【作者】 郑翠娥；

【导师】 郭伟星；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2007， 博士

【摘要】 目的:观察芪蛭合剂治疗不稳定型心绞痛的临床疗效及研究芪蛭合剂抗大鼠动脉粥样硬化形成、稳定动脉粥样硬化斑块的作用机理。方法:临床研究:70例气虚痰瘀阻络型不稳定型心绞痛患者随机分为芪蛭合剂组(试验组)36例,通心络胶囊组(对照组)34例。两组均用常规西药治疗,同时试验组予芪蛭合剂,对照组予通心络胶囊。观察治疗前后临床症状和实验室指标的变化。实验研究:依据冠心病的发病机制建立了大鼠动脉粥样硬化模型,探讨芪蛭合剂抗大鼠动脉粥样硬化形成、稳定动脉粥样硬化斑块的作用机理。运用生化、放免、免疫组化、光镜等现代检测技术,从血脂、血液流变学、内皮血管活性物质、炎症反应、主动脉的病理改变等入手,并从血液、组织、细胞及分子生物学水平,多层次、多角度揭示芪蛭合剂抗动脉粥样硬化的综合调节作用。结果:临床结果:治疗组心绞痛缓解总有效率为94.44%,显效率69.44%;心电图总有效率94.44%,显效率52.78%。症状改善总有效率97.22%,显效率66.67%,治疗组明显优于对照组(P<0.05或P<0.01)。SV、CI、PFVE、E/A提高,PFVA降低,与对照组相比有显著性差异(P<0.05或P<0.01)。显著降低TG、TC、全血粘度(高切)、全血粘度(低切)、血栓素B2 (TXB2)、内皮素-1(ET-1),与对照组比较有显著性差异(P<0.05或P<0.01)。显著升高凝血酶时间(TT)、一氧化氮(NO),与对照组比较有显著性差异(P<0.05或P<0.01)。实验结果:芪蛭合剂可降低动脉粥样硬化大鼠TG、TC、LDL-C,升高HDL-C,显著降低全血粘度、血浆粘度,可降低TXB2、ET-1和升高NO、6-keto-PGF1α,降低血清中TNF-a、IL-6、IL-8等炎性细胞因子的释放,与模型组有显著差异(P<0.05或P<0.01);可抑制动脉粥样硬化大鼠主动脉组织vWF、ICAM-1、VCAM-1、MMP-9高表达。结论:气虚痰瘀阻络是不稳定型心绞痛的主要病机之一,以益气活血、化痰通络为治法的芪蛭合剂有明显的临床治疗作用。实验研究通过纠正动脉粥样硬化大鼠脂质紊乱、保护内皮功能、抑制血栓形成、抑制炎性分子的释放及抑制主动脉vWF、ICAM-1、VCAM-1、MMP-9高表达达到抗动脉粥样硬化形成、稳定动脉粥样斑块的作用。更多还原

【Abstract】 Objective:To observe the clinical effect of Qizhi Mixture on unstable angina and experimental research on prevent atherosclersis. Methods:clinical research:seventy cases of unstable angina belong to the syndrome of Qi deficiency and sputum block and blood stasis were randomly divided into treatment group (36 cases)and control group (34 cases).Conventional Western medical therapy was given to both groups. At the same time, the treatment group recived Qizhi Mixture and the control group recived Tongxinluo Capsule. The changes of clinical symptoms and laboratory indexes in all the patients were observed before and after treatment. experimental research: the successful model of atherosclerosis rats with hyperlipemia was developed.While,utilizing the model detective techniques, such as radio-immunity, biochemistry, optical microscope,electron the paper observe the effect of the treatment of qizhi mixture activating blood circulation, resolving phlegm on the pathologic changes of blood, myocardium and aorta, and surveys the change of the serum lipids, hemorheological indexes,endothelial vasoactive substance and inflammatory reaction to prove the synthetic accommodation action.Results:clinical research:In the treatment group, the total effective rate of relieving angina,improving ECG and meliorating symptoms were respectively 94.44%,94.44% and 97.22%;the corresponding remarkable rate were respectively 69.44%,52.78% and 66.67%,which were significantly better than those of the control group,P<0.05 or P<0.01. The level of TC ,TG,ηbH ,ηbL,TXB2,ET-1 were decreased remarkably in the treatment group, which were statistically different compared with those of the control group, P<0.05 or P<0.01. Meanwhile, the level of TT,NO were increased remarkably after treatment, which were statistically different compared with those berore treatment. experimental research:For the atherosclerotic rats, Qizhi Mixture could relate to decreasing TC, TG, LDL-C, the blood viscosity, plasma viscosity, increasing HDL-C,and while reducing serum IL-6,IL-8,TNF-a,TXB2,ET-1 level,increasing NO,6-keto-PGF1a as well as reducing the high expression of ICAM-1,VCAM-1,MMP-9 of aorta tissue. Conclusion:Qi deficiency and sputum block and blood stasis is the basic cause of UA. Qizhi Mixture the therapeutic method of supplementing Qi and dispelling sputum and quickening blood has the evident effect on UA. Experiment research indicates that Qizhi Mixture had an exact of reducing blood liqid,protecting vascular endothelium, suppressing the form of thrombus , ruducing the high expression of ICAM-1,VCAM-1,MMP-9 of aorta tissue .So it could play a great role of anti-atherosclerosising and stabilizing atherosclerotic plaque .更多还原