冠心病合并高脂血症的中医证候学研究

【作者】 黄淑英；

【导师】 郭维琴；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2008， 硕士

【摘要】 本论文分文献综述与临床研究两部分。文献综述分中医部分和西医部分。中医部分论述中医对冠心病心绞痛及高脂血症病因病机的认识,其辨证论治及治法的研究进展。西医部分论述冠心病心绞痛的概念,控制血脂对冠心病患者治疗的重要性,以及控制高脂血症的研究进展。临床研究部分详述冠心病合并高脂血症的中医证候学研究。本论文着重研究冠心病合并高脂血症中医临床证候规律,在研究既往文献的基础上,遵循临床流行病学的原则和方法,以北京地区多家医院189例患者的临床资料为依据,运用统计学中因子分析方法,对冠心病合并高脂血症的中医证候规律进行新的探索。冠心病合并高脂血症为中老年人疾病,在189例患者当中,50-79岁患者占80.95%。男性病者占大多数。男性患者平均年龄为60.92±12.3岁,女性患者平均年龄为65.02±9.72岁。冠心病合并高脂血症与家族史有一定的关系。从生活习惯上分析:76.72%患者从事极轻或轻体力劳动,43.92%体型肥胖(BMI＞25),75.13%的患者饮食偏咸,68.25%的患者喜食油荤。189例冠心病合并高脂血症患者资料分出9个中医证型,分别为:①肺肾两虚、②肝郁、③肝郁化热、④气虚痰浊、⑤肾虚、⑥痰浊、⑦血瘀、⑧阳虚水饮、及⑨阴虚。其中以气虚痰浊所占比例最大,占23.81%,其次为肝郁化热和肺肾两虚。根据导师的临床经验,把以上证型调整后得出的分布是以气虚痰瘀互阻为绝大多数,占48.15%。这与导师临床上的总结相一致。男女患者的证型的分布稍有分别。男女患者都以气虚痰瘀互阻居多。除此以外,男性患者以肝郁化热型为多;女性患者则以肺肾两虚为多。这个分别与男性的生活、饮食习惯以及女性的生理条件有关。气虚痰浊型患者的年龄偏高,80%气虚痰浊的患者在60-79的岁数群中。肝郁或肝郁化热型的患者的年龄较气虚痰瘀型患者低,主要(54.16%)在40-59的岁数群中。从冠心病病变情况来看,单支病变者以肝郁化热者居多,占24.43%,其次为气虚痰浊型,占15.62%。双支病变者以气虚痰浊型为主,占32.91%;其次为肝郁化热型,占16.46%。三支以上病变者也以气虚痰浊型最多,占19.56%:其次为肺肾两虚性占17.39%。高脂血症是引起冠心病的独立及主要原因之一,积极调节冠心病患者的血脂是治疗冠心病及预防冠心病事件的最重要途径。由于高脂血症起病隐匿、病程长,所以防治冠心病应从防治高脂血症,推广血脂的检查开始,这也符合中医“治未病”的道理。治疗冠心病患者的同时应积极做降脂治疗并监测血脂水平并,治疗性生活方式改变也应是防治冠心病的有力措施。更多还原

【Abstract】 This thesis consists of two sections.The first section contains three literature summaries.The first two summaries relate to Traditional Chinese Medicine(TCM),both are discussions on the etiology,pathogenesis,syndrome differentiation,epidemiology and the therapy of Coronary Artery Disease(CAD) and dyslipidemia from the TCM point of view.The third literature summary relates to the modern medicine’s approach to the treatment of CAD.The second section is a clinical study on CAD cum dyslipidemia under the guidance of TCM.The clinical study attempts to find out the distribution of TCM syndrome type of patients with CAD cum dyslipidemia in order to improve the effectiveness of TCM treatment for this group of patients.The study covered 189 patients with confirmed diagnosis of CAD cum dyslipidemia from 3 hospitals in the Beijing city.Findings:CAD affects people advancing in age.Among the 189 cases selected,80.95%came from patients in the 50-79 age-group,predominated by male patients.Average age of these patients were 61 and 65 years for males and females respectively.Family history of CAD or dyslipidemia was one of the risk factors in causing the disease.Lifestyle factors weighed heavy for the 189 patients selected.76.72%of them were physically inactive;43.92 had indication of obesity(BMI＞25);75.13%had high salt diet and 68.25%had high fat diet.We found 9 TCM syndrome type from the 189 eases,they were:①deficiency in lung and kidney;②liver stagnation;③stagnation of liver with heat;④qi deficiency cum turbid phlegm;⑤deficiency of kidney;⑥turbid phlegm;⑦blood stasis;⑧yang deficiency with excessive fluid;and⑨yin deficiency. Among the 9 syndrome types,qi deficiency cum turbid phlegm formed the largest proportion with 23.81%,followed by liver stagnation with heat and deficiency of the lung and kidney.Based on the clinical experience of Thesis Advisor, after making slight adjustment to the above classification,the syndrome type of qi deficiency with phlegm and blood clot formed the largest group with 48.15%.Syndrome type distribution was slight different between male and female. Besides qi deficiency with phlegm and blood clot,which formed the largest proportion in both men and women,the next largest group for men was with the syndrome type of deficiency of liver with heat.For women it was the syndrome type of deficiency of lung and kidney.This difference in distrbution pattern could be due to the lifestyle and biological difference between men and women.From the age-group analysis of the syndrome types,patients with qi deficiency cum turbid phlegm syndrome came from a higher age-group,with 80% of these patients in the 60-79 age-group.Patients with liver stagnation or liver stagnation with heat came from a lower age group,with 54.16%comes from the 40-59 age-group.From the analysis of CAD severity of the syndrome type,patients with single artery blockage mainly came from the liver stagnation with heat, forming 24.43%;followed by qi deficiency and turbid phlegm with 15.62%. Patients with two arteries blockage mainly had the qi deficiency cum turbid phlegm syndrome type,forming 32.91%,followed by liver deficiency with heat with 16.46%.19.56%of patients with 3 or more arteries blockage had qi deficiency cum turbid phlegm syndrome type followed by deficiency of lung and kidney with 17.39%.Dyslipidemia is the single and important risk factor in causing the development of CAD,therefore more aggressive action in the management of lipid levels of these patients is a key treatment method.As the development of dyslipidemia is slow and has no apparent symptoms,preventive measures such as regular cholesterol test for adults above 20 years of age should be encouraged.In addition to regular blood test of lipid levels and cholesterol lowering for CAD patients,therapeutic lifestyle changes are important part of the treatment for CAD.更多还原