【作者】 王治宽；

【导师】 王发渭；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2004， 硕士

【摘要】 目的：观察中药复方调脂增寿汤对血脂异常患者血脂系列、动脉硬化指数、非高密度脂蛋白胆固醇的临床疗效及其对C-反应蛋白和同型半胱氨酸的影响，确认调脂增寿汤对血脂异常的治疗作用，及对冠心病等心脑血管疾病的预防和治疗作用，并对该药的安全性进行评价。 材料和方法：诊断标准根据我国《血脂异常防治建议》及参考美国成人胆固醇教育计划（NCEP）等为标准，中医辨证分型主要参考陈可冀主编的《实用中西医结合内科学》为标准。 本研究按患者就诊顺序的先后，将病人随机分为中药组、西药组及中西药结合组。病例资料完整患者共120例，其中中药组43例，西药组40例，中西药组37例。中药组给予调脂增寿汤，西药组给予普伐他汀片，中西药组给予调脂增寿汤和普伐他汀片，药物剂量、组成及服用法均相同，各治疗8周。以胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-c）、载脂蛋白A_I（ApoA_I）、载脂蛋白B₁₀₀(ApoB₁₀₀)、动脉硬化指数[（TC—HDL-c）／HDL-c]、非高密度脂蛋白胆固醇（non-HDL-c）、同型半胱氨酸（Hcy）、C-反应蛋白（CRP）等为观察指标，在服药前后进行上述各项检查，并对肝功、肾功、电解质、血糖、转氨酶、血常规、尿常规等进行测定。分析调脂增寿汤、普伐他汀片及二者合用时用药前后的各项指标变化，比较两药的治疗效果，评定调军医进修学院硕士论文中文摘要脂增寿汤对血脂异常的治疗作用，进行该药的安全性评价。 结果:调脂增寿汤治疗血脂异常的临床总体有效率为83.72%。与普伐他汀片的临床调脂疗效无显著性差异，而调脂增寿汤配合普伐他汀片的临床调脂疗效则更明显;调脂增寿汤与普伐他汀片在降低TC、TG、LDLc，升高APoA:方面差异无显著性，而调脂增寿汤可显著升高HDL一，降低A训Bloo;调脂增寿汤与普伐他汀片均可有效降低动脉硬化指数及非高密度脂蛋白胆固醇;调脂增寿汤与普伐他汀片均可有效降低血脂异常患者的CRP，而调脂增寿汤还可显著降低血脂异常患者Hcy。血脂异常患者以痰浊中阻型和气滞血癖型为主要证型，痰浊、血癖为主要病因病机。调脂增寿汤治疗血脂异常不良反应发生率低，患者耐受性良好。 结论:调脂增寿汤治疗血脂异常临床疗效确切，能有效升高HDL一c，降低APoB100，可有效预防和治疗心脑血管疾病及相关病变，且不良反应发生率低，具有推广价值。更多还原

【Abstract】 Objectives: To observe the clinical curative effect of Tiaozhi Zengshou Decoction on blood lipids, atheromatous index, non-high density lipoprotein-cholesterol, C-reactive protein and homocystine in patients with dyslipidaemia. To validate it’s therapeutical effect on dyslipidaemia and it’s preventive and curative effect on coronary heart disease and cardiovascular and cerebrovascular diseases and to assess the safety of Tiaozhi Zengshou Decoction.Methods: The diagnosis standard were "Prevention, detection, evaluation, and treatment of dyslipidaemia" and "National cholesterol education program(NCEP)". Traditional Chinese Medicine differentiation refer to Chen Keji’s "Practical internal medicine of combination of TCM and western medicine".There are only 120 patients with dyslipidaemia who have whole data. Patients with their coming order were randomly divided into traditional Chinese medicine group receiving Tiaozhi Zengshou Decoction (n=43), western medicine group receiving Pravastatin Tablet (n=40)禄 traditional Chinese medicine and western medicine group receiving Tiaozhi Zengshou Decoction and Pravastatin Tablet (n=37) . The therapeutic course for each group was 8 weeks. The levels of TC, TG, HDL-c, LDL-c, ApoAI, ApoB100,( TC - HDL-c)/HDL-c, non-HDL-c, Hey and CRP were performed as observingindexes. All indexes were examined at the beginning and the end of treatment At the same time, the patients’ liver function, renal function, electrolure, blood sugar, transaminase, routine tests of blood and urine were tested. All these indexes were analyzed to contrast the therapeutical efficacies of each group. The effect of Tiaozhi Zengshou Decoction in regulating blood lipids and adverse effect in patients were observed.Results: The total effective rate of Tiaozhi Zengshou Decoction group was 83.72%. There was no significant difference between Tiaozhi Zengshou Decoction group and Pravastatin Tablet group about total effective rate. The effect of Tiaozhi Zengshou Decoction and Pravastatin Tablet group was more superior than that of the other two groups. After 8 weeks, the levels of TC, TG, LDL-c, (TC-HDL-c)/HDL-c, non-HDL-c and CRP were significantly decreased and the level of ApoAj were obviously increased in Tiaozhi Zengshou Decoction group and Pravastatin Tablet group. The level of HDL-c were significantly increased and the levels of ApoBioo and Hey were significantly decreased in Tiaozhi Zengshou Decoction group. The main syndrome differentiation of dyslipidaemia are stagnant of qi and blood stasis type and phlegm stagnancy type. The main pathogenic factors and pathogenesis of dyslipidaemia are phlegm and blood stasis. The adverse effect of Tiaozhi Zengshou Decoction was better than that of Pravastatin Tablet group.Conclusion: Tiaozhi Zengshou Decoction have definite curative effect in treatingpatients with dyslipidaemia. It can effectively raise the level of HDL-c, decrease the level of ApoB100, prevent and treat cardiovascular and cerebrovascular disease and have little side effects.更多还原