【作者】 颜芳；

【导师】 赵立诚； 冼绍祥；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2001， 硕士

【摘要】 近年来，随着中医证候现代化研究的不断深入，血瘀证与病相结合的冠心病心血瘀阻证的研究也取得了可喜的成绩，但以往的研究多集中于宏观症状和微观指标等方面，具有一定的局限性。而同时中医情志致病理论的研究因其概念的模糊性、随意性和理论的直观性、思辨性而滞缓不前，难以突破。随着现代医学模式向生物-心理-社会模式的转变，情志因素在疾病的发生、发展及预后中所起的作用，日益引起人们的重视。冠心病作为最常见的心血管疾病之一，其发病、演变和预后与情志因素关系尤为密切，而心血瘀阻证又是冠心病最常见的证型。因此，本研究试图在中医整体观、辨证观的基础上，运用现代医学心理学的研究方法，使用国际通用的心理测验量表进行调查，将中医的情志因素进行量化，以分析其与冠心病心血瘀阻证的相关性，并从”神经-内分泌-免疫网络”角度初步探讨其机理，以推动冠心病临床辨治规律研究的进一步深入，并摸索中医情志致病理论可行的研究思路。 本论文首先就古代文献对“心血”和“心血瘀阻证”的认识进行了复习，并对中医情志理论和个性理论的渊源和发展作了系统的回顾，同时还对古代文献关于情志因素与冠心病的相关性的论述进行了分析。 在现代文献研究中，则首先回顾了近年来冠心病心血瘀阻证在宏观计量和微观诊断方面的初步研究进展；对心理社会因素与冠心病相关性的研究进展作了简要的综述；并依据研究现状，就中医情志理论与现代医学心理学的相关性进行了分析，即为此研究的可行性提供了理论依据。—— 本研究以中医理论为指导，在中医辨证的基础上，借用现代医学心理学的测验量表（EPQ和SCL·90）对106名冠心病患者进行了调查，并将结果与全国常模川闷］进行比较，以分析冠心病心血瘀阻证与患者个性特征、心理状态的相关性。结果显示：冠心病心血瘀阻证患者的E分及N分均明显高于常模和对照组（P＜0．05～0．of）气质类型则以胆汁质为多见（占49．15％），提示冠心病心血瘀阻证患者以外向、情绪不稳定等为其个性特征，易冲动、敏感、注意力易转移、兴趣或情感易交换等个性特点与冠心病的发病有密切关系；在心理状态方面，冠心病心血瘀阻证患者则焦虑、抑郁及睡眠障碍等因子分明显高于常模和对照组（P＜0．of～0．001），且不同年龄段和不同文化程度又表现出不同的特点：30－49岁组的冠心病心血瘀阻证病人的焦虑、抑郁及睡眠障碍等症状程度明显高于70岁以上年龄组，大专以上文化程度的病人在焦虑、睡眠障碍等症状程度亦明显高于大专以下文化程度的病人，组间比较有显著性差异（P＜0．05～0．of），提示不同证型、不同年龄、不同文化程度的冠心病患者在冠心病患病时存在不同特点的心理状态。 为探讨上述相关性的机理，随机抽取心血瘀阻证和非心血瘀阻证各35例，并设健康对照组30例。检测其自由基三项和sIL－ZR等理化指标，经统计显示冠心病心血瘀阻证患者sIL－ZR水平明显高于对照组（P＜0．of），提示其存在看免疫紊乱状态。两组冠心病患者u 明显槽高，SOD及GSH千x明显减少，较正常组均有显著性差异，而心血瘀阻证组u 增多较对照组亦有显著性差异，提示在冠心病患者均存在着自由基异常增多，抗自由基能力不足的情况，但在此共性基础上，不同证型又各有其特点。更多还原

【Abstract】 A pilot study on the correlation and it’s mechanism of the heart blood stasis syndrome in coronary heartdisease and individual personalitymental stateABSTRACTIn these years, along with advancement of the research of modernization of TCM, the study on the heart blood stasis syndrome of coronary heart disease (CHD) have made great progress . But ancient works were mainly focused on the microcosmic diagnosis and macrocosmic quantitative diagnosis. At the same time, accompany with the medical mode changing to bio-psychosocial mode, more and more studies show that mental factors have a significant effect on the occurence * development and prognosis of disease .Heart blood stasis is the most common syndrome of coronary heart disease (CHD). So we want to use modern mental measuring scales to find out the correlation of the heart blood stasis syndrome in CHD and the individual personality the mental state of the patient, and to discuss it’s mechanism in the “nerves-endocrine-immunity”network.In the first part of this article, we first reviewed the ancient opinion of the “heart blood”and the “heart blood stasis” It’s also expounded that the modern research of the heart blood stasis syndrome in CHD which was mainly focused on the microcosmic diagnosis and macrocosmic quantitative diagnosis. Following that, we stressed on the correlation of the emotional theory of TCM and the modern psychology.To find out the correction , 106 patients with CHD ~vere involved to the investigation with Eysenck Personality Questionaire (EPQ) and Symptom Check-List 90 (SCL-90) including the heart blood stasis syndrome group (59 cases) and non- heart blood stasis syndrome group (47 cases). The EPQ results showed that E-scales (extroversion and introversion) and N-scales (neuroticism) in heart blood stasis syndrome group were higher than the control group and the routine mode (P<0.05-0.0l)~ and most of their temperament types were choleric (49.15%)~ which indicated the patient抯 individual personality with heart blood stasis syndrome were extroversion emotional instability sensitivity and easy to impulse~ With regard to the mental state the SCL-90 showed that the scales of the factors such as depressions anxiety and insomnia of heart blood stasis syndrome of CHD were much higher than that of non-heart blood stasis syndrome and routine mode (P<0.01-0.001). Furthermore, the patients of 30-49 years old had a obviously difference from the patients who were old than 70, and that patients who have a culture degree than university also had this characteristic , which indicated that the patients with CHD in different syndromes different ages and different culture degree have different mental state.To find out the mechanism of these correlation , we choosed the Serum Superoxide Dismutase (SOD), Lipid Peroxides (LPO), Glutathione Peroxedase (GSI-I-Px) and Soluble Interleukin-2 Receptor (SIL-2R) for observation index. Seventy patients with CHD and 30 normal control casese were tested. The results showed (1) The serum degree of SIL-2R of CHD group with the heart blood stasis syndrome were much higher than those of control group (P<0.0 1); (2)In the CHD group , the degree of SOD and GSH-Px~vere much lower than those of control group, and the group with the heart blood stasis syndrome have a more apparent difference of this. These results indicate that the abnormal increase of Oxygen Free Radical and the turblance of immunity play an important role in the pathogenesis of CHDI and different syndromes have their individual characteristic更多还原