Treatment of Unstable Angina Pectoris with Modified Nuan Gan Jian-A Report of 33 Cases

Objective: To observe the effectiveness of Modified Nuan Gan Jian Jiao Nang (MNGJ 加减暖肝煎胶囊Modified Liver-Warming Capsule) in treating unstable angina pectoris. Method: Sixty-six eligible cases were assigned randomly into a treatment group and a control group and treated for 3 weeks. Results:MNGJ produced an effect in reducing episodes, improving the abnormal findings in electro-cardiogram (ECG) (P＜0.05) significantly, and decreasing myocardial oxygen consumption (P＜0.05). In addition, it could decrease the plasma TXB2 level and increase 6-keto-prostaglandin F1α (6-Keto-PGF1α) level (P＜0.01). Conclusion: MNGJ was quite effective in treating unstable angina pectoris, suggesting that the treatment of the disease could start from the liver.     

奥扎格雷对急性冠脉综合征患者TXB2和6-Keto-PGF1α的影响

目的观察奥扎格雷对急性冠脉综合征(acute coronary syndrome ACS)患者血浆血栓素B2(TXB2)和6-酮-前列腺素F1a(6-Keto-PGF1a)的影响.方法选择80例ACS病人,其中急性心肌梗死(acute myocardiol infarction AMI)40例,不稳定心绞痛(unstable angina pectoris UAP)40例,随机分为治疗组(常规治疗加奥扎格雷,N=40)和对照组(常规治疗,N=40),分别测定治疗前后病人血浆TXB2和6-Keto-PGF1a的含量,进行统计分析.结果两组病人治疗前的血浆TXB2明显增高,而6-Keto-PGF1a明显减低,6-Keto-PGF1a/TXB2(K/T)降低;治疗后TXB2明显降低,而6-Keto-PGF1a明显增高,K/T增高.且奥扎格雷治疗组K/T增高幅度大于对照组.结论用奥扎格雷治疗ACS病人,能明显降低血浆TXB2水平,升高6-Keto-PGF1a含量,增高K/T.     

Effects of Codonopsis pilosulae on the synthesis of thromboxane A2 and prostacyclin

24 angina pectoris patients were treated with Codonopsis pilosulae (CP) oral solution 20 ml (containing crude CP 20 g) thrice daily for 7 days, other 10 cases were treated by aspirin 0.5 g per day for a week as the control group. After treatment, in the CP group, the plasma level of TXB2 was obviously reduced from 156.76 +/- 11.87 pg/ml to 125.01 +/- 8.85 pg/ml (means +/- S means), the inhibitory rates was 15. 67% (P less than 0.05), and of 6-keto-PGF1 alpha (6-K) was not markedly changed (P greater than 0.05). In the aspirin group, TXB2 was also reduced significantly (P less than 0.05); 6-K was reduced more than that of CP group, the inhibitory rate was 24.33 +/- 9.40% (P less than 0.05). To reveal the mechanism of CP action on the synthesis of TXA2 and PGI2, the porcine lung microsome was used as the donor of cyclooxygenase, thromboxane synthase and prostacyclin synthase, the effects of CP on the formation of TXB2 and 6-K from arachidonic acid (AA) or endoperoxides were measured by RIA respectively. The results showed that both the levels of the formation of TXB2 from AA or endoperoxides were markedly reduced by CP in a dose-dependent (at doses of 3-300 mg/ml). The synthesis of TXB2 was distinctly inhibited alone with a dose of 100 mg/ml CP, which suggested that CP might be an inhibitor of TXB2 synthase at that dose; while at a dose of 300 mg/ml CP, the synthesis of TXB2 and 6-K were inhibited simultaneously (P less than 0.001). It showed that a larger dosage of CP, which could inhibited the synthesis of both TXA2 and PGI2, its mechanism of action needs further study.     

葛根素静滴配合穴位埋植药线和自我穴位指压治疗心绞痛疗效观察

目的探讨治疗心绞痛更为有效的治疗方法。方法选择100例冠心病心绞痛患者作为研究对象,随机分为观察组和对照组,每组各50例。对照组在内科常规治疗的基础上采用葛根素注射液100mL（含0．2g）,静脉点滴,2次,d。观察组在上述治疗的基础上给予穴位埋植药线并配合自体指压穴位。两组均治疗14d为1个疗程．连续治疗2个疗程后评定疗效。主要观察两组患者临床症状．心绞痛程度及发作频率以及心电图缺血状态等的改变情况。结果两组治疗后心绞痛症状和心电图疔比较差异具有高度统计学意义（均P〈0．01）,观察组疗效优于对照组。两组每周的心绞痛发作次数治疗前无显著性差异（P〉0．05）,治疗后具有非常显著性差异（P〈0．01）,观察组治疗后的心绞痛发作次数较对照组大大减少。结论葛根素注射液静脉点滴配合指压和穴位埋植药线用于治疗冠心病心绞痛疗效可靠．     

类心绞痛患者抑郁状态评估及原因分析

目的 分析类心绞痛患者是否存在情感障碍及冠状动脉造影对其的影响,以便更好的找出护理措施.方法 应用抑郁自评量表（SDS）对心内科住院的所有类心绞痛患者分别在进行冠状动脉照影前后进行评估.结果 类心绞痛患者存在抑郁状态,冠状动脉造影后其抑郁状态患者的例数和程度有所增加.结论类心绞痛患者由于病因的不明,其心理障碍应该得到重视.     

葛根素治疗老年不稳定性心绞痛的临床观察

目的:探讨葛根素治疗老年不稳定性心绞痛的临床疗效。方法:分别观察葛根素组(32例)、对照组(24例)治疗前后心绞痛发作频率、持续时间,硝酸甘油用量,静息心电图,血压、心率的变化。结果:葛根素组在减少心绞痛发作,降低硝酸甘油用量,改善异常心电图方面优于对照组(P<0.05),心肌耗氧量也明显减少(P<0.05)。结论:葛根素治疗老年不稳定性心绞痛有较好的效果。     

葛根素联合参麦注射液治疗冠心病心绞痛的疗效分析

目的探讨葛根素联合参麦注射液治疗冠心病心绞痛的临床疗效。方法将84例冠心病心绞痛患者分为治疗组和对照组,各42例。治疗组给予葛根素联合参麦注射液静脉滴注,每日1次;对照组单用葛根素注射液静脉滴注,每日1次,14 d为1疗程,应用2疗程。结果症状改善的总有效率:治疗组88.1%,对照组54.76%,两组比较差异显著(P<0.01)。心电图ST-T改善的总有效率:治疗组61.90%,对照组40.48%,两组比较差异显著(P<0.05)。结论葛根素联合参麦注射液治疗冠心病心绞痛能显著提高该病的疗效。     

Clinical Implication of the Changes of cAMP, TXA_2 and PGI_2 in CSF of Asphyxiated Newborns

Summary:To evaluate the changes of 3',5'-cyclic adenosine monophosphate(cAMP),thromboxane A_2(TXA_2)and prostacyclin(PGI_2)in cerebrospinal fluid(CSF)in the asphyxiated newborn andexplore their roles in hypoxic-ischamic brain damage(HIBD).Thirty-six full term newborns were di-vided into 3 groups,including 12 with moderate-severe hypoxic-ischaemic encephalopathy(HIE),13with mild HIE,11 without HIE(control group).The levels of cAMP,TXB_2(TXA_2 metabolite)and6-keto-PGF_(1α)(PGI_2 metabolite)in CSF and plasma were measured 36—72h after birth by RIA.andthe concentrations were expressed as nM/L(cAMP),ng/L(TXB_2 and 6-keto-PGF_(1α)).The infantswere followed-up at 6 and 12 month of age and Mental Development Index(MDI)and PsychomotorDevelopment Index(PDI)were measured using Bayley Scales of Infant Development(BSID).TheCSF cAMP level in moderate-severe HIE group was 8.60±2.40,significantly lower than that of themild HIE group(14.83±2.84)and the control group(24.43±2.39)(for both P<0.01).The lev-els of TXB_     

葛根素治疗冠心病心绞痛的近期疗效观察

目的探讨葛根素葡萄糖注射液治疗冠心病心绞痛的近期临床疗效。 方法对30例冠心病心绞痛患者采用阿斯匹林、消心痛及复方丹参等常规治疗，对其中无明显疗效的18例改为葛根素葡萄糖注射液治疗。 结果常规治疗组30例中显效8例（26．7％），有效4例（13．3％），无效18例（60．0％），总有效率40．0％。对其中治疗无缓解的18例改用葛根素葡萄糖注射液治疗，显效9例（50．0％），有效7例（38．9％），无效2例（11．1％），总有效率88．9％。 结论葛根素葡萄糖注射液治疗冠心病心绞痛具有较好的临床疗效。     

葛根素对不稳定型心绞痛病人胰岛素抵抗及纤溶活性的影响

①目的　探讨葛根素对不稳定型心绞痛 (UA)病人胰岛素抵抗 (IR)及纤溶活性异常的影响。②方法6 9例UA病人随机分为常规治疗组 (31例 )和葛根素治疗组 (38例 ,于常规治疗基础上加用葛根素治疗 ) ,均于治疗前及治疗结束时检测血糖、血浆胰岛素 (FINS)、纤溶指标 ,计算胰岛素敏感性指数 (ISI)。选择 30例健康人作为对照组。③结果　与对照组比较 ,UA组FINS浓度增高 ,ISI降低 ,组织型纤溶酶原激活物 (tPA)活性降低 ,纤溶酶原激活物抑制物 1(PAI 1)活性升高 (t=2 .139～ 3.2 0 7,P <0 .0 5 ,0 .0 1)。葛根素组治疗后 ,FINS浓度降低 ,ISI增高 ,tPA活性增高 ,PAI 1活性下降 (t=2 .116～ 3.6 36 ,P <0 .0 5 ,0 .0 1)。UA组治疗前及葛根素组治疗后FINS ,ISI与PAI 1之间存在高度线性相关 (r =0 .35 1,- 0 .332 ,0 .4 2 7,- 0 .4 5 2 ,P <0 .0 1)。④结论　葛根素可改善UA病人的IR及与IR密切相关的纤溶活性异常。     

The role of cyclooxygenase-2/prostanoid pathway in visceral

Background Cyclooxygenase (COX) is the rate-limiting enzyme in the production of prostanoids from arachidonic acid. COX-2 is the inducible enzyme in the COX family, together with the prostanoids forms the COX-2/prostanoid pathway. Research showed that the COX-2/prostanoid pathway is activated in hepatic diseases and liver stress reaction, such as fibrogenesis, portal hypertension, carcinogenesis, and ischemic/reperfusion injury. But there was no report on visceral pain induced liver stress. This study was to investigate the role of the COX-2/prostanoid pathway in liver stress response in rat acute colitis visceral pain liver stress model. Methods Fifty-three male SD rats were randomly divided into Naive, Model, NS398 treatment, and Morphine treatment groups. The rat acute colitis visceral pain liver stress model was established under anesthesia by the colonic administration of 0.5 ml of 6% acetic acid using a urethral catheter. NS398 and morphine were administrated 30 minutes prior to model establishment in NS398 and Morphine treatment groups respectively. Spontaneous activities and pain behavior were counted and the extent of colonic inflammation was assessed histologically. Liver tissue levels of Glutathione-S-Transferase (GST) activity, COX-2 mRNA, prostaglandin E2 (PGE2), thromboxane B2 (TXB2) and 6-Ketone-prostaglandin F1α (6-K-PGF1α) contents were assessed.Results Thirty minutes after the colonic administration of acetic acid, a significant decrease in spontaneous activities and an increase in pain behaviors were observed in Model group (P&lt;0.01 and P&lt;0.05 respectively), accompanied by colonic inflammation. Liver GST activity levels significantly dropped (P&lt;0.05). Liver COX-2 mRNA expression significantly increased, accompanied by an increase in liver concentrations of PGE2 and TXB2, but no obvious change in 6-K-PGF1α concentrations. NS398 and morphine both ameliorated post-stress liver GST activity (P&lt;0.05 and P&lt;0.01 respectively), decreased stress-induced COX-2 expression, decreased PGE2 and TXB2 production, but increased liver 6-K-PGF1α levels. Morphine attenuation in colonic tissue inflammation was apparent at 24 hours (P&lt;0.05).Conclusions Acute colitis visceral pain liver stress can induce liver injury. Liver injury might have occurred through the activation of the COX-2/prostanoid pathway and increased production of PGE2 and TXB2. Effective analgesia might offer protective effect during visceral pain stress.     

通心络辅治冠心病心绞痛伴抑郁症状患者的临床观察

目的探讨通心络对改善冠心病心绞痛伴抑郁症状患者生活质量和抑郁状态的疗效。方法将冠心病心绞痛伴抑郁障碍的患者72例随机分成2组,每组36例。对照组予常规治疗,观察组在常规治疗基础上再给予通心络胶囊治疗,疗程均为8周,治疗前后应用西雅图心绞痛量表(sAQ)和汉密尔顿抑郁量表(HAMD)分别评定患者健康相关的生活质量和抑郁状态。结果与治疗前比较,观察组患者治疗后心绞痛稳定状态、心绞痛发作、治疗满意程度和疾病认知程度均显著改善,对照组心绞痛发作情况、治疗满意度、疾病认知程度均有改善(P<0.05或P<0.01)。观察组在心绞痛稳定状态和心绞痛发作方面的改善与对照组相比差异有统计学意义(P<0.01)。2组HAMD评分较治疗前均显著下降(P<0.01),且观察组较对照组下降更显著(P<0.01)。2组的治疗总有效率分别为77.78%和36.11%,差异具有统计学意义(P<0.01)。结论加用通心络治疗较常规治疗能改善冠心病心绞痛伴抑郁症状患者的生活质量及抑郁状态。     

异舒吉对不稳定心绞痛患者氧自由基和血液流变学的影响

目的 探讨异舒吉防治心脑血管病机理。方法 观察异舒吉对30例不稳定心绞痛患者氧自由基和血液流变学影响,并与用硝酸甘油治疗的30例作对照。结果 异舒吉能增加血清超氧化物化酶活性和前列腺素含量,显著降低丙二醛、血栓素B2水平,降低全血比粘度、血浆比粘度和血浆纤维蛋白原水平,其药理效应优于硝酸甘油。结论 异舒吉有抗氧化作用,消除自由基,改善血液流变学作用。     

反复心绞痛患者服用阿司匹林后尿11-脱氢血栓素B_2及血小板聚集功能的变化

目的评价血小板聚集功能和尿11-脱氢血栓素B2在评定反复心绞痛患者服用阿司匹林方面的价值。方法 48例反复心绞痛患者和50例一次心绞痛患者服用阿司匹林(100 mg/d)至少7d以上,测定血小板聚集功能和尿11-脱氢-血栓素B2的含量。结果花生四烯酸作诱导剂时,反复心绞痛患者与一次性心绞痛患者相比其血小板聚集功能的差异有统计学意义(P<0.01);反应敏感者尿11-脱氢血栓素B2与反应不敏感者相比其差异有统计学意义(P<0.01)。结论服用阿司匹林后,需检测血小板聚集功能和尿11-脱氢-血栓素B2。     

松龄血脉康胶囊治疗老年稳定性心绞痛临床观察

将82例接受常规治疗的心绞痛患者按系统随机方法分为正常组（40例）和对照组（42例）,治疗组加用松龄血脉康胶囊,治疗12周,分别进行治疗前后心绞痛分级、超敏C反应蛋白、血压水平及中文版SF-36量表生存质量评估的比较。两组心绞痛分级、超敏C反应蛋白、血压水平均有明显降低,生存质量均明显提高,治疗组效果较对照组明显,差异有统计学意义（P〈0．05）。提示在常规西药治疗基础上加用松龄血脉康胶囊能进一步改善老年稳定性心绞痛患者缺血性胸痛。     

低分子肝素钠联合葛根素治疗不稳定型心绞痛临床观察

目的观察低分子肝素钠联合葛根素治疗不稳定型心绞痛的临床疗效。方法将108例确诊为不稳定型心绞痛的患者随机分为治疗组和对照组,每组54例,均给予相同的常规治疗,在此基础上,治疗组加用低分子肝素钠及葛根素,比较2组治疗效果。结果治疗组心绞痛及心电图疗效均明显优于对照组,差异有显著性(P<0.05);治疗组每日硝酸甘油用量显著少于对照组(P<0.01)。结论低分子肝素钠联合葛根素治疗不稳定型心绞痛疗效肯定、安全,优于常规治疗方法。     

先兆早产患者宫颈粘液6—酮—PGF1α,TXB2变化与硫酸镁疗效的关系

为观察先兆早产患者硫酸镁治疗前后宫颈粘液６－酮－ＰＧＦ１α,ＴＸＢ２变化与疗效的关系,探讨其能否作为判断早产疗效及预后的指标,采用放射免疫法检测２８例先兆早产患者与硫酸镁治疗前后宫颈粘液６－酮－ＰＧＦ１α和ＴＸＢ２水平。结果：治疗成功的患者其宫颈粘膜６－酮－ＰＧＦ１α与ＴＸＢ２水平较治疗前明显下降,６－酮－ＧＰＦ１α与ＴＸＢ２比值明显升高;治疗失败的患者其宫颈粘液６－酮－ＰＧＦ１α和ＴＸＢ２水平较     

冠状动脉心脏病伴有糖尿病患者的心绞痛特点分析

目的 提高对冠状动脉心脏病(冠心病)合并糖尿病患者的心绞痛特点的认识.方法 回顾性分析1996年1月1日至2007年1月1日行冠状动脉造影的患者4873例,分为糖尿病组和非糖尿病组,记录胸痛发作的症状.以冠状动脉造影为金标准,将胸痛症状与冠状动脉造影结果比较,分析胸痛症状对诊断冠状动脉狭窄的敏感性、特异性、阳性预测值和阴性预测值.结果 4873例研究对象中,冠状动脉明显狭窄的糖尿病患者1431例,表现为胸痛1组症状(非心源性胸痛)187例、2组症状(不典型心绞痛)492例及3组症状(典型心绞痛)752例.冠状动脉明显狭窄非糖尿病者2056例,表现为非心源性胸痛、不典型心绞痛和典型心绞痛的患者分别为297例、735例和1024例.糖尿病和非糖尿病组之间比较,无论是非心源性胸痛、不典型心绞痛和典型心绞痛,对于冠状动脉明显狭窄的诊断,阳性预测值和阴性预测值差异均有统计学意义,敏感性和特异性差异无统计学意义.临床症状对于冠心病诊断的准确性,胸痛3组症状优于2组症状,2组症状优于1组症状.在非糖尿病组,冠状动脉狭窄的支数与心绞痛的表现类型密切相关(P＜0.01),而在糖尿病组,冠状动脉狭窄的支数与心绞痛的表现类型相关不明显(P=0.333).结论 典型心绞痛对于冠心病诊断的准确性较高.在非糖尿病患者中,胸痛特点能反映冠状动脉病变严重程度.     

冠心病与血浆脂联素、高敏C-反应蛋白的关系

目的:探讨冠心病患者血浆脂联素、高敏C-反应蛋白的相关性。方法:选择冠心病患者82例,分为急性心肌梗死组22例,不稳定型心绞痛组30例,稳定型心绞痛组30例,正常对照组30例,测定血浆脂联素和高敏C-反应蛋白水平,进行对比分析。结果:冠心病组患者血浆脂联素水平明显降低,且稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组3组血浆脂联素依次降低,各组间差异有统计学意义(P<0.01);冠心病组患者血浆高敏C-反应蛋白水平明显升高,且稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组3组血浆高敏C-反应蛋白依次升高,各组间差异有统计学意义(P<0.01)。冠心病组患者血浆脂联素水平与高敏C-反应蛋白呈负相关(r=0.46,P<0.01)。结论:冠心病患者代表抗炎因素的血浆脂联素显著降低,代表炎症活跃的高敏C-反应蛋白显著升高,两者结合应用可以为早期抗炎治疗及对预后判断提供依据。     

Prolonged exercise augments plasma triglyceride clearance

We studied ten male distance runners before and after a marathon to determine the effects of prolonged exercise on serum lipoprotein values and the capacity to clear plasma triglycerides. Serum lipid and lipoprotein concentrations, intravenous fat clearance, and postheparin plasma lipolytic activities were measured 24 hours before and 18 hours after the race. The clearance rate of exogenous fat increased 76% +/- 64%, postheparin lipoprotein lipase activity increased 46% +/- 35%, and fasting triglyceride levels decreased 26% +/- 13% after the race. High-density lipoprotein (HDL) cholesterol level increased 10% +/- 8%, primarily due to a 19% +/- 17% increase in the HDL2 subfraction. Changes in the clearance rate of exogenous fat were directly related to changes in HDL cholesterol level and the HDL2 subfraction. Thus, the rise in HDL cholesterol concentrations after prolonged exercise may be a consequence of enhanced fat clearance.