早发冠心病血瘀证DNA羟甲基化相关差异基因研究

目的 探讨早发冠心病(premature coronary heart disease,PCHD)血瘀证DNA羟甲基化相关差异基因表达,以期寻找PCHD血瘀证诊断和治疗的新靶点.方法 病例来自湖南中医药大学第二附属医院PCHD患者,分为PCHD血瘀证组(A组)和PCHD非血瘀证组(B组),各6例,采用DNA羟甲基化免疫...     

冠心病血瘀证与超氧化物歧化酶、丙二醛关系的探讨

通过对60例冠心病患者辨证分型后血清SOD及MDA水平检测分析，结果表明血瘀证患者血清SOD水平显著低于非血瘀证组（P〈0．05）和正常对照组（P〈0．01），而血清MDA含量明显高于非血瘀证组（P〈0．05）和正常对照组（P〈0．01）。提示SOD减少和自由基增高与冠心病血瘀证证型密切相关，自由基可能参与了血瘀的形成。     

冠心病血瘀证研究进展

中医认为冠心病属于“胸痹”、“心痛”等范畴 ,临床和实验都证明活血化瘀方药治疗冠心病具有扩张冠状动脉、改善心肌缺血、降低心肌耗氧、改善血液流变学、降低内皮素(ET)、升高一氧化氮 (NO)、维持 ET/ NO平衡、保护内皮细胞、预防冠脉内血栓形成等作用。现就冠心病血瘀证的现代研究及活血化瘀方药的防治作一综述。1　冠心病血瘀证的现代研究陈氏 [1 ] 等将血瘀证分为血瘀证 型 (血瘀证高流变性型 )和血瘀证 型 (血瘀证低流变性型 )。按其分法 ,冠心病属血瘀证 型 :具有一种或多种血液高粘、高凝、高纤维蛋白血症 ,高血栓素水平 ,…     

冠心病血瘀证家族史背景与疗效相关性初探

目的 探讨冠心病血瘀证家族史与疗效的相关性。方法 筛选符合冠心病血瘀证中西医诊断标准的病例20例,经血府逐瘀汤加减治疗1个月,观察疗效,对治疗前后血瘀证证候进行评分和统计学处理。结果 7例冠心病血瘀证有家族史的病例组无明显疗效,而13例无家族史的病例取得明显疗效。结论 有家庭史背景的冠心病血瘀证可能具备更复杂的遗传背景,而增加了中医药治疗的难度,为中医药防治冠心病的疗效预测提供新的参考因素。     

冠心病心绞痛气滞血瘀证与血瘀气滞证辨析

通过对冠心病心绞痛既往辨证分型标准的回顾,提出冠心病心绞痛血瘀气滞证新证型,认为冠心病心绞痛气滞血瘀证与血瘀气滞证是气血同病的两个不同证型,并从病因病机、临床证候以及治法方药方面将两证型进行了比较鉴别,对临床具有重要指导意义。     

冠心病心绞痛血瘀证四亚型与血管性假血友病因子相关性探讨

目的 探讨血管性假血友病因子(VWF)与冠心病心绞痛血瘀证四亚型的相关性.方法 对符合诊断标准的受试者112例、健康对照组30例、冠心病非血瘀证组30例分别检测其VWF指标.结果 与冠心病心绞痛非血瘀证比较,冠心病心绞痛血瘀证患者VWF水平均有不同程度升高(P<0.01),各亚型之间比较,为痰浊血瘀>气滞血瘀>气虚血瘀>阴虚血瘀.结论 冠心病心绞痛血瘀证内皮细胞损伤实证比虚证较为严重,尤其是痰浊血瘀亚型更为严重.     

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...     

血栓前状态分子与冠心病血瘀证的相关性研究

目的探讨血栓前状态(PTS)分子与冠心病血瘀证之间的相关性。方法研究分为家系冠心病血瘀证组、家系冠心病非血瘀证组、家系非冠心病血瘀证组、家系健康人组、非家系冠心病血瘀证组、非家系健康人组6组,运用ELISA试剂盒检测外周静脉血血浆(或血清)中血栓调节蛋白(TM)、血小板P-选择素(P-Selectin)、凝血酶原片段1、2(F1+2)、可溶性纤维蛋白单体(SFMC)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制物(PAI-1)、凝血酶-抗凝血酶III复合物(TAT)等分子水平。结果家系人群研究中冠心病血瘀证患者与健康人比较TM、t-PA、P-Selectin、F1+2、TAT水平增加,SFMC、PAI-1水平无差异;冠心病血瘀证患者与冠心病非血瘀证患者比较TM、t-PA、P-Selectin、TAT、SFMC水平增加。非家系冠心病血瘀证与非家系健康人比较各PTS分子均无差异。结论家系人群中PTS分子与冠心病血瘀证存在一定相关性,但抗凝血、促凝血等相互拮抗的分子水平变化趋势一致值得进一步探讨;非家系冠心病血瘀证与健康人比较PTS分子均无差异;且PTS分子水平在家系和非家系人群中有明显区别,这种差异是否与遗传因素有关也值得后续研究进一步探索。     

冠心病血瘀证辨治述要

冠心病的发生多与情志失调、寒邪内侵、劳倦过度、饮食失节、年老久病等因素有关。气、血、阴、阳亏虚或脏腑功能失调是血瘀证形成的基本病机,多由寒邪、热邪、痰湿等实邪阻碍血液运行,导致瘀血停滞于心胸,不通则痛;或由郁怒伤肝,肝失疏泄,肝郁气滞而使血行失畅,脉络不利而致气血瘀滞,胸阳不运,心脉痹阻,不通则痛。并对冠心病血瘀证细化分型为痰瘀互结、寒凝血瘀、气滞血瘀、气虚血瘀、阳虚血瘀等,分别采用活血化痰、温经活血、行气活血、补气活血、温阳活血等法,以提高临床疗效。     

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.     

冠心病痰瘀互结证中医证治研究

痰瘀互结证为冠心病中医临床辨证的重要证候之一,痰浊与瘀血是冠心病发病最主要的两大病理因素,两者相互胶结贯穿该病发生、发展的始终.冠心病病位在心,与肝、脾、肾密切相关,治疗多从痰瘀同治,并根据其发病标本虚实,以及脏腑、气血阴阳失调等不同情况,按气虚、气滞、气阴两虚、阳虚、寒邪、热邪、毒邪的轻重加以辨证施治.该文通过对冠心...     

电针治疗心血瘀阻型冠心病心绞痛的临床观察

目的观察电针治疗心血瘀阻型冠心病心绞痛的临床疗效。方法 90例患者随机分为电针组和对照组各45例,对照组予以辛伐他汀片、阿司匹林肠溶片和丹参川芎嗪治疗,有高血压、糖尿病者予以降压、降糖治疗;电针组在对照组治疗基础上加用电针治疗。两组10d为1疗程,1个疗程结束后观察各组临床症状疗效、心电图疗效、治疗期间药物副反应发生情况和预后心绞痛复发情况。结果电针组临床症状疗效总有效率显著高于对照组,两组间比较具有显著统计学意义(P0.05);电针组心电图疗效总有效率极显著高于对照组,两组间比较具有极显著统计学意义(P0.01);电针组的药物副反应发生率极显著低于对照组,两组间比较具有极显著统计学意义(P0.01);电针组治疗结束后2周和4周的复发率分别低于对照组的20.0%和66.7%,2周后两组间比较具有显著统计学意义(P0.05),4周后两组间比较具有极显著统计学意义(P0.01)。结论电针疗法安全有效,与西药联用不仅能提高临床疗效,还能减轻西药引起的副作用和减少复发率,同时还能良性调节心电图的异常改变。     

Metabolomic Profiling Reveals Distinct Patterns of Tricarboxylic Acid Disorders in Blood Stasis Syndrome Associated with Coronary Heart Disease

Objective

To investigate the underlying metabolomic profifiling of coronary heart disease (CHD) with blood stasis syndrome (BSS).

Methods

CHD model was induced by a nameroid constrictor in Chinese miniature swine. Fifteen miniature swine were randomly divided into a model group (n=9) and a control group (n=6), respectively according to arandom number table. After 4 weeks, plasma hemorheology was detected by automatic hemorheological analyzer, indices including hematocrit, plasma viscosity, blood viscosity, rigidity index and erythrocyte sedimentation rate; cardiac function was assessed by echocardiograph to detect left ventricular end-systolic diameter (LVED), left ventricular end-diastolic diameter (LVEDd), ejection fraction (EF), fractional shortening (FS) and other indicators. Gas chromatography coupled with mass spectrometry (GC-MS) and bioinformatics were applied to analyze spectra of CHD plasma with BSS.

Results

The results of hemorheology analysis showed signifificant changes in viscosity, with low shear whole blood viscosity being lower and plasma viscosity higher in the model group compared with the control group. Moreover, whole blood reduction viscosity at high shear rate and whole blood reduction viscosity at low shear rate increased signifificantly (P <0.05). The echocardiograph results demonstrated that cardiac EF and FS showed signifificant difference (P <0.05), with EF values being decreased to 50% or less. The GC-MS data showed that principal component analysis can clearly separate the animals with BSS from those in the control group. The enriched Kyoto Encyclopedia of Genes and Genomes biological pathways results suggested that the patterns involved were associated with dysfunction of energy metabolism including glucose and lipid disorders, especially in glycolysis/gluconeogenesis, galactose metabolism and adenosine-triphosphate-binding cassette transporters.

Conclusions

Glucose metabolism and lipid metabolism disorders were the major contributors to the syndrome classifification of CHD with BSS.

     

基于iTRAQ技术的冠心病血瘀证蛋白质谱研究

目的：探索冠心病血瘀证差异蛋白质谱,从蛋白水平阐释冠心病血瘀证的生物学机制。方法对冠心病血瘀证与非血瘀证两组,应用同位素标记相对和绝对定量(isobaric tags for relative and absolute quantitation, iTRAQ)技术分离、鉴定两组的差异蛋白质。结果鉴定到的蛋白质数量780个。两组共有27个蛋白点表达相差1.5倍以上,其中11个上调,16个下调。上调的差异蛋白中主要功能涉及免疫反应、细胞间粘附作用主要指血小板参与的凝血反应、脂质代谢。下调的差异蛋白中主要功能涉及血小板细胞变形、细胞与细胞间关系迁移、细胞损伤表达。结论冠心病血瘀证与免疫反应、血小板参与凝血反应的亢进,以及影响血小板形态变化、血小板间、血管内皮细胞与血小板的粘附迁移有密切的关系。     

冠心病从痰瘀论治探析及思考

冠心病是严重危害人类健康的常见病、多发病,近年来,我国人群的冠心病发病率及死亡率呈明显上升趋势。中医认为,痰浊、瘀血是冠心病的重要病理因素,痰瘀互结、痹阻心脉导致心脉不通是冠心病的主要病理基础,同时也与冠心病的诸多危险因素密切相关。临床研究表明,痰瘀互结是冠心病的主要证型。因此,在治疗上强调“痰瘀同治”的重要性,在临床应用中,又应据证立法,灵活应用。     

论从痰与瘀论治冠心病

冠心病是临床常见心血管病,其主要类型是心绞痛。中医药通过辨证论治对冠心病心绞痛的治疗具有一定的特色。跟随导师期间,深悟导师从痰、瘀论治冠心病的临证经验,在治本的基础上,采取痰瘀同治的原则,运用祛痰化瘀方法,取得良好的临床疗效。     

冠心病“痰瘀”证素特征的临床研究

目的:探讨冠心病由"痰凝"至"痰瘀"病性证素变化对冠心病形成的影响。方法:对冠心病痰瘀痹阻证组120例、痰凝心脉证组98例、非痰非瘀证组92例、健康人对照组30例进行血脂、血液流变学、血糖、胰岛素敏感性指数及相关基因表达的检测分析。结果:冠心病血脂痰凝心脉证组与非痰非瘀证组、正常组均有显著差异(P<0.01);由非痰非瘀证→痰凝心脉证→痰瘀痹阻证血液流变学各项指标均增加;FINS、ISI值呈健康对照<非痰非瘀证组<痰凝心脉证组<痰瘀痹阻证组递进趋势(均P<0.01);由非痰非瘀→痰凝心脉→痰瘀痹阻的病理演变中,患者c-myc mRNA和PDGF-AmRNA的表达量均逐渐增加。结论:痰瘀痹阻证血液流变学指标均显著高于非痰非瘀证、痰凝心脉证,提示血液流变学异常是血脉瘀阻的客观指证;IR可能是产生"痰瘀"并由"痰"到"瘀"演变的重要内在生化物质基础;IR与冠状动脉脉病变严重程度呈正相关,提示IR可作为预测冠心病严重程度的参考指标之一;冠心病"痰瘀"证素变化的分子机制与c-myc、PDGF-AmRNA异常表达有关。     

从痰瘀浅析冠心病

冠心病在中医学中属于胸痹心痛的范畴,其主要的病因病机为"痰浊"、"血瘀",二者各自作用或相互转化,致使机体经络瘀阻,气血运行不畅,最终导致胸闷、气短、胸痛等症状的发生。