【作者】 谢慧君；

【导师】 李泽恩；

【作者基本信息】 广州中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的近年来,随着生活水平的不断提,血脂异常疾病发病率上长特别快,我国约有9000万人患有血脂异常,每年约有150-200万人死于与血脂异常相关疾病,全世界每年死于心脑血管疾病的人数高达1500万人。目前医学研究证实,血脂异常是引起人类动脉粥样硬化性疾病的主要危险因素。如常见的动脉粥样硬化性疾病：冠心病(包括心肌梗塞、心绞痛及猝死)、脑梗塞以及周围血管血栓栓塞性疾病等。这些心脑血管性疾病的发病率高,病情进展凶险,危害性大,其死亡率约占人类总死亡率的半数左右。血脂异常已成全球人类健康的重大威胁。本课题的研究目的是观察加味五苓散对治疗广东地区常见的脾虚痰浊型血脂异常患者的疗效。研究意义在于通过运用中医的整体观念和辨证论治理论为指导,通过运用健脾化湿、理气化痰为主法,充分发挥中医辨证论治、三因制宜的特色和中药毒副作用少的优势,应用中药治疗广东地区血脂异常患者,探索合理的临床用药方案,更好地控制血脂异常患者症状,改善预后,提高生活质量。方法将诊断为脾虚痰浊型血脂异常的住院患者40例按随机方法分为两组：治疗组20例,男11例,女9例,平均年龄52.4岁；对照组20例,男10例,女10例,平均年龄50.5岁。两组患者的一般情况无统计学差别。所选病人中医辨证均属于脾虚痰浊型。对照组用中成药血脂康0.6 bid治疗；治疗组采用血脂康胶囊加中药汤剂(加味五苓散)治疗。4w为1个疗程,共治疗1个疗程。观察两组病例治疗后临床疗效及治疗前后中医证候积分、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)等变化情况,作统计分析,得出结论。结果1.两组患者治疗前后疗效比较：治疗组20例中显效12例(60%),有效6例(30%),无效2例(10%),总有效率90%；对照组20例中显效7例(35%),有效5例(25%),无效8例(40%),总有效率60%。两组疗效采用Ridit分析进行比较有显著差异(P<0.05),治疗组优于对照组。2.在中医临床症状改善方面,治疗后两组中医症候积分均较前有显著降低,治疗组在眩晕,头重,心悸,胸闷气短,肢麻沉重,乏力等症状及体征方面与对照组比较有显著性差异(P<0.05)。3.两组治疗后TC、TG、LDL-C均有所下降,HDL-C均有所上升,与治疗前比较,有显著性差异(P<0.05),与对照组比较,治疗后治疗组TC、TG、LDL-C水平均低于对照组,HDL-C高于对照组,有显著性差异(P<0.05)。4.两组患者不良反应观察：两组患者均未出现明显不良反应。结论本课题临床研究表明,以中医辨证论治为原则,辨证与辨病相结合,紧密结合现代医学,根据脾虚痰浊型血脂异常的临床表现,运用具有健脾化湿、理气化痰兼活血化瘀功效的加味五苓散进行治疗,临床疗效确切。加味五苓散可以减轻病人的症状和体征：眩晕,头重,心悸,胸闷气短,肢麻沉重,乏力,腹胀,纳呆,口黏,恶心欲吐基本消失,血脂指标明显改善。充分发挥中医副作用少、价格大众化的优势,而加味五苓散的组方又充分体现了中医治疗的辨证论治、标本兼顾、安全有效、灵活多变原则,明显增强疗效,缩短病程,改善预后,提高生活质量。此外,临床观察显示,应用加味五苓散治疗本病没有明显的不良反应,是治疗广东地区脾虚痰浊血脂异常的良方。更多还原

【Abstract】 Objectivein recent years, with the developing countries living standard, the high incidence of disease on special fast, our country about 90 million people every year with blood, and about 150-200 million people die from diseases worldwide, blood die each year as the number of disease of heart head blood-vessel 15 million. Medical researchers confirmed, hyperlipidemia is caused by human atherosclerotic disease risk factor. Like common atherosclerotic disease, coronary heart disease (including myocardial infarction and sudden cardiac death, angina), cerebral infarction and peripheral vascular thromboembolic disease. These cardio-cerebral vascular disease, the harm of high morbidity and mortality, its forbidding progression of total mortality accounted for about half of the human. Hyperlipidemia has become a global human major killer. This topic research aim is to observe flavored scattered five lingya district for treatment of common spleen in guangdong stagnant blood type of patients. Research by using the traditional meaning lies in the overall concept and TDS theory as the guide, through the use of phlegm, facilitating wet article mainly method and give full play to the syndrome differentiation and treatment, due to the characteristics of three Chinese nutriology and fewer side effects of the medicine therapy, application in guangdong, dyslipidemia patients with clinical medicine reasonably, in order to better control and improve symptoms dyslipidemia prognosis.Methodsdiagnosed sputum turbidity of pixu type dyslipidemia in 40 patients hospitalized patients randomized methods are divided into two groups according to.20 cases in treatment group, male and female,9 cases, average age was 52.4,20 cases, male and female,10 cases, average age 50.5 years. Two sets of patients generally statistical differences. Selected patients TCM syndrome differentiation belong to pixu stagnant. Using proprietary control; the bid 0.6:USES:treatment group (Chinese native capsule and scattered) therapy (five flavour, 1w be total treatment 1 treatment. Two cases treatment after observing clinical curative effect and the treatment of TCM syndrome integral, serum total cholesterol (TC) and triglycerides (TG), high-density lipoprotein (HDL-C), low density lipoprotein cholesterol (C) changesResults1. Two groups were compared before and after the treatment effect of 20 cases in treatment group:<12 cases (60%),6 patients (30%) and 2 patients (10%), the total effective 90%,20 cases of 7 cases (35%),5 cases (25%),8 cases (40%),60%. Two groups Ridit by comparing analyzing effect was significant difference (P<0.05), the treatment group than in control group.2. In TCM clinical symptoms improved, two groups of TCM symptoms after treatment were integral before a significant reduction in treatment group, dizziness, head, palpitations, chest distress, flax, short segments, such as the lack of symptoms and signs aspects compared with controls have significant difference (P<0.05).3. After the treatment group and TG TC, LDL-C all declined, hdl-c both rose, compared with before treatment, significant difference (P<0.05), compared with controls, the treatment group TC and TG, LDL levels were lower than that of the control group-C, have significant difference (P<0.05).4. Two groups of patients, adverse reaction:two groups of patients was significantly adverse reactions.Gonclusionthis study, with clinical syndrome differentiation and treatment for the principle, syndrome differentiation and disease differentiation, combining modern medicine according to the spleen, stagnant blood type, use the clinical manifestations of gas, the article has water permeability, invigorate the efficacy of wet flavored scattered five lingya treatment, clinical efficacy. Flavored scattered five lingya can reduce the patient’s symptoms and signs, dizziness, head, palpitations, chest distress, limb, fatigue, abdominal distension flax heavy, sticky, nausea, stay to vomit a basic disappearance, obesity, disappear or mitigate, lipid indicators improved obviously. Full effects of TCM, moderate price advantage and flavored the formula and scattered five lingya fully reflects the syndrome differentiation and treatment of TCM treatment, both, safe and effective, flexible, obvious effect, principles, improve the prognosis shorten course, improve the quality of life. In addition, the clinical observation shows that application flavored scattered five lingya disease treatment had no obvious adverse reactions, treatment is stagnant pixu guangdong area of dyslipidemia.更多还原