现实意义。现特将近年来的相关研究进行综合,以探索绝经后冠心病的更广泛的治疗途径。     

利用循证药物疗法进行冠心病二级预防：一项中医医院与综合性医院的对照研究

Objective： To determine differences in adherence to secondary prevention guidelines （pharmacological interventions） among coronary heart disease （CHD） patients between a Chinese medicine （CM） hospital and a general hospital in a Chinese city. Methods： Medical records of 200 patients consecutively discharged from the CM hospital and the general hospital for CHD were reviewed to determine the proportions of eligible patients who received antiplatelet agents, 13-blockers, angiotensin-converting enzyme （ACE） inhibitors or angiotensin receptor blockers （ARBs） and statins at discharge. The effects of patient characteristics and hospital type on the use of these medicines were estimated using logistic regression models. Results： Patients discharged from the CM hospitals were older; more likely females; had greater history of hyperlipidemia, cerebrovascular diseases and less smoker （P〈0.01 or P〈0.05）. They were less likely to receive coronary angiography and percutaneous coronary intervention, and had a longer length of stay than those discharged from the general hospital （P〈0.01 or P〈0.05）. There were no significant differences in antiplatelet agents （96% vs. 100%, P=0.121） or statins （97.9% vs. 100%, P=0.149） use between the CM hospital and the general hospital. In multivadable analyses that adjusted for patient characteristics and hospital type, there was no significant difference in use of 13 -blockers between the CM hospital and the general hospital. In contrast, patients discharged from the CM hospital were less likely to receive ACE inhibitors/ARBs compared with those discharged from the general hospital （odds ratio： 0.3, 95% confidence interval： 0.105-O.854）. Conclusion： In this study, the CM hospital provides the same quality of care in CHD for prescribing evidence-based medications at discharge compared with another general hospital except for ACE inhibitors/ARBs use.     

中西医结合治疗冠心病心肌缺血30例疗效观察

目的观察中西医结合疗法治疗冠心病心肌缺血的临床疗效。方法将62例冠心病心肌缺血患者随机分为2组。治疗组30例,以黄芪注射液及我院制剂参麦养心片(由丹参、毛冬青、瓜蒌、麦冬等组成)配合单硝酸异山梨醇酯缓释胶囊、肠溶阿斯匹林治疗;对照组32例,单纯以单硝酸异山梨酯缓释胶囊、肠溶阿斯匹林治疗。结果治疗组显效10例,有效15例,无效5例,总有效率83.3%;对照组显效5例,有效12例,无效15例,总有效率53.1%,两组比较,差异有显著性意义(P<0.05);心电图治疗组总有效率为86.7%,对照组43.8%,两组比较,差异有显著性意义(P<0.05);硝酸甘油停减率治疗组为73.3%,对照组37.5%,两组比较,差异有显著性意义(P<0.05)。结论中西医结合治疗冠心病心肌缺血疗效优于单用西药治疗。     

40例冠心病合并2型糖尿病患者冠状动脉病变及中医证型分析

目的观察冠心病合并2型糖尿病（diabetes mellitus type 2-coronary heart disease,DM-CHD）患者冠状动脉病变及中医证型的特征。方法经冠状动脉造影诊断的冠心病患者80例,根据有无合并糖尿病分为2组,其中DM—CHD组40例,非合并糖尿病的冠心病（non diabetes mellitus type 2-coronary heart disease,NDM—CHD）组40例,观察两组患者冠状动脉病变情况（累及支数、狭窄程度及形态病变）及中医证型（虚证、实证及虚实夹杂证）的分布特征。结果DM-CHD组冠状动脉病变多见于3支病变或重度弥漫狭窄或严重钙化,与NDM—CHD患者的1支病变、轻重度狭窄和局限性狭窄比较,差异具有显著性（P〈0．01）。两组多见气虚、血瘀、痰浊、阴虚4证,DM—CHD组痰浊、阴虚、阳虚证发生率显著高于NDM—CHD组（P〈0．05）,同时DM-CHD组多见复合证及虚实夹杂证,与NDM-CHD比较,差异具有显著性（P〈0．05）。结论DM—CHD患者冠脉病变程度较NDM—CHD患者严重,DM—CHD患者中医证型复杂,在气虚、血瘀基础上,多有阴虚、痰浊。     

冠心病血瘀证：从现代医学视角理解

The medical community as a whole is attempting to start preventive therapy for coronary heartdisease （CHD） patients earlier in life. However, the main limitations of such interventions are drug resistanceand adverse reactions. Additionally, traditional biomarker discovery methods for CHD focus on the behavior ofindividual biomarkers regardless of their relevance. These limitations have led to attempting novel approachesto multi-dimensionally investigate CHD and identify safe and efficacious therapies for preventing CHD. Recently,the benefit of Chinese medicine （CM） in CHD has been proven by increasing clinical evidence. More importantly,linking CM theory with modern biomedicine may lead to new scientific discoveries. According to CM theory,all treatments for patients should be based on patients＇ syndromes. A recent epidemiological investigation hasdemonstrated that blood stasis syndrome （BSS） is the major syndrome type of CHD. BSS is a type of complexpathophysiological state characterized by decreased or impeded blood flow. Common clinical features ofBSS include a darkish complexion, scaly dry skin, and cyanosis of the lips and nails, a purple or dark tonguewith purple spots, a thready and hesitant pulse, and stabbing or pricking pain fixed in location accompaniedby tenderness, mass formation and ecchymosis or petechiae. The severity of BSS is significantly correlatedwith the complexity of coronary lesions and the degree of stenosis, and is an important factor affecting theoccurrence of restenosis after percutaneous coronary intervention. The mechanisms of BSS of CHD patientsshould be investigated from a modern medicine perspective. Although many studies have attempted toexplore the biomedical mechanisms of BSS of CHD, from hemorheological disorders to inflammation andimmune responses, the global picture of BSS of CHD is still unclear. In this article, the current status of studiesinvestigating the biomedical mechanisms of BSS of CHD and future perspectives are discussed.     

中成药治疗冠心病

医学的进步使冠心病患者的生存率和生活质量明显得到提高,其中中成药的使用也发挥了重要的作用,随着现代药理学中成药及其有效中药成分的作用及其作用机理的研究越来越深入,中成药越来越被广泛的应用5-q~,床。临床应用中成药治疗冠心病时,应将现代药理学的研究成果与中医辨证施治的方法相结合,才能收到满意的疗效。文章就治疗冠心病的中成药分类综述。     

多巴酚丁胺阿托品负荷超声心动图对冠心病的早期诊断价值

目的应用多巴酚丁胺、阿托品负荷超声心动图，探讨该试验对冠心病的早期诊断价值。方法应用多巴酚丁胺、阿托品负荷超声心动图观察２２例单支轻度冠状动脉狭窄患者负荷试验前后室壁运动改变，并与正常对照组比较。结果多巴酚丁胺负荷超声心动图对轻症冠心病的感性为５９．１％，特异性９４．６％，准确性７５．０％，加用阿托品后其敏感性提高至７７．３％，特异性９４．６％，准确性８５．０％。结论多巴酚丁胺负荷超声心动图对冠心病具有较高的早期诊断价值，加用阿托品可进一步提高试验的敏感性。     

中医药治疗冠心病心绞痛研究进展简

目的：随着社会生活状态的改变,脂质代谢异常高发,冠心病发病率逐年上升,治疗成为了人民关注的棘手问题,综述近5年中医药治疗冠心病心绞痛的新进展。方法：大量查阅近5年的相关文献资料及治疗指南。结果：分别从中药、中成药及其他外治法论述了对冠心病心绞痛的治疗方法及效果。结论：中医药在冠心病心绞痛的治疗领域有着不可替代的地位。     

胆红素与冠状动脉病变的关系

目的　探讨胆红素水平与冠状动脉病变的关系。方法　对拟诊冠心病的 178例患者行选择性冠状动脉造影 ,测定血清总胆红素 (Bili T)、直接胆红素 (Bili D) ,并计算间接胆红素 (Bili I)水平。结果　①与冠脉造影阴性者相比 ,阳性组患者血清Bili T、Bili I水平明显降低 (P <0 .0 5 ) ;②冠脉狭窄程度和范围与胆红素浓度无相关关系 ;③急性冠脉病变时胆红素浓度显著升高 (P <0 .0 5 )。结论　胆红素对冠状动脉具有保护作用。     

中西医结合治疗慢性盆腔炎的疗效观察

目的:观察中西医结合治疗慢性盆腔炎的疗效。方法:将64例慢性盆腔炎患者随机分为对照组和治疗组各32例;对照组予替硝唑,1次/d,头孢哌酮,2次/d,静脉滴注,连续用药14d;治疗组在对照组基础上加用中药保留灌肠,1次/d,半个月为1个疗程,连续用3个疗程。结果:治疗组的总有效率(93.8%)明显高于对照组(75.0%),差异有统计学意义(χ2=4.27,P<0.05)。结论:静脉点滴抗生素同时加用中药保留灌肠治疗慢性盆腔炎疗效满意。     

miRNA及DNA甲基化与中医药干预冠心病研究新进展

现代社会,心血管疾病已然成为人类健康的主要威胁之一,其中,冠心病作为最常见的类型,具有高发病率及致死致残率.越来越多研究证实,微小核糖核酸(miRNA)调节与脱氧核糖核酸(DNA)甲基化调控与冠心病的发生、发展关系密切,其可涉及调控冠心病的发病机理,且特殊的miRNA表达及特定基因的DNA甲基化状态可以作为冠心病预测及...