急性冠脉综合征瘀毒互结证诊断标准研究

目的 基于冠心病“瘀毒”病因病机的理论认识,建立急性冠脉综合征瘀毒互结证诊断标准。方法 采用文献系统分析与横断面临床研究构建条目池,采用德尔菲法专家咨询对条目进行筛选,采用层次分析法确定各条目权重。在此基础上,结合条目权重及临床实用性原则建立诊断标准。结果 文献系统分析筛选条目43个,横断面临床研究纳入患者400例,筛选条目39个,归纳分类后形成包含67个条目的条目池;经过两轮德尔菲专家咨询,筛选保留条目28个;通过层次分析法,确定高权重类条目（0.0430~0.1976）9个、中权重类条目（0.0153~0.0289）9个与低权重类条目（0.0060~0.0147）10个。结合临床实用性原则,优化形成包括必要指标（心绞痛程度进行性加重、近1个月反复发作性心绞痛等）、理化指标（心脏肌钙蛋白或肌酸激酶同工酶升高等）及舌象脉象（舌青紫或紫暗等、脉弦细或脉涩）3个维度的急性冠脉综合征瘀毒互结证诊断标准。两轮专家问卷咨询肯德尔和谐系数分别为0.368、0.395,格朗巴赫系数为分别为0.967、0.893,提示专家意见一致性好,结果可信度高。结论 该诊断标准涵盖了反映瘀毒互结致病特点的宏观表征和理化指标,可指导急性冠脉综合征瘀毒互结证的诊断。     

基于“少阴为枢”理论探析《伤寒论》方对心律失常的治疗

心律失常是以心脏的起搏和(或)传导功能紊乱导致的心脏节律、频率、传导速度或激动次序异常为特征的疾病,少阴枢机不利是心律失常的病理基础。本文深刻剖析了“少阴为枢”理论的来源、含义及其枢利气机、枢转水道和血脉的临床意义。少阴枢机不利通过影响水火、阴阳交通互济及太阴与厥阴之开合导致的心肾不交、水饮内停和心脉不通等病理变化是引起心律失常的病理基础。《伤寒论》方对心律失常的治疗多从调畅少阴枢机切入,对于少阴枢机不利致阳气下行受阻而从少阴寒化者以四逆汤温通少阴枢机、交通心肾,若致阴精不能上滋而从少阴热化者则以黄连阿胶汤滋清并用以调畅少阴枢机、交通心肾;对于少阴枢机不利致太阴开之不及而水气内停者以苓桂术甘汤调畅少阴枢机、温阳化饮;对于少阴枢机不利致厥阴阖之不及而心脉不通者可用桂枝汤类或四逆散以运转少阴枢机、温通心脉。“少阴枢机”理论为灵活运用《伤寒论》方治疗心律失常提供了新的思路和方法。     

Preliminary Comparative Study on the Effect of Different Chinese Drugs for Strengthening Pi(脾)in Antagonizing Diet Induced Obesity

<正>Objective:To observe the difference in fatty degree,glucose-lipid disorder and adipose-hormones between diet induced obesity(DIO) rats and diet induced obesity resistance(DIO-R) rats,and to explore the effect and acting mechanism of Chinese drugs for strengthening Pi(脾,CD-SP) and those for both strengthening Pi and dissolving phlegm(CD-SPDP) in inhibiting obesity.Methods:Excepting eight rats allocated in the blank control group,the other 54 rats were fed with high-lipid forage for 12 weeks to establish models of obesity. Finally,30 DIO rats and 8 DIO-R rats(shown by their body weight) were obtained.The DIO rats were divided into three groups,which were given gastric perfusion,respectively,with normal saline(Group A),CD-SP(Group B),and CD-SPDP(Group C).Fourteen weeks later,the animals' body weight(BW),length(BL),blood levels of fasting insulin(Fln),fasting glucose(FBG),triglyceride(TG),cholesterol(TC),leptin(LP),neuropeptide Y(NPY), C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),adiponectin(AN),and resistin(RS) were measured; insulin resistance index(IRI) was calculated,and the degree of obesity and lipid content in abdominal cavity of rats were estimated.Moreover,the levels of LP,CRP,TNF-α,AN and RS in homogenate of rats' adipose tissues(ATH) were determined.Results:After 12 weeks of high-lipid diet,the BW of DIO rats was higher than that of normal or DIO-R rats.After a 14-week continuous high-lipid diet feeding,in DIO rats,BW,lipid coefficient (LC),and IRI were significantly increased(P0.01);serum levels of TNF-α,LP and AN were lower,NPY was higher,while the ATH levels of LP and AN were lower and TNF-αwas higher in DIO rats than in DIO-R rats (P0.05 or P0.01);blood levels of FBG and lipids in DIO rats showed an increasing trend but was statistically insignificant(P0.05);no significant difference was found in serum levels of CRP and RS due to the overly high data dispersion.Comparisons of the 3 DIO groups showed that BW,body weight index(BWI),LC and IRI were significantly lowered after treatment(P0.01) in Group C,while these indexes were not significantly different between Group A and B;the serum levels of TNF-α,LP,and AN increased,NPY decreased in Group B and C, ATH levels of LP and AN increased,and TNF-αdecreased in the two groups;but NPY,LP,and AN in blood and ATH were higher in Group C than those in Group B(P0.05 or P0.01).Conclusion:CD-SPDP could inhibit DIO and IR,showing that the effect is better than that of CD-SP,and its mechanism is related to promotion of LP and AN secretion and elevation of serum NPY.     

蒽环类药物心脏毒性的监测与防治研究进展

<正>癌症是全球第二大死亡原因,其患病率逐年递增。据世界卫生组织(WHO)预测,全球癌症患病人数在未来20年内将会增加60%^[1]。随着医疗技术的进步,近10年来癌症的年龄标准化死亡率呈缓慢下降的趋势,癌症患者生存周期日渐延长^[2]。蒽环类药物(ANTs)如阿霉素等,具有抗肿瘤作用强、抗瘤谱广的特点,是临床治疗实体瘤和血液系统肿瘤的一线化疗药物。但其造成的心脏毒性严重降低了癌症患者的生存质量,长期随访研究发现ANTs引起的心脏损害已超过肿瘤复发,成为导致癌症患者死亡的主要原因^[3-4]。     

活血解毒方对缺氧/复氧所致心肌细胞凋亡的影响＊

目的 研究活血解毒方对缺氧/复氧（H/R）所致的心肌细胞凋亡的影响。方法 体外培养H9C2心肌细胞并分成正常对照组（Control组）、缺氧复氧组（H/R组）、H/R + 活血解毒中药组、LY294002组和活血解毒中药 + LY294002组，其中正常对照组给予DMEM培养基培养，缺氧复氧组给予缺氧4 h、复氧6 h处理，缺氧复氧 + 活血解毒中药组、LY294002组和活血解毒中药 + LY294002组分别给予活血解毒中药、LY294002、活血解毒中药配合LY294002预处理24 h，然后均给予缺氧4 h、复氧6 h处理。采用CCK8检测各组心肌细胞的存活率，流式细胞术检测各组细胞凋亡水平，电镜观察各组心肌细胞中线粒体、自噬体的变化，Western Blot检测各组细胞凋亡蛋白半胱氨酸天冬氨酸蛋白酶3（Caspase3）、半胱氨酸天冬氨酸蛋白水解酶3（Cleaved caspase3）、β-连环蛋白（β-Catenin）、p-p65、B淋巴细胞瘤-2（B-cell lymphoma-2，Bcl-2）蛋白的表达。结果 活血解毒方预处理显著增加H/R诱导的H9C2心肌细胞凋亡，降低凋亡相关蛋白Cleaved caspase3、β-Catenin、p-p65表达，增加Bcl-2表达。结论 活血解毒方可通过抑制细胞凋亡，降低缺氧/复氧所致的心肌细胞损伤，其作用机制可能与PI3K信号通路相关。     

冠状动脉微血管疾病的中西医结合研究进展

从冠脉微血管疾病的病因和发病机制、治疗进展以及中西医结合研究3方面入手探讨冠脉微血管疾病的研究进展,指出冠脉微血管疾病的发病机制及临床表型复杂,诊断技术受限,现代医学尚缺乏有效的治疗药物和方法,而中医药对改善临床症状及患者的不良预后具有一定优势,因此探究有效的中西医结合治疗手段将成为今后冠脉微血管疾病领域的主要研究方向。     

黄芪在心血管疾病中的临床应用

<正>黄芪乃补气药之长,在临床上的应用非常广泛,随着对黄芪有效成分及其活性研究的进展,发现黄芪具有改善心脏功能,保护心肌等作用,临床上运用黄芪治疗心血管疾病的范围不断扩大,本文对此做一概述。1黄芪药用溯源《神农本草经》将黄芪列为"上品",认为可"逐五脏间恶血"。秦汉时期的《名医别录》中记载黄芪可"通调血脉,流行经络"。唐代     

国医大师陈可冀中西医结合治疗高血压的经验撷英

国医大师陈可冀院士勤求古训,创制新方,针对高血压肝肾阴虚、肝阳上亢证,创制清眩降压汤以益肝肾、平肝阳、清肝热;针对高血压肝阳上亢,心火上炎证创制清达颗粒以清肝热、平肝阳、泻心火。陈可冀院士临床推崇中西医结合治疗高血压,中医治疗以补益肝肾、平肝息风法为基础,辨证论治结合清肝泻火、清心安神及化痰活血法,临床常用桑寄生、怀牛膝、鲜地黄、杜仲等以补益肝肾;天麻、钩藤、珍珠母等以平肝息风;酸枣仁、首乌藤、白芍等以养血安神;苦丁茶、黄芩、夏枯草、桑叶、菊花等以清肝泻火;莲子心以清心安神;瓜蒌、半夏、白术等以化痰散结;川牛膝、延胡索、郁金等以活血化瘀,取得了较好的临床疗效。     

稳定性冠心病合并脑卒中的中医证候分布特点分析

目的观察稳定性冠心病合并脑卒中患者中医证候的分布特点。方法采用现况调查方法调研稳定性冠心病患者的合并病及中医证候要素。结果调研736例稳定性冠心病患者,其中合并脑卒中的患者94例,占12.77%。稳定性冠心病常见证候是血瘀（501例,68.07%）、痰浊（363例,49.32%）、气虚（344例,46.74%）。冠心病合并脑卒中患者常见证候是血瘀（65例,69.14%）、气虚（47例,50.00%）、痰浊（44例,46.81%）;亚组分析显示稳定性冠心病合并脑卒中的患者,无论男女均多见气滞证;稳定性冠心病合并脑卒中兼夹糖尿病的患者多见气滞证,稳定性冠心病合并脑卒中兼夹高血压病、高脂血症的患者较不合并脑卒中的患者多见气滞证。结论稳定性冠心病合并脑卒中的基本症候是血瘀、气虚、痰浊,气滞是其关键病机。