基于“血-脉-心-神”一体观探讨方证对应模式干预稳定型心绞痛疗效的生物学基础
|
摘要
目的:基于"血-脉-心-神"一体观,探讨方证对应模式干预稳定型心绞痛的生物学基础,并揭示该病分期论治内涵。方法:纳入77例患者,根据常见证型根据治法分为益肾健脾组和滋阴解毒组,以辨证论治为前提,在西药常规治疗基础上叠加中药汤剂,采取疗效自身前后对照研究方法,以0周、4周、8周为观察时点,以"太阳系学说"各机制为辐射靶位。结果:方证对应各组均可使患者中医证候积分、心绞痛积分和生存质量明显改善,各组各时段疗效机制均涉及炎症、凝血、内皮功能、心肌保护等多方面,涵盖血、脉、心各维度但存在时序差异。早期获效归功于IL-1β、ADMA等血液和血管致损因子下调,重在宁血、畅脉,后期疗效归因于Arg、SDF-1等内皮和心肌保护因子升高,重在育心、保脉。结论:方证对应模式干预稳定型心绞痛疗效机制具有多靶点性,关乎血、脉、心多维度;冠心病治疗具有分期特征,急性期速通血脉,缓解期育心保脉。
Objective: Exploring biological mechanismn about the effect of stable angina in correspondence of prescription-syndrome mode based on "blood-pulse-heart-spirit " integral view,and revealing the connotation of the treatment by stage. Methods: According to Traditional Chinese Medicine syndrome differentiation,the 77 patients were divided into two groups: Invigorating spleen and nourishing kidney group,nourishing Yin and detoxification group. Carrying out integrated Chinese-Western therapy without prejudice to the principle of syndrome-differentiation treatment.The method is to take effect before and after contrast,collecting data at 0 weeks,4 weeks,8 weeks,respectively. Results: Each group of correspondence of prescription-syndrome,can improve the patient TCM score,angina pectoris symptoms and quality of life.Each group and period,the effect mechanism all involves inflammation,coagulation,endothelial function,myocardial protection and so on,covering blood,pulse and heart,but existing timing differences. Early benefit dues to the reduction of destructire factor about blood and endothelial such as IL-1β and ADMA,pacifying blood and smoothing pulse; while the later effect dues to the rise of of protection factors about endothelial and myocardial, cultivating heart and pulse.Conclusion: The treatment in correspondence of prescription-syndrome mode shows multiple targets,associated with blood,pulse,myocardium.The treatment of CHD shows stage characteristics,smoothing the blood vessel promptly in acute phase;while cultivating heart and pulse in remission stage.
Objective: Exploring biological mechanismn about the effect of stable angina in correspondence of prescription-syndrome mode based on "blood-pulse-heart-spirit " integral view,and revealing the connotation of the treatment by stage. Methods: According to Traditional Chinese Medicine syndrome differentiation,the 77 patients were divided into two groups: Invigorating spleen and nourishing kidney group,nourishing Yin and detoxification group. Carrying out integrated Chinese-Western therapy without prejudice to the principle of syndrome-differentiation treatment.The method is to take effect before and after contrast,collecting data at 0 weeks,4 weeks,8 weeks,respectively. Results: Each group of correspondence of prescription-syndrome,can improve the patient TCM score,angina pectoris symptoms and quality of life.Each group and period,the effect mechanism all involves inflammation,coagulation,endothelial function,myocardial protection and so on,covering blood,pulse and heart,but existing timing differences. Early benefit dues to the reduction of destructire factor about blood and endothelial such as IL-1β and ADMA,pacifying blood and smoothing pulse; while the later effect dues to the rise of of protection factors about endothelial and myocardial, cultivating heart and pulse.Conclusion: The treatment in correspondence of prescription-syndrome mode shows multiple targets,associated with blood,pulse,myocardium.The treatment of CHD shows stage characteristics,smoothing the blood vessel promptly in acute phase;while cultivating heart and pulse in remission stage.
引文
[1]张运,陈文强.缺血性心脏病发病机制的新观点[J].中华心血管病杂志,2014,42(2):94-97.
[2]王丹,李小妮,邹煜,等.补肾抗衰片干预不稳定型心绞痛的临床疗效观察及其对血清炎症介质的影响[J].中国实验方剂学杂志,2016,22(14):171-176.
[3]高修仁.我国慢性稳定型心绞痛诊断与治疗指南解读[J].新医学,2007,38(11):704-707.
[4]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:68-73.
[5]卜军,王琳.2002年ACC/AHA慢性稳定型心绞痛诊疗指南修订纲要[J].临床心血管病杂志,2003,19(5):317-319.
[2]王丹,李小妮,邹煜,等.补肾抗衰片干预不稳定型心绞痛的临床疗效观察及其对血清炎症介质的影响[J].中国实验方剂学杂志,2016,22(14):171-176.
[3]高修仁.我国慢性稳定型心绞痛诊断与治疗指南解读[J].新医学,2007,38(11):704-707.
[4]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:68-73.
[5]卜军,王琳.2002年ACC/AHA慢性稳定型心绞痛诊疗指南修订纲要[J].临床心血管病杂志,2003,19(5):317-319.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |