【作者】 刘琳；

【导师】 叶穗林；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2007， 硕士

【摘要】 目的：本课题通过采用对冠心病内皮功能疗效评价的指标进行严格的临床设计，通过测定具有益气活血的补阳还五汤治疗冠心病心绞痛治疗前后ET-1，NO，vWF，FMD的变化，来论证补阳还五汤对改善CHD患者临床症状，改善预后的意义，进而更加科学的评价其对CHD的治疗效果，同时对于CHD的中药治疗客观评价有重要意义。方法：选择随机单盲对照的试验方案进行研究。纳入符合冠心病心绞痛诊断标准，属于气虚血瘀型的患者共60例，按照1：1的比例随机分组成治疗组和对照组，在给予基础治疗的基础上再分别给予补阳还五汤及安慰剂治疗，疗程为3周。在治疗前后观察心绞痛症状、心电图疗效、中医症候以及内皮指标的变化。结果：心绞痛疗效：补阳还五汤组心绞痛积分有明显改善(P＜0.01)，对照组治疗后积分虽有所下降但与治疗前比较无统计学差异(P＞0.05)，治疗后补阳还五汤组改善程度明显优于对照组(P＜0.05)。心绞痛临床疗效方面治疗组的总有效率为90％，明显优于对照组的66.67％，两组差异具有显著性差异(P＜0.01)。心电图疗效：治疗组和对照组心电图的总有效率分别为86.7％和56.7％，两组差异具有显著性差异(P＜0.05)。中医症候：两组中医证候积分均有明显改善(P＜0.05)，尤以治疗组改善程度明显优于对照组(P＜0.01)。中医症候临床疗效方面治疗组总有效率为90.0％，明显优于对照组的66.7％，两组差异具有显著性差异(P＜0.01)。ET、NO变化：对照组治疗后虽然ET比治疗前略有下降，NO略有升高，但变化无显著性差异(P＞0.05)，治疗组用补阳还五汤后ET比治疗前下降，NO比治疗前升高，两者均由显著性差异(P＜0.01)。治疗后补阳还五汤组的ET水平显著低于对照组(P＜0.01)，治疗后补阳还五汤组的NO水平较对照组有明显升高(P＜0.05)。vWF变化：治疗前两组vWF水平无显著性差异，治疗组用补阳还五汤后vWF水平比治疗前明显下降(P＜0.05)，治疗后补阳还五汤组vWF水平明显低于对照组(P＜0.05)，而对照组治疗后虽然vWF比治疗前略有下降，但无统计学差异(P＞0.05)。FMD变化：两组无论从同组治疗前后或者是组间治疗前后比较均无显著性差异(P＞0.05)。结论：补阳还五汤能有效改善冠心病患者心电图疗效；补阳还五汤既能有效减少心绞痛发作，又能改善中医证候群，无明显毒副作用；补阳还五汤是通过下调ET水平，同时上调NO水平，抑制vWF释放的作用从而使受损的血管内皮功能得以部分恢复。更多还原

【Abstract】 Objective: To validate clinicalcurative effect that Buyang Huanwu Decoction improveclinical symptom and prognosis in patients of coronary heart disease through testingthe level of ET-1, NO, vWF in serum and FMD.Method: This is a single-blind, randomized, matched controlled trial. 60 patients thatwere diagnosed as coronary angina pectoris and qixu xueyu symdrome wererandomly grouped to treatment group and controlled group. Each group had 30 cases.The two groups were treated with Buyang Huanwu Decoction and placebo separatelyon the basis of basical treatment by 3 weeks continuously. After 3 weeks, we observedthe change of ET-1, NO, vWF, FMD, EKG reading, clinical symptoms of anginapectoris, and Chinese medical symptoms.Result:Clinical symptoms of angina curative effect: Symptoms of angina were improvedeffectively in treatment group, while there was no statistical significance in controlledgroup. Treatment group shown 90％and controlled group shown 66.7％. Theirdifferences had great statistical significance.EKG curative effect: The EKG curative effect of the two group separately shown86.7％and 56.7％. Their differences had great statistical significance.Chinese medical symptoms curative effect: Chinese medical symptoms wereimproved effectively in two groups, but the treatment group was more improved thancontrolled group. Treatment group shown 90％and controlled group shown 66.7％.Their differences had great statistical significance.ET, NO: Although the level of ET in serum decreased and the level of NO increased in controlled group, there were no statistical significance. The level of ET decreased,the level of NO increased after treatment in treatment group which had greatstatistical significance. The level of ET in serum was much lower than that ofcontrolled group after treatment. The level of NO in serum was much higher than thatof controlled group after treatment.vWF: The level of vWF of treatment group was lower than controlled group whichhad statistic significance. Furthermore, the level of vWF was much lower than that ofcontrolled group after treatment. Although the level of vWF of controlled groupdecreased but there was no statistical significance.FMD: There was no change of FMD in two groups after treatment. There was nochange of FMD alter treatment in the same group.Conclusion: The results of the experiment show that Buyang Huanwu Decoction caneffectively improve EKG curative effect. It can control angina pectoris attack,improve Chinese medical symptoms without side-effect. By decreasing the level ofET and increasing the level of NO in serum and controlling reversed bloodendothelium function obstacle partly.更多还原