糖心宁治疗糖尿病性心脏病的临床研究及其分子生物学基础

【作者】 宋冰；

【导师】 吕仁和； 魏执真；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2002， 博士

【摘要】 本文从师承、综述、理论研究、临床研究和实验研究五个方面对中医药治疗糖尿病性心脏病(消渴病心病)进行了比较系统地研究。 师承部分：对导师吕仁和教授诊治消渴病及其并发症的主要学术思想进行了总结，并比较系统地总结了导师魏执真教授辨治消渴病心病的主要学术思想和经验。 综述部分：对消渴病心病的中医药研究现状从病因病机、诊断标准、疗效评定标准及临床研究等几个方面进行了总结，并进行了评述与展望，明确了消渴病心病的病名。综述了现代医学有关糖尿病性心脏病的流行病学、病理和发病机理、临床诊断和治疗等方面的研究概况。 理论研究部分：总结研究了《内经》以来至隋唐时期、宋金元时期以及明清时期等历代医家对消渴病和消渴病心病在病因、病机、辨证、治法、方药等方面的主要认识。 临床研究部分：临床观察了糖心宁治疗糖尿病性冠心病心绞痛患者30例，并以鲁南欣康治疗的30例患者作为随机对照，从两组病例的心绞痛等临床症状以及心电图，心功能、血脂等客观指标进行了多角度的临床对比研究。结果表明，糖心宁可明显改善糖尿病性冠心病患者心绞痛等临床症状，改善患者的心肌缺血状态、改善心功能以及纠正脂肪代谢紊乱，从而提高患者的生活质量。并经统计分析，治疗组综合疗效明显优于对照组，说明糖心宁对糖尿病性冠心病心绞痛有显著的治疗作用。 实验研究部分：运用分子生物学方法从细胞分子水平研究了糖心宁防止动脉粥样硬化(AS)的发生及治疗糖尿病性冠心病的作用机制。实验以不含药血清作为对照，分别对高糖及外源内皮素-1(ET-1)刺激下的血管平滑肌细胞(VSMC)的增殖情况、血小板衍化生长因子(PDGF)的生成情况以及原癌基因C-myc、C-fox的表达情况进行了观测。结果显示，糖心宁药物血清可明显抑制VSMC的增殖，抑制PDGF的生成和C-myc、C-fox基因的表达，这是糖心宁重要的治疗机制。更多还原

【Abstract】 The paper systematically studied the treatment of diabetic cardiopathy using the traditional Chinese medicine from five aspects: shicheng, review, theoretical, clinical and experimental studies.In the part of shicheng study, this paper summarized tutor professor L iiRenhe’s main theoretical thought and experience in clinical diagnosis and treatment of Diabetes Mellitus and complications. In the meantime, the paper summed up tutor professor Wei Zhizhen’ s main theoretical thought and clinical experience in treatment of diabetic cardiopathy using traditional medical theory.In the part of review study, the paper reviewed and evaluated all traditional research on diabetic cardiopathy : etiology, pathogenesis, clinical diagnosis criterionet cl. For modern medicine research, the paper summarized the studies on diabetic cardiopathy, including epidemiological data, etiology, pathogenesis, clinical diagnosis, laboratory examination and treatment.In the part of theoretical study, the paper summarized and induced all the ancient theories of traditional Chinese medicine about diabetic cardiopathy, including etiology, pathogenesis and therapeutic principles, et cl.In the part of clinical research, 30 patients with diabetic cardiopathy complicating with CHD treated by Tangxinning (TXN) were observed, another 30 patients with same condition treated by Lunanxinkang were compared randomly as the control group. Two group patients were studied in contrast with the aspects of general data, clinical symptoms, blood glucose, blood lipid, ECG et cl. The results indicated that TXN can obviously relieve the clinical symptoms such as angina pectoris, and enhance the pa t lent s’ quality of life, it is superior to the control group. All the data show that TXN has a good treatment for diabetic cardiopathy. Through the analysis of clinical examination, the mechanism of treatment is related to decreasing blood glucose, adjustijng lipid metabolism disorder, improving the blood support of cardiac muscle and enhancing the function of heart.In the part of experimental study, using molecular biologic methods, the paper studied the TXN’s mechanism of the prevention foratherosclerosis and the treatment of diabetic cardiopathy. We detected the cell proliferation, the expression level of platelet-derived growth factor (PDGF) , the expression of C-myc and C-fox gene by MTT, radioiramunoassay (RIA) and Northern blotting methods after smooth muscle cell stimulated by high glucose or high glucose and ET-1 in vitro at different time points. Compared with non-drug serum control groups, results demonstrate that TXN has inhibitory effects of the proliferation of vascular smooth muscle cells, and it can suppress the synthesization of PDGF and expression of C-myc, C-fos gene induced by ET-1 and high glucose. These results suggest that TXN is a potent, Chinese medicine with major anti- proliferative properties that may provide protection against atherosclerosis in diabetic cardiopathy. this property is one of main treatment mechanisms of TXN .更多还原