【作者】 张莉；

【导师】 张文高；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2008， 硕士

【摘要】 目的:观察解毒活血方案大黄、红曲微粉配伍对颈动脉粥样硬化斑块的临床疗效,探讨作用机制,为应用解毒活血药防治颈动脉粥样硬化斑块及相关心脑血管疾病提供科学依据。方法:将纳入的100例颈动脉粥样硬化斑块患者随机分为五组:大黄微粉组,20例,给予大黄微粉治疗;红曲微粉组,20例,给予红曲微粉治疗;大黄红曲微粉组,20例,给予大黄、红曲微粉配伍治疗;洛伐他汀对照组,20例,给予洛伐他汀治疗;空白对照组,20例,不给予药物治疗。疗程6个月。观察患者的临床症状疗效,治疗前后颈动脉内膜-中层厚度(IMT)、内径、Crouse斑块积分、收缩期峰值流速(PSV)、舒张末期流速(EDV)、斑块超声声像病理学分型、颈动脉超声声像学分型以及血脂、血清炎症因子[超敏C反应蛋白(hs-CRP)、可溶性细胞间粘附分子-1(sICAM-1)、可溶性血管细胞粘附分子-1(sVCAM-1)]、基质降解相关因子[基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶抑制因子-1(TIMP-1)]水平的变化。结果:大黄红曲微粉组显著改善患者的临床症状;减小颈动脉IMT,增大血管内径;提高PSV、EDV;调节血脂;降低血压;降低hs-CRP、sICAM-1、sVCAM-1;降低MMP-1及MMP-1/TIMP-1比值,疗效显著优于大黄微粉组、红曲微粉组和洛伐他汀对照组。结论:大黄、红曲解毒活血配伍方案具有抗动脉粥样硬化、调脂、降压、抗炎、减少细胞外基质降解,稳定斑块的作用,优于单纯解毒或活血,值得临床推广应用。更多还原

【Abstract】 Objective: To observe therapeutic effect and discuss mechanism of treatment of carotid atherosclerosis plaque with micropowder of Rhubarb with Monascus; to provide scientific proof for prevention and cure of carotid atherosclerosis plaque and related cardiovascular and cerebrovascular diseases with trational Chinese medicine which is Toxin-resolving and Blood-activating. Methods: 100 cases of carotid atherosclerosis plaque were divided into five groups randomly: micropowder of Rhubarb group, 20 cases, was treated with micropowder of Rhubarb; micropowder of Monascus group, 20 cases, was treated with micropowder of Monascus; micropowder of Rhubarb with Monascus group, 20 cases, was treated with compatibility of micropowder of Rhubarb and Monascus; Lovastatin group , 20 cases, was treated with Lovastatin; blank group , 20 cases, was not treated with any medicines. The course of treatment was six months. To observe the effect on clinical symptoms, and changes of intima-media thickness (IMT),inside diameter, Crouse plaque integral, peak systolic velocity (PSV),end diastolic velocity (EDV), plaque pathologic classification and carotid classification in carotid, and the level of blood lipid, hypersensitive C–reactive protein (hs-CRP), soluble intercellular adhesion molecule (sICAM-1), Soluble vascular cell adhesion molecule (sVCAM-1), Matrix metalloproteinase-1 (MMP-1), Matrix metalloproteinase inhibitor-1 (TIMP-1) in blood serum. Results: micropowder of Rhubarb with Monascus group is able to relieve clinical symptoms; reduce IMT and expand inside diameter of the carotid; increase PSV and EDV; regulate blood lipid; decrease blood pressure; and decrease hs-CRP, sICAM-1, sVCAM-1, MMP-1 and MMP-1/TIMP-1. Curative effect of micropowder of Rhubarb with Monascus group is remarkably superior to micropowder of Rhubarb group、micropowder of Monascus group and Lovastatin group. Conclusion: The principle of Toxin-resolving and Blood-activating which is compatibility of micropowder of Rhubarb and Monascus can regulate blood lipid, decrease blood pressure and have therapeutic effects on anti-inflammation and Matrix Degradation. All above is capable of enhancing the stability of atherosclerotic plaque and delaying the process of Atherosclerosis.The therapeutic effect of Toxin-resolving with Blood-activating is superior to pure Toxin-resolving or pure Blood-activating, and deserves further clinical application.更多还原