【作者】 王楠；

【导师】 李芮；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 目的:收集病例进行临床观察,建立兔动脉粥样硬化模型进行实验研究,观察加味生脉饮治疗冠心病的临床疗效,并进一步探讨其抗动脉粥样硬化的作用机制。方法:1.临床研究:将60例冠心病稳定型心绞痛患者随机分为2组,分别给予加味生脉饮+西药常规治疗（试验组）和西药常规治疗（对照组）治疗3个月。观察用药前后患者症状、体征及心电图的变化。2.实验研究:将24只新西兰大白兔,随机分为三组,每组8只,第一组为高脂组,饲以高胆固醇饮食（1%胆固醇+5%猪油的颗粒饲料）;第二组作为中药组,用加味生脉饮(1g·d^-1·Kg^-1),同时饲以高胆固醇饮食（1%胆固醇+5%猪油的颗粒饲料）;第三组为正常对照组,予正常饮食。三组均喂养4个月后,于耳缘静脉取血,采用酶学方法测定各组动物的血脂水平。处死动物,取胸主动脉,做HE染色、MASSON染色观察动脉硬化程度、斑块纤维含量,免疫组织化学染色观察平滑肌细胞的蛋白表达。结果:1.临床研究:治疗后与对照组相比,试验组心绞痛病情积分显著降低（P<0.05）,心绞痛疗效改善明显（P<0.05）,中医症状积分明显降低（P<0.05）,中医证候疗效显著改善（P<0.05）,说明加味生脉饮能显著改善冠心病心绞痛患者的症状、体征。两组相比较,试验组心电图疗效（总有效率76.67%）改善优于对照组（总有效率43.33%）。治疗过程中,两组均未发现胃肠道不适、皮疹等不良反应。治疗前后肝、肾功能及三大常规检查亦无异常发现,说明使用该方法治疗是安全、可靠的。2.实验研究:（1）三组血脂结果比较:高胆固醇组、中药组的TC及LDL水平均明显高于正常饮食组（P<0.05）,中药组的TC及LDL水平明显低于高胆固醇组（P<0.05）,组间有统计学差异,加味生脉饮可降低血脂水平。（2）三组动脉粥样硬化程度比较:中药组血管内膜厚度、内膜/中膜厚度比值（I/M thickness）均较高脂组明显减小（P<0.05）,斑块纤维含量明显升高（P<0.05）。（3）三组平滑肌细胞的蛋白表达:中药组与高胆固醇组相比,平滑肌细胞蛋白表达明显减少（P<0.05）,而正常对照组无表达。结论:1.加味生脉饮治疗冠心病稳定型心绞痛（气阴两虚证）疗效显著。2.加味生脉饮可以明显抑制动脉粥样硬化平滑肌细胞的蛋白表达。3.加味生脉饮可以明显减轻动脉粥样硬化的程度。更多还原

【Abstract】 Objective:To study the clinical effect of Jia Wei Sheng Mai Yin （JWSMY） on the patients of coronary, and inquire into the mechanism of experimental atherosclerosis in Rabbits that its Resistance to atherosclerosis.Methods:1.Clinical research:60 patiens of CHD with stable tired angina were chosen and divided into 2 groups randomly,one group were treated with anti-angina drugs and JWSMY as experiment group ,while the other group were treated with anti-angina drugs as control group.Three months later,we observed the effet on the patiens.2. Experimental Study: 24 New Zealand white rabbits were randomly divided into three groups, n = 8. The first group were fed a high cholesterol diet; the second group with JWSMY (1g·d^-1·Kg^-1), at the same time the rabbits were fed a high cholesterol diet; the third group to a normal diet. Three groups were fed four months later,we took some blood from the ear margin veins, and used enzymology methods to determine each animal blood lipid levels.Then we killed animals, took chest aortas, and made HE staing and MASSON staing to observe atherosclerosis and spot mass fiber.Also we used immunity organization chemistry to observe smooth muscle cells protein expression.Results:1.Clinical research:Compared with control, the treatment group angina illness integral significantly reduced （P<0.05） after treatment,and the angina curative effect improved （P<0.05）. TCM symptoms integral decreased obviously （P<0.05）, and TCM symptoms improved efficacy significant （P<0.05）. All of them could explain that JWSMY markedly improve CHD patients, angina symptoms, and signs. Two groups compared, the electrocardiogram curative effect of treatment group （the effective rate 76.67%）obviously improved than that in control group （the effective rate43.33 % ）. In the course of treatment, both groups were not found fever, hemorrhage, skin rash, adverse reactions. During the treatment, the liver, kidney and three conventional check and also have no abnormal findings.This method treatment is safe and reliable. 2.Experimental research shows that: （1） Comparison of three groups of lipids:The degree of atherosclerosis was significantly lower in JWSMY group than that in high-cholesterol group.（2） Three degree of atherosclerosis in comparison:The intima thickness and intima-media thickness ratio （I/M thickness） of JWSMY group were significantly reduced than the high-cholesterol group （P< 0.05）,and plaques fiber content increased obviously （P<0.05）.（3）Three groups of smooth muscle cell protein expression: Compared with the high-cholesterol group,JWSMY group decreased significantly （P<0.05）, and the normal control group without expression.Conclusions:1.JWSMY treatment of coronary heart disease chronic stable angina （Qi and Yin deficiency syndrome） curative effect is distinct.2. JWSMY can significantly inhibited the protein expression of smooth muscle cells in AS. 3. JWSMY can significantly reduce the degree of atherosclerosis.更多还原