冠状动脉粥样硬化性心脏病血瘀证与冠脉病变程度及血管内皮功能的相关性研究

目的探讨冠状动脉粥样硬化性心脏病血瘀证与冠脉病变程度及血管内皮功能的相关性。方法纳入79例首次行冠状动脉造影检查并诊断为冠状动脉粥样硬化性心脏病的患者,根据造影结果行Gensini评分,并检查肱动脉内皮舒张功能(FMD);记录中医证候与血瘀证积分,分析中医证素分布情况,以及血瘀证与FMD、Gensini评分的相关性。结果冠状动脉粥样硬化性心脏病中医证素以血瘀最常见,血瘀证组FMD值低于非血瘀证组,Gensini评分高于非血瘀证组(P0.05,P0.01)。血瘀证积分与FMD值呈负相关(r=-0.597,P0.01),与Gensini评分呈正相关(r=0.693,P0.01);血瘀证积分与空腹血糖呈正相关(r=0.358,P0.01),与糖化血红蛋白呈正相关(r=0.264,P0.05),FMD与Gensini评分呈负相关(r=-0.700,P0.01)。结论冠状动脉粥样硬化性心脏病患者血瘀证越明显,其冠脉病变程度及内皮功能损伤越严重。     

Aged garlic extract modulates glutathione redox cycle and superoxide dismutase activity in vascular endothelial cells

In this study the effect of an aged garlic extract (AGE) on glutathione (GSH) redox cycle and activity of antioxidant enzymes was investigated. Confluent monolayers of bovine pulmonary artery endothelial cells (PAEC) were incubated with varying concentrations of AGE for 8–48 h, washed, and then lysed with Triton X-100. Biochemical assays were performed with the lysate. AGE caused both dose- and time-dependent increases in intracellular GSH level, glutathione disulphide (GSSG) reductase and superoxide dismutase (SOD) activity while GSSG level was decreased. These results suggest that the antioxidant effect of AGE may be due to its modulation of the GSH redox cycle and SOD activity in vascular endothelial cells. © 1997 John Wiley & Sons, Ltd.     

Ginkgo biloba extract improves coronary artery circulation in patients with coronary artery disease: contribution of plasma nitric oxide and endothelin-1

In patients with coronary artery disease (CAD), coronary blood flow is usually impaired due to imbalanced vasoactive substances such as nitric oxide (NO) and endothelin-1 (ET-1). The study was designed to test the effects of Ginkgo biloba extract (GBE) on the distal left anterior descending coronary artery (LAD) blood flow and plasma NO and ET-1 levels. Eighty CAD patients were randomly assigned to GBE (n = 42) and control (n = 38) groups. The LAD blood flow was assessed non-invasively using Doppler echocardiography at baseline and after 2 weeks. GBE treatment demonstrated a significant improvement in maximal diastolic peak velocity (MDPV), maximal systolic peak velocity (MSPV) and diastolic time velocity integral (DTVI) compared with controls (14.61 +/- 4.51% vs 0.67 +/- 2.66%, 9.03 +/- 4.81% vs 0.34 +/- 2.67% and 14.69 +/- 5.08% vs 0.68 +/- 3.00%, respectively, p < 0.01). NO was increased by 12.42% (p < 0.01), whereas ET-1 was decreased by 5.82% (p < 0.01). The NO/ET-1 ratio was increased by 19.47% (p < 0.01). A linear correlation was confirmed between the percentage change in LAD blood flow and in NO, ET-1 or NO/ET-1 ratio following GBE treatment. The results suggest that GBE treatment in CAD patients led to an increase of LAD blood flow, which might at least be related partly to the restoration of the delicate equilibrium between NO and ET-1.     

电针内关、神门穴对冠心病冠脉旁路移植术后心功能的影响

目的观察电针内关、神门穴对冠心病冠脉旁路移植术后心功能的影响。方法将62例冠心病冠脉旁路移植术后患者随机分为2组,试验组患者于术后返回ICU 1 h后开始电针双侧内关及神门,每12 h针刺1次,留针20 min,针刺治疗至术后48 h;对照组予单纯药物治疗。结果术后2组每搏量、心排血量、心排指数、射血分数均呈上升趋势,但试验组上升更明显,与对照组比较有显著性差异(P均<0.05)。试验组治疗后与治疗前相比,中心静脉压、肺动脉压、肺毛细血管楔压均明显下降,与对照组治疗后相比也显著降低。结论电针内关、神门穴能有效提高冠心病冠脉旁路移植术后患者的心排血量,改善心功能。     

麝香保心丸长期用药对冠心病患者血管内皮功能改善作用的研究

目的:观察长期服用麝香保心丸(SXBXP)对冠心病患者血管内皮功能的改善作用。方法:入选80例冠心病患者随机分为SXBXP组和对照组,两组均给予冠心病常规治疗,SXBXP组加服SXBXP.2丸/次,3次/日,至少6月。测定肱动脉血流介导内皮依赖性舒张功能(FMD)评价两组患者血管内皮功能。分别在入选时,随访3个月、6个月、18个月时检测FMD,并同时检测血一氧化氮(NO)、一氧化氮合酶(NOS)、超氧化物歧化酶(SOD)、内皮素(ET)等血管内皮功能相关因子。结果:随访期间SXBXP组FMD、NO、NOS、SOD、ET均较对照组改善,FMD、SOD水平于随访3个月时达统计学显著差异标准(P0.05),NO、NOS、ET水平于随访6个月时达统计学显著差异标准(P0.05)。随访18个月时,SXBXP组中继续服用SXBXP的患者FMD、NO、NOS、SOD水平明显高于对照组(P0.05)。结论:冠心病患者长期服用麝香保心丸6个月可明显改善血管内皮功能。     

老年冠心病患者肠系膜上动脉造影影像分析

目的提高对老年冠心病患者并发肠缺血的认识,完善冠心病防治规则。方法选择经临床和影像检查确诊的36例老年(65~74岁)冠心病患者(观察组)与31例中青年(35~50岁)冠心病患者(对照组),观察比较2组肠系膜上动脉造影结果,分析年龄、冠状动脉病变程度与肠系膜上动脉病变之间的关系。结果观察组发现肠系膜上动脉病变19例(53%),对照组发现3例(10%)(P<0.05)。观察组冠状动脉多支血管病变者24例(67%),对照组多支血管病变者7例(23%)(P<0.05)。2组中冠状动脉多支血管病变31例(46%),合并肠系膜上动脉病变19例(19/22,86%);单支血管病变36例(54%),合并肠系膜上动脉病变3例(3/22,14%)(P<0.05)。结论冠心病患者的年龄越大,冠状动脉损害越严重,肠系膜上动脉损害多在冠状动脉损害较严重时发生,应重视老年冠心病患者并发肠缺血的存在。     

Aged garlic extract, garlic powder extract, S-allylcysteine, diallyl sulfide and diallyl disulfide do not interfere with the antibiotic activity of gentamicin

It was shown that aged garlic extract (AGE), garlic powder and the following garlic-derived compounds: S-allylcysteine (SAC), diallyl sulfide (DAS) and diallyl disulfide (DADS), ameliorate gentamicin (GM)-induced nephrotoxicity in rats. However, it was not established if the above mentioned extracts and compounds of garlic could interfere with the antibiotic action of GM. To address this point, AGE, garlic powder extract (GPE), SAC, DAS and DADS were assessed for their ability to interfere with the in vitro antibiotic activity of GM in Escherichia coli cultures. It was found that the above mentioned extracts and compounds of garlic were unable to decrease the antibiotic capacity of GM and even SAC, DAS and DADS alone inhibited the growth of Escherichia coli and enhanced the antibiotic effect of GM. Our data show that SAC, DAS and DADS are antibacterial compounds against E. coli and suggest that AGE, GPE, SAC, DAS and[sol ]or DADS may be administered along with GM-treatment to ameliorate GM-induced nephrotoxicity without interfering with its antibiotic activity.     

冠心病患者阿司匹林抵抗的临床特征分析

目的分析冠心病患者阿司匹林抵抗(AR)的临床特征。方法记录186例冠心病患者性别、血压;检测患者血小板聚集率及血脂、血糖、C反应蛋白(CRP)水平;多元逐步回归方法分析各因素与血小板聚集率的相关性。结果AR发生率为9.1%(17/186),阿司匹林半抵抗(ASR)发生率为20.4%(38/186),总发生率为29.5%。AR患者以年轻、女性和高低密度脂蛋白血症者居多,AR患者的CRP含量较阿司匹林敏感(AS)患者高;而合并糖尿病、高血压病各组之间比较差异无统计学意义。结论女性、年轻患者AR多见,AR与高血脂及CRP水平关系密切,而与糖尿病、高血压病无关。     

银杏叶提取物对冠心病患者冠状动脉血流的影响

目的：研究银杏叶提取物对冠心病患者冠状动脉血流的影响。方法：90例经冠状动脉造影证实的冠心病患者随机分为银杏叶提取物注射液治疗组和对照组（各45例），两组均于用药前、后采用经胸超声心动图检测冠心病患者冠状动脉左前降支（LAD）血流的变化。结果：银杏叶提取物注射液显著增加冠心病患者LAD舒张期峰值流速、收缩期峰值流速和舒张期时间速度积分（P〈0．01）；而对照组LAD血流无明显变化（P〉0．05）。结论：银杏叶提取物注射液可增加冠心病患者LAD血流。     

补阳还五汤对冠状动脉粥样硬化性心脏病左室舒张功能的影响

目的观察补阳还五汤治疗冠状动脉粥样硬化性心脏病（以下简称冠心痛）的临床疗效及对左室舒张功能的影响。方法将98例冠心病患者随机分为2组,在常规治疗基础上,治疗组49例予补阳还五汤100mL,每日3次口服;对照组予复方丹参片3片,每日3次口服。观察2组临床疗效及治疗前后左室舒张功能超声指标：舒张早期心室血流充盈峰值速度（E）、晚期血流速度峰值（A）、E与A比值（E／A）和E峰减速时间（OF）的变化。结果治疗组与对照组相比,左室舒张功能指标（E、A、E／A和DT）均有明显改善（P〈0．05）;治疗组总有效率（95．92％）优于对照组（75．51％）（P〈0．05）。结论补阳还五汤能明显提高临床疗效。改善冠心病左室舒张功能。     

Aged garlic extract induces proliferation and ameliorates gentamicin-induced toxicity in LLC-PK1 cells

Gentamicin (GM)-induced nephrotoxicity limits the use of this antibiotic. It has been shown that aged garlic extract (AGE) and S-allylcysteine (SAC), the most abundant organosulfur compound in AGE, ameliorate GM-induced nephrotoxicity in rats. The present communication evaluated the effect of AGE and SAC on proliferation and on GM-induced toxicity and genotoxicity of porcine kidney epithelial cell line (LLC-PK1 cells). The cells were preincubated with different concentrations of AGE or SAC for 12 h before incubation with 8 mm GM for an additional 72 h. At the end of this time, cell viability, genotoxicity and proliferation were evaluated. AGE stimulated cell proliferation and protected LLC-PK1 cells from GM-mediated toxicity and genotoxicity. SAC partially prevented only GM-induced genotoxicity. These results suggest that the stimulation of cell proliferation could possibly be one of the mechanisms involved in the in vitro protective effect of AGE in GM-induced toxicity of LLC-PK1 cells.     

冠状动脉钙化积分在老年冠心病中的诊断价值及其界限值研究

目的探讨冠状动脉钙化积分(CACS)在老年冠心病中的诊断价值及其界限值。方法对年龄≥70岁的54例冠心病患者(冠心病组)与36例非冠心病患者(对照组)分别行16层螺旋CT冠脉钙化积分检查。结果冠心病组与对照组CACS分别为(805±528)分与(106±78)分(P<0.001);冠心病组男性、女性CACS分别为(842±446)分与(772±667)分(P>0.05),对照组男性、女性CACS分别为(113±84)分与(98±69)(P>0.05);CACS分别≥1分、≥100分、≥200分、≥300分、≥400分时,诊断冠心病敏感性与特异性分别为100%与0、100%与56%、96%与69%、87%与100%、71%与100%,诊断价值分别为60%、82%、84%、92%、89%。结论CACS对诊断老年冠心病有重要价值,诊断界限值以300分为妥。     

Aged garlic extract restores nitric oxide bioavailability in cultured human endothelial cells even under conditions of homocysteine elevation

Ethnopharmacological relevance

Supplementation with aged garlic extract (AGE) has been shown to restore impaired endothelium-dependent vasodilator response in subjects with acutely elevated plasma homocysteine (Hcy) levels after an oral methionine load and in patients with chronic coronary artery disease. Moreover, AGE has been shown to inhibit the progression of coronary calcifications in patients with coronary artery disease. The molecular mechanisms, by which AGE preserves endothelial function is unknown. Our objective was to explore whether AGE preserves endothelial nitric oxide (NO) output even under conditions of elevated Hcy levels by preventing oxidative inactivation of the NO synthase cofactor tetrahydrobiopterin.

Material and methods

Endothelial (EA.hy 926) cells were incubated with hypoxanthine, aminopterin, thymidine and methionine (HAT/MET) to increase cellular Hcy levels, and with and without AGE. Agonist stimulated NO output was measured using the fluorescent probe DAF-2, and cellular thiol levels (Hcy, cysteine, reduced and oxidized glutathione) and cellular tetrahydrobiopterin levels were measured by high performance liquid chromatography.

Results

HAT/MET incubation resulted in significantly increased cellular Hcy levels, unaffected by coincubation with AGE. Elevated Hcy went along with significantly decreased NO output (to 34.4±4.4% of control) and levels of tetrahydrobiopterin (from 4.67±2.17 to 2.17±0.97 pmol/mg). Incubation with AGE (5 mg/mL) in HAT/MET-treated cells prevented the declines in NO output and tetrahydrobiopterin levels. AGE increased cellular levels of cysteine and total glutathione, and prevented glutathione and tetrahydrobiopterin oxidation induced by elevated Hcy.

Conclusion

Incubation with AGE preserved normal NO output from endothelial cells even under conditions of elevated Hcy levels by increasing cellular thiol antioxidant and prevention of tetrahydrobiopterin oxidation. This suggests that AGE might be useful in the prevention of endothelial dysfunction.     

冠心病患者低高密度脂蛋白血症与冠脉病变分析

目的探讨血浆高密度脂蛋白(HDL)水平与冠脉病变的关系。方法选择经冠状动脉造影确诊为冠心病患者100例,其中50例伴有低HDL,50例血脂正常,对2组患者临床资料进行比较。结果低HDL组冠状动脉病变累及左主干6例(12%),对照组1例(2%)(P<0.05)。病变狭窄95%以上者低HDL组34例(68%),对照组19例(38%)(P<0.05);低HDL组冠状动脉病变累及左前降支和左回旋支分别为36例(72%)和31例(62%),明显高于对照组的26例(52%)和22例(44%)(P均<0.05);TiMi分级为0级者低HDL组10例(20%),对照组4例(8%)(P<0.05)。结论血浆HDL与冠脉病变程度具有负相关关系。     

冠心病患者低高密度脂蛋白血症与冠脉病变分析

目的探讨血浆高密度脂蛋白（HDL）水平与冠脉病变的关系。方法选择经冠状动脉造影确诊为冠心病患者100例，其中50例伴有低HDL，50例血脂正常，对2组患者临床资料进行比较。结果低HDL组冠状动脉病变累及左主干6例（12％），对照组1例（2％）（P〈0.05）。病变狭窄95％以上者低HDL纽34例（68%），对照纽19例（38％）（P〈0.05）；低HDL组冠状动脉痛变累及左前降支和左回旋支分别为36例（72％）和31例（62％），明显高于对照组的26例（52%）和22例（44%）（P均〈0.05）；TiMi分级为0级者低HDL组10例（20%），对照组4例（8％）（P〈0.05）。结论血浆HDL与冠脉病变程度具有负相关关系。     

保元汤对冠心病心力衰竭患者血管内皮依赖性舒张功能的影响

目的探讨保元汤对冠心病心力衰竭患者血管内皮依赖性舒张功能(FMD)的影响。方法将113例冠心病心力衰竭患者随机分为2组,对照组56例予西医常规治疗,治疗组57例在对照组治疗基础上加保元汤。2组均治疗1个月。采用彩色多普勒超声诊断仪测定2组治疗前后FMD变化情况,并统计临床疗效。结果治疗组总有效率87.72%,对照组总有效率71.43%,2组总有效率比较差异有统计学意义(P0.05),治疗组临床疗效优于对照组。治疗组治疗后FMD与本组治疗前比较明显升高(P0.05),且高于对照组治疗后(P0.05)。结论保元汤能改善冠心病心力衰竭患者血管内皮功能,从而达到治疗心力衰竭的目的。     

实时心肌声学造影对冠状动脉病变严重程度的评价

目的本研究以冠心病（Coronary Artery Disease,CAD）患者为研究对象,通过实时心肌声学造影（Real—time myocardial contrast echocardiography,RT—MCE）定量分析,探讨其对评价冠状动脉病变严重程度的应用价值。方法入选37例患者均行RT-MCE和冠状动脉造影术。对22例冠状动脉病变患者行Gensini评分,与A值、β值及A×β值行相关分析。结果A值、β值及A×β值在Gensini评分轻、中、重组间均有统计学显著性差异（P〈0．05）。A值、β值及A×β值与Gensini评分间的相关系数分别为-0．79、～0．51和-0．76。结论RT—MCE定量指标与Gensini评分具有良好的相关性,可用于冠脉病变严重程度的评判。     

梓醇抑制NADPH氧化酶保护2型糖尿病早期血管内皮功能

该研究观察梓醇对2型糖尿病(T2DM)大鼠血管内皮功能的保护作用并探讨其抑制NADPH氧化酶表达的机制。40只高糖高脂饮食联合腹腔注射链脲佐菌素致糖尿病大鼠随机分为模型组、梓醇低、中、高剂量组(10,50,100 mg·kg-1·d-1)。另以10只健康Wistar大鼠作为正常组。正常组、模型组分别给予相当量的生理盐水。6周后全自动生化分析仪检测血糖、血脂;ELISA检测血清8-异前列腺素F2α(8-iso-PGF2α)含量;硝酸还原法检测血清一氧化氮(NO)水平;羟胺法检测血清超氧化物歧化酶(SOD)含量;观察离体胸主动脉环内皮依赖性血管舒张反应;荧光法检测主动脉组织活性氧(ROS)的水平;HE染色观察主动脉病理形态学改变;RT-PCR,western-blot分别检测主动脉组织Nox4,p22phox mRNA及蛋白表达。结果显示梓醇中、高剂量组血管内皮损伤明显减轻,主动脉ROS水平降低,血清NO水平升高,8-iso-PGF2α含量减少,SOD含量升高;主动脉组织Nox4,p22phox mRNA及蛋白表达均降低,差异均有统计学意义(P<0.05)。因此梓醇对T2DM血管内皮具有保护作用,其机制可能与其下调Nox4,p22phox表达,抑制氧化应激反应有关。     

芪苈强心胶囊对冠脉粥样病变伴慢性左心衰患者血管内皮细胞功能及氧化应激的影响

目的:探讨芪苈强心胶囊对冠脉粥样病变伴慢性左心衰患者血管内皮细胞功能及氧化应激的影响。方法:将96例患者随机分为对照组、观察组各48例,对照组给予常规治疗,观察组在对照组治疗的基础上加用芪苈强心胶囊,比较2组临床疗效、不良反应及治疗前后心功能、血管内皮细胞功能、氧化应激等指标的变化情况。结果:总有效率观察组为91.67%,对照组为75.00%,2组比较差异有统计学意义(P0.05)。与治疗前比较,2组治疗后左室收缩末内径(LVEF)、肱动脉内皮依赖性舒张功能(EMD)、非内皮依赖性舒张功能(NMD)、一氧化氮(NO)、超氧化物歧化酶(SOD)水平显著上升,而左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、内皮素1(ET-1)、丙二醛(MDA)显著下降,差异均有统计学意义(P0.05),且观察组治疗后上述指标均明显优于对照组(P0.05)。2组均未见明显药物不良反应发生。结论:芪苈强心胶囊能明显改善冠脉粥样病变伴慢性左心衰患者的心功能,安全有效,其作用机制可能为改善血管内皮细胞功能及抑制氧化应激反应相关功能。     

杏丁注射液对冠心病患者甲襞微循环和血液流变学特性的影响

目的　观察杏丁注射液对冠心病患者甲襞微循环和血液流变学特性的影响。方法　选择 6 5例经Judkins法冠脉造影确诊冠心病的患者 ,给予杏丁注射液 30mL加入 5 %葡萄糖液 2 5 0mL中静滴 1次 /d ,连用 2周 ,用药前后观察甲襞微循环、血液流变学等指标。结果　用药后甲襞微循环、血液流变学等指标明显改善。结论　杏丁注射液能改善冠心病患者的微循环及血液黏度。