【作者】 齐双；

【导师】 刘东方；

【作者基本信息】 黑龙江中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的:本课题旨在观察调脂汤对冠心病稳定型心绞痛(痰阻心脉证)患者的临床疗效及LP(a)、MMP-9、IMT的影响,初步评价其临床疗效、安全性及有效性,并探讨其部分作用机制。方法:将冠心病稳定型心绞痛(痰阻心脉)患者60例分为治疗组(调脂汤)组30例,对照组(辛伐他汀)组30例。治疗组给予调脂汤,对照组给予辛伐他汀,疗程2个月。观察对比治疗前后心绞痛发作次数、持续时间;心电图;中医症候积分;血清基质金属蛋白酶9浓度;颈动脉内膜中层厚度;TC、TG、LDL-C、HDL-C、Lp(a)水平和血、尿常规;血糖和肝肾功能。结果:1.经过治疗后两组患者病情都有明显改善,治疗组与对照组疗效相比无显著性差异(P>0.05)。治疗组患者心绞痛疗效、心电图疗效分别为96.67%、93.33%优于对照组93.33%、90.00%。2.在中医症候指征(胸痛、胸闷、心悸、乏力、自汗)方面,两药物均有显著的效果(P<0.01),调脂汤组略有优势,但无统计学意义(P>0.05)。3.两组药物可以显著降低血清总胆固醇、低密度脂蛋白及甘油三酯水平(P<0.01)。但两组之间差别较小,无统计学意义(P>0.05)。4.血清基质金属蛋白酶9浓度,明显下降(P<0.01),彩色多普勒超声显示颈动脉内中膜厚度、斑块积分均有一定程度的下降,组间差异没有统计学意义(P>0.05)。脂蛋白A水平在治疗组有一定程度的下降而在对照组无明显变化。组间差异有统计学意义(P<0.01)。5.两组治疗前后生命体征平稳,治疗前后血、尿常规和肝、肾功能等各项指标差异无统计学意义(P>0.05)。结论:1.调脂汤可以改善冠心病稳定型心绞痛患者的临床症状,减少心绞痛发病次数,持续时间及中医症候指征积分。2.调脂汤可以降低冠心病稳定型心绞痛患者血清脂蛋白A及基质金属蛋白酶-9水平。3.调脂汤可以降低颈动脉内膜厚度,在一定程度上阻止动脉粥样硬化病变的进展。更多还原

【Abstract】 Objective:To study the efficacy and saftety of tiaozhi decoction, treating stable angina patients of(the congealing phlegm of heart vessels)and impact of LP(a)、MMP-9、IMT, discuss a preliminary evaluation of its safety and effectiveness and part of its clinical mechanism.Methods:selected a total of 60 angina pectoris patients with the syndrome of the congealing phlegm ofheart vessels.were divided into two groups. The treatment group had 30 patiens who were given Tiaozhi decoction,The control group had 30 patiens who were given simvastatin.All the patiens were treated with two months. Cure and effictive rates in the two groups were evaluated .Duration of angina attack and ferquence were counted and measured; ECG; TCM; serum MMP-9、carotid artery IMT; TC,LDL-C,HDL-C,TG, Lp(a),Glucose, were measured regularly before study entry and close to the study respectively.Results:1.After treatment ,two groups of patients there has been a marked improvement,and in the treatment group compared with control group there was no significance difference(P>0.05).The treatment group with syptoms of angina、ECG effective rates were 96.67%、93.33% better than the control group93.33%、90.00%.2.TCM symptoms and signs such as chest pain, chest constriction, palpitation, breath shortness, fatigue,spontaneous perspiration were ameliorated significantly in both groups (P<0.01). No differents between two groups (P>0.05).3.The levels of CH,LDL,TG in both groups were lowered markedly (P<0.01) .But there have no difference between the two groups(P>0.05).4. The level of serum MMP-9 were lowered as compared with before treatment,indicating significantly differences(P<0.01); The carotid IMT and plaque score in both groups trended to decrease at the end of the study.There have no differents between two groups (P>0.05);The leve of lp(a) in the treatmen group trended to decrease at the end of the study,but in the control group did not, The treatmen group is superior to the control group(P<0.01). 5. No changes were found at at pre-and post-treatment in safety indexes of the both groups ,like routine tests of blood and urine hepatic function and renal function.Conclusion:1.Tiaozhi decoction can improved clinical symptoms of stable angina pectoris, decrease angina attack and frequency and TCM.2. Tiaozhi decoction can decrease the level of serum MMP-9 and Lp(a) in stable angina patients.3. Tiaozhi decoction can decrease carotid artery IMT, On a certain degree to prevent AS.更多还原