冠心病急性冠脉综合征中医“瘀毒”证的临床辨证标准研究
|
摘要
急性冠脉综合征(ACS)是冠心病中的危重急症,近年来发病率不断上升。尽管现代医学在ACS的诊断和治疗上已经取得了很大进展,但并不能改变ACS病人高死亡、高致残的现实,病人的生活质量下降,远期生存率低仍然是临床治疗中的难题。
我们通过对古代文献“瘀”“毒”理论的整理发掘,结合现代医学动脉粥样硬化“炎症”学说、冠心病病理生理机制的观念更新,认同动脉粥样硬化、冠心病“瘀毒”致病理论。本文第一部分利用临床流行病学和数理统计方法对急性冠脉综合征中医“瘀毒”证的辨证标准进行了探索;第二部分采用活血解毒药物干预不稳定性心绞痛,对活血解毒药物治疗不稳定性心绞痛的疗效进行评价。
第一部分急性冠脉综合征中医“瘀毒”证的临床辨证标准研究
背景:目前由于缺少根据临床调查总结出的冠心病急性冠脉综合征中医“瘀毒”证的临床辨证标准,影响了临床研究的进一步深入进行。因此亟待我们用客观科学的方法对急性冠脉综合征中医“瘀毒”证的辨证标准进行研究。
目的:采用临床流行病学和数理统计多因素分析方法,结合临床实践,为急性冠脉综合征中医“瘀毒”证的辨证提供客观科学的依据。
方法:本研究自2008年3月之2009年3月,运用大样本、多中心、横断面、前瞻性的临床流行病学调查方法对北京3所三甲医院的165例ACS患者进行调查,调查内容包括:一般资料、既往病史、西医诊断、病情分级、冠脉造影结果、实验室检查结果、症状、体征、中医证型、中医主症计分、血瘀证计分、心绞痛计分。建立数据库,统计方法采用频数分析、卡方检验、logistic回归分析、主成分分析、相关分析等多因素分析方法,结合临床实践,提取出急性冠脉综合征中医“瘀毒”证的证候要素,对证候要素进行相关组合分析,分为虚实两类。对主成分分析提取的主要症状按虚实分类,总结出了急性冠脉综合征中医“瘀毒”证的辨证标准。
结果:初步总结出“瘀毒”证的临床辨证分型,分为虚实两型:“瘀毒”实证:胸痛,胸闷,口苦,口干欲饮,便干便秘,舌暗红,苔黄腻,脉滑。“瘀毒”虚证:胸痛、胸闷,气短,乏力,心悸,畏寒,自汗,舌淡暗,苔白,脉细。虚实证常互相影响,兼夹为病,实证日久可耗气伤阴,由实转虚;虚证日久则易化生瘀毒痰浊之邪,且正气虚弱,无力祛邪,以致虚实夹杂,形成恶性循环,变证丛生。
Logistic回归分析发现,LDL-C水平升高、陈旧心梗病史、吸烟、糖尿病、肌钙蛋白阳性、脑卒中病史为“瘀毒”证的危险因素。其中,LDL-C的回归系数B值最大,说明LDL-C水平升高是“瘀毒”证发生发展的最重要危险因素;其相对危险度Exp(B)为3.942。其他因素按相关程度大小排列依次是陈旧心梗病史、吸烟史、糖尿病病史、肌钙蛋白阳性、脑卒中病史,相对危险度分别是:3.812、3.345、2.898、1.717、1.640。
结论:通过数理统计的结果与中医理论相结合,可以得出相对客观的急性冠脉综合征中医“瘀毒”证的辨证诊断标准,前瞻性的临床调查与多因素数理统计分析相结合是进行急性冠脉综合征中医“瘀毒”证辨证标准客观化研究的一种有效方法,值得进一步深入研究。
第二部分活血解毒中药干预不稳定性心绞痛的临床随机对照研究
背景:不稳定性心绞痛是指介于稳定性心绞痛和急性心肌梗死之间的一组临床心绞痛综合征,从中医角度属“胸痹心痛”范畴,其基本病机则是心脉瘀阻,血瘀证是不稳定性心绞痛最常见的证型之一。活血化瘀法治疗不稳定性心绞痛已经进行了大量临床研究,取得了一定成效。近年有学者根据现代医学研究进展,结合中医学有关“瘀毒”致病的病因病机学说,提出了冠心病“瘀毒”致病理论并进行了一些相关研究。前期研究证实活血解毒中药具有稳定易损斑块、抑制炎症、调节血脂等功效。那么临床上它是否能够改善心绞痛症状,抑制炎症指标、改善不稳定性心绞痛患者预后,从而发挥对不稳定性心绞痛的治疗作用呢?因此我们按照RCT试验的要求对活血解毒中药干预不稳定性心绞痛的疗效进行进一步的探讨与研究。
目的:探讨在常规西医治疗的基础上活血解毒中药对不稳定性心绞痛的治疗效果,观察其治疗前后对不稳定性心绞痛患者中医症状、血瘀证计分、心绞痛计分、hsCRP、血脂指标的影响。
方法:本研究白2008年3月至2008年9月,严格按照RCT的要求采用前瞻性、随机、对照研究方案,选取介入治疗后的不稳定性心绞痛患者63例,后剔除2例,可评价患者61例,其中活血解毒组30例,活血组31例。两组均给予西医标准化药物治疗,均在接受介入治疗后48小时内给予中药干预治疗两周,活血解毒组在常规西药治疗的同时加口服芎芍胶囊2粒,3次/日,黄连胶囊2粒,3次/日,用药2周。活血组在常规西药治疗的同时加口服芎芍胶囊2粒,3次/日,用药2周。用药两周后随访,对治疗前后心绞痛计分、治疗前后中医主症计分、血瘀证计分、实验性指标观测(包括hsCRP、Cr、ALT、血脂:TC、TG、LDL、HDL)、治疗前后心电图、安全性观察:观察患者服药期间可能出现的不良反应,记录其发生时间、评估严重程度。以后每3个月门诊或电话随访1次,重点观察生存质量、终点指标发生的情况。
结果:两组病例治疗前后在心绞痛疗效、心电图疗效及总体疗效方面,均疗效显著,组间比较无显著差异,疗效相当。两组病例治疗前后在降低心绞痛计分、血瘀证计分、改善中医主症计分方面均有统计学意义,但组间比较无显著差异,疗效相当。与活血组相比,活血解毒组有进一步降低不稳定性心绞痛患者心绞痛计分的作用趋势。
在西医常规治疗基础上,活血解毒组可显著降低冠心病不稳定性心绞痛患者的hsCRP水平,而活血组效果不显著(P＞0.05)。提示:在西医常规治疗基础上加用活血解毒中药,可显著降低不稳定性心绞痛患者血hsCRP水平,效果优于单纯活血药物治疗组。各中医证型治疗前后hsCRP分析发现,“痰热血瘀”证治疗前后比较有统计学意义(P＜0.05),其它证型治疗前后比较无统计学意义(P＞0.05),提示活血解毒药物可能对“血瘀痰热”证患者的证候疗效更佳。
在西医常规治疗基础上,两组治疗后TC、LDL水平较治疗前显著降低,组间比较无显著性差异(P＞0.05)。两组治疗前后TG和HDL水平无明显变化(P＞0.05)。
结论:活血解毒药物在降低炎症指标、改善心绞痛症状方面有一定疗效,且服用安全,活血解毒法在冠心病不稳定性心绞痛的治疗中有一定的临床意义,值得进一步深入研究。
ACS is the severe and critical disease in CAD.Although modern medicine has made substantial progress in recent years, its high mortality and disability rates are still a big problem in clinical practice.In order to improve the therapeutic and preventive effects on ACS with TCM, we followed the toxin-stasis theory through analyzing the traditional medical literature and combining modern pathophysiologic mechanisms of ACS, to conduct a prospective clinical research to explore the diagnostic standard of the toxin-stasis syndrome and the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.
This study is divided into two parts: review and clinical study.
1.Review: This part includes 2 reviwes,the research progress between traditional Chinese medicine toxin-stasis pathogenesis and atherosclerotic vulnerable plaque, and the diagnosis and treatment progress in ACS.
2. Clinical research: Including the following two parts.
Part 1: The Clinical Research on the Differentiation Standard for Toxin-stasis Syndrome of ACS in Chinese Medicine.
Objective: To provide the objective and scientific evidence for differentiation Standard of toxin-stasis syndrome of ACS in Chinese medicine.
Method: This research continued from March of 2008 to March of 2009.According to the requirement of large sample, multicenter, prospective clinical epidemiology, we investigated 165 patients with ACS treated by PCI and conventional medicine. The content of CRF included registering date, past medical history, diagnosis, the grade of patient's condition, the result of coronary angiography and laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms、BBS and angina. And then we imported these data into database.There were several statistical methods used in the analysis, including Frequencies, Logistic regression, Principal components analysis and correlation. We summarized objectively the differentiation Standard for toxin-stasis syndrome of ACS in Chinese medicine.
Result: Integrating clinical practice, we filtered the syndrome factors and risk factors of the toxin-stasis syndrome of ACS, the syndrome factors including the blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience, Qi stagnatin. And blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience were positive correlation to the toxin-stasis syndrome, Qi stagnatin was negative correlation to the toxin-stasis syndrome. The risk factors including the high level of LDL-C, diabetes mellitus, stroke, smoking and previous myocardial infarction. In these risk factors, the high level of LDL-C was the most strong than others.
Applying principal components analysis, we found the primary symptoms. Then according to the combination of syndrome factors, we classified two sort of syndrome factors,the one was deficience syndrome,the other was excess syndrome.And the primary symptoms were divided on the basis of the classification of syndrome factors, Finally, we gained the result of differentiation Standard of the TCM toxin-stasis syndrome of ACS. The one is toxin-stasis with deficiency syndrome, the symptoms including chest pain, chest distress, lassitude, short breath, palpatation, spontaneous perspiration, tongue pale and dark, thready pulse. The other is toxin-stasis with excess syndrome, the symptoms including chest pain, chest distress, bitter taste in the mouth, thirst and polydipsia, constipation, tongue red and dark, fur yellow and wax, slippery pulse.
Conclusion: According to the results of mathematical statistics combining with theory of TCM, it is found that the differentiation standard of the TCM toxin-stasis syndrome of ACS has its regularity , and is worth extending and studying further.
Part 2: Clinical Randomized Controlled Study on UA Intervened by Chinese Medicine for Activating Blood Circulation and Detoxicating.
Objective: To evaluate the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.
Method: By designing a prospective randomized controlled research program, we observed 61 patients diagnosed by UA and treated by PCI and conventional medicine. 31 patients were divided into the treatment group of activating blood circulation and detoxicating, 30 patients were divided into the control group of activating blood circulation. the treatment group was treated by Xiongshao capsule and Huanglian capsule, the control group was treated by Xiongshao capsule alone. The period of taking medicine is two weeks, then we observed the result of laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms、BBS and angina, and compared the effects between pre-treatment and post-treatment.
Result: Based on the conventional treatment, the treatment group could lower the level of hsCRP, there was significant difference compared to that of control group. Comparing with the control group, the treatment group seemed to show superiority in lowering the score of UA. Analysis to the effect on the pattern of syndrome indicated that phlegm with pyretic syndrome combined blood stasis syndrome was most obvious pattern treated by Chinese medicine for activating blood circulation and detoxicating.
Conclusion: The treatment of activating blood circulation and detoxicating could decrease the level of hsCRP and relieve the symptoms of UA, there was some significance to treat UA with the Chinese Medicine for activating blood circulation and detoxicating.
我们通过对古代文献“瘀”“毒”理论的整理发掘,结合现代医学动脉粥样硬化“炎症”学说、冠心病病理生理机制的观念更新,认同动脉粥样硬化、冠心病“瘀毒”致病理论。本文第一部分利用临床流行病学和数理统计方法对急性冠脉综合征中医“瘀毒”证的辨证标准进行了探索;第二部分采用活血解毒药物干预不稳定性心绞痛,对活血解毒药物治疗不稳定性心绞痛的疗效进行评价。
第一部分急性冠脉综合征中医“瘀毒”证的临床辨证标准研究
背景:目前由于缺少根据临床调查总结出的冠心病急性冠脉综合征中医“瘀毒”证的临床辨证标准,影响了临床研究的进一步深入进行。因此亟待我们用客观科学的方法对急性冠脉综合征中医“瘀毒”证的辨证标准进行研究。
目的:采用临床流行病学和数理统计多因素分析方法,结合临床实践,为急性冠脉综合征中医“瘀毒”证的辨证提供客观科学的依据。
方法:本研究自2008年3月之2009年3月,运用大样本、多中心、横断面、前瞻性的临床流行病学调查方法对北京3所三甲医院的165例ACS患者进行调查,调查内容包括:一般资料、既往病史、西医诊断、病情分级、冠脉造影结果、实验室检查结果、症状、体征、中医证型、中医主症计分、血瘀证计分、心绞痛计分。建立数据库,统计方法采用频数分析、卡方检验、logistic回归分析、主成分分析、相关分析等多因素分析方法,结合临床实践,提取出急性冠脉综合征中医“瘀毒”证的证候要素,对证候要素进行相关组合分析,分为虚实两类。对主成分分析提取的主要症状按虚实分类,总结出了急性冠脉综合征中医“瘀毒”证的辨证标准。
结果:初步总结出“瘀毒”证的临床辨证分型,分为虚实两型:“瘀毒”实证:胸痛,胸闷,口苦,口干欲饮,便干便秘,舌暗红,苔黄腻,脉滑。“瘀毒”虚证:胸痛、胸闷,气短,乏力,心悸,畏寒,自汗,舌淡暗,苔白,脉细。虚实证常互相影响,兼夹为病,实证日久可耗气伤阴,由实转虚;虚证日久则易化生瘀毒痰浊之邪,且正气虚弱,无力祛邪,以致虚实夹杂,形成恶性循环,变证丛生。
Logistic回归分析发现,LDL-C水平升高、陈旧心梗病史、吸烟、糖尿病、肌钙蛋白阳性、脑卒中病史为“瘀毒”证的危险因素。其中,LDL-C的回归系数B值最大,说明LDL-C水平升高是“瘀毒”证发生发展的最重要危险因素;其相对危险度Exp(B)为3.942。其他因素按相关程度大小排列依次是陈旧心梗病史、吸烟史、糖尿病病史、肌钙蛋白阳性、脑卒中病史,相对危险度分别是:3.812、3.345、2.898、1.717、1.640。
结论:通过数理统计的结果与中医理论相结合,可以得出相对客观的急性冠脉综合征中医“瘀毒”证的辨证诊断标准,前瞻性的临床调查与多因素数理统计分析相结合是进行急性冠脉综合征中医“瘀毒”证辨证标准客观化研究的一种有效方法,值得进一步深入研究。
第二部分活血解毒中药干预不稳定性心绞痛的临床随机对照研究
背景:不稳定性心绞痛是指介于稳定性心绞痛和急性心肌梗死之间的一组临床心绞痛综合征,从中医角度属“胸痹心痛”范畴,其基本病机则是心脉瘀阻,血瘀证是不稳定性心绞痛最常见的证型之一。活血化瘀法治疗不稳定性心绞痛已经进行了大量临床研究,取得了一定成效。近年有学者根据现代医学研究进展,结合中医学有关“瘀毒”致病的病因病机学说,提出了冠心病“瘀毒”致病理论并进行了一些相关研究。前期研究证实活血解毒中药具有稳定易损斑块、抑制炎症、调节血脂等功效。那么临床上它是否能够改善心绞痛症状,抑制炎症指标、改善不稳定性心绞痛患者预后,从而发挥对不稳定性心绞痛的治疗作用呢?因此我们按照RCT试验的要求对活血解毒中药干预不稳定性心绞痛的疗效进行进一步的探讨与研究。
目的:探讨在常规西医治疗的基础上活血解毒中药对不稳定性心绞痛的治疗效果,观察其治疗前后对不稳定性心绞痛患者中医症状、血瘀证计分、心绞痛计分、hsCRP、血脂指标的影响。
方法:本研究白2008年3月至2008年9月,严格按照RCT的要求采用前瞻性、随机、对照研究方案,选取介入治疗后的不稳定性心绞痛患者63例,后剔除2例,可评价患者61例,其中活血解毒组30例,活血组31例。两组均给予西医标准化药物治疗,均在接受介入治疗后48小时内给予中药干预治疗两周,活血解毒组在常规西药治疗的同时加口服芎芍胶囊2粒,3次/日,黄连胶囊2粒,3次/日,用药2周。活血组在常规西药治疗的同时加口服芎芍胶囊2粒,3次/日,用药2周。用药两周后随访,对治疗前后心绞痛计分、治疗前后中医主症计分、血瘀证计分、实验性指标观测(包括hsCRP、Cr、ALT、血脂:TC、TG、LDL、HDL)、治疗前后心电图、安全性观察:观察患者服药期间可能出现的不良反应,记录其发生时间、评估严重程度。以后每3个月门诊或电话随访1次,重点观察生存质量、终点指标发生的情况。
结果:两组病例治疗前后在心绞痛疗效、心电图疗效及总体疗效方面,均疗效显著,组间比较无显著差异,疗效相当。两组病例治疗前后在降低心绞痛计分、血瘀证计分、改善中医主症计分方面均有统计学意义,但组间比较无显著差异,疗效相当。与活血组相比,活血解毒组有进一步降低不稳定性心绞痛患者心绞痛计分的作用趋势。
在西医常规治疗基础上,活血解毒组可显著降低冠心病不稳定性心绞痛患者的hsCRP水平,而活血组效果不显著(P＞0.05)。提示:在西医常规治疗基础上加用活血解毒中药,可显著降低不稳定性心绞痛患者血hsCRP水平,效果优于单纯活血药物治疗组。各中医证型治疗前后hsCRP分析发现,“痰热血瘀”证治疗前后比较有统计学意义(P＜0.05),其它证型治疗前后比较无统计学意义(P＞0.05),提示活血解毒药物可能对“血瘀痰热”证患者的证候疗效更佳。
在西医常规治疗基础上,两组治疗后TC、LDL水平较治疗前显著降低,组间比较无显著性差异(P＞0.05)。两组治疗前后TG和HDL水平无明显变化(P＞0.05)。
结论:活血解毒药物在降低炎症指标、改善心绞痛症状方面有一定疗效,且服用安全,活血解毒法在冠心病不稳定性心绞痛的治疗中有一定的临床意义,值得进一步深入研究。
ACS is the severe and critical disease in CAD.Although modern medicine has made substantial progress in recent years, its high mortality and disability rates are still a big problem in clinical practice.In order to improve the therapeutic and preventive effects on ACS with TCM, we followed the toxin-stasis theory through analyzing the traditional medical literature and combining modern pathophysiologic mechanisms of ACS, to conduct a prospective clinical research to explore the diagnostic standard of the toxin-stasis syndrome and the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.
This study is divided into two parts: review and clinical study.
1.Review: This part includes 2 reviwes,the research progress between traditional Chinese medicine toxin-stasis pathogenesis and atherosclerotic vulnerable plaque, and the diagnosis and treatment progress in ACS.
2. Clinical research: Including the following two parts.
Part 1: The Clinical Research on the Differentiation Standard for Toxin-stasis Syndrome of ACS in Chinese Medicine.
Objective: To provide the objective and scientific evidence for differentiation Standard of toxin-stasis syndrome of ACS in Chinese medicine.
Method: This research continued from March of 2008 to March of 2009.According to the requirement of large sample, multicenter, prospective clinical epidemiology, we investigated 165 patients with ACS treated by PCI and conventional medicine. The content of CRF included registering date, past medical history, diagnosis, the grade of patient's condition, the result of coronary angiography and laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms、BBS and angina. And then we imported these data into database.There were several statistical methods used in the analysis, including Frequencies, Logistic regression, Principal components analysis and correlation. We summarized objectively the differentiation Standard for toxin-stasis syndrome of ACS in Chinese medicine.
Result: Integrating clinical practice, we filtered the syndrome factors and risk factors of the toxin-stasis syndrome of ACS, the syndrome factors including the blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience, Qi stagnatin. And blood stasis, phlegm with pyretic syndrome, Qi deficience, Yin deficience were positive correlation to the toxin-stasis syndrome, Qi stagnatin was negative correlation to the toxin-stasis syndrome. The risk factors including the high level of LDL-C, diabetes mellitus, stroke, smoking and previous myocardial infarction. In these risk factors, the high level of LDL-C was the most strong than others.
Applying principal components analysis, we found the primary symptoms. Then according to the combination of syndrome factors, we classified two sort of syndrome factors,the one was deficience syndrome,the other was excess syndrome.And the primary symptoms were divided on the basis of the classification of syndrome factors, Finally, we gained the result of differentiation Standard of the TCM toxin-stasis syndrome of ACS. The one is toxin-stasis with deficiency syndrome, the symptoms including chest pain, chest distress, lassitude, short breath, palpatation, spontaneous perspiration, tongue pale and dark, thready pulse. The other is toxin-stasis with excess syndrome, the symptoms including chest pain, chest distress, bitter taste in the mouth, thirst and polydipsia, constipation, tongue red and dark, fur yellow and wax, slippery pulse.
Conclusion: According to the results of mathematical statistics combining with theory of TCM, it is found that the differentiation standard of the TCM toxin-stasis syndrome of ACS has its regularity , and is worth extending and studying further.
Part 2: Clinical Randomized Controlled Study on UA Intervened by Chinese Medicine for Activating Blood Circulation and Detoxicating.
Objective: To evaluate the effects on UA treated by Chinese medicine for activating blood circulation and detoxicating.
Method: By designing a prospective randomized controlled research program, we observed 61 patients diagnosed by UA and treated by PCI and conventional medicine. 31 patients were divided into the treatment group of activating blood circulation and detoxicating, 30 patients were divided into the control group of activating blood circulation. the treatment group was treated by Xiongshao capsule and Huanglian capsule, the control group was treated by Xiongshao capsule alone. The period of taking medicine is two weeks, then we observed the result of laboratory examination, the symptoms, the physical sign and the pattern of TCM, the score of primary symptoms、BBS and angina, and compared the effects between pre-treatment and post-treatment.
Result: Based on the conventional treatment, the treatment group could lower the level of hsCRP, there was significant difference compared to that of control group. Comparing with the control group, the treatment group seemed to show superiority in lowering the score of UA. Analysis to the effect on the pattern of syndrome indicated that phlegm with pyretic syndrome combined blood stasis syndrome was most obvious pattern treated by Chinese medicine for activating blood circulation and detoxicating.
Conclusion: The treatment of activating blood circulation and detoxicating could decrease the level of hsCRP and relieve the symptoms of UA, there was some significance to treat UA with the Chinese Medicine for activating blood circulation and detoxicating.
引文
[1]丁书文,李晓,李运伦.热毒学说在心系疾病中的构建与应用.山东中医药大学学报,2004,28(6):413-416.
[2]周明学,徐浩,陈可冀.中医脂毒、瘀毒与易损斑块关系的理论探讨.中国中医基础杂志,2007,13(10):737-738.
[3]于俊生,王砚琳.痰瘀毒相关论.山东中医杂志,2000,19(6):323-325.
[4]韩学杰,沈绍功.中医心病痰瘀互结毒损心络的理论渊源.中国中医急症,2007,16(10):1169-1172.
[5]杜武勋,刘长玉,刘梅,等.热瘀痰湿毒与急性心肌梗死发病机理的探讨.辽宁中医杂志,2007,34(4):427-428.
[6]徐浩,史大卓,殷惠军,等.“瘀毒致变”与急性心血管事件:假说的提出与临床意义.中国中西医结合杂志,2008,28(10):934-938.
[7]朱愉,多秀瀛.实验动物的疾病模型.天津:天津科技翻译出版社,1997.163-168.
[8]Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I.Circulation,2003,108(14):1664-1672.
[9]Zhang SH,Reddick RL,Piedrahita JA,et al.Spontaneous hypercholesterolemia and arterial lesions in mice lacking apolipoproteinE.Science,1992,258(5081):468-471.
[10]Cullen P,Baetta R,Bellosta S,et al.Rupture of the atherosclerotic plaque:does a good animal model exist?Arterioscler Thromb Vasc Biol,2003,23(4):535-542.
[11]杨进,陆平成.家兔“热毒血瘀证”系列动物模型的试制.南京中医药大学学报,1995,11(2):70-72.
[12]陆付耳,冷三华,屠庆年,等.黄连解毒汤与黄连素对2型糖尿病大鼠葡萄 糖和脂质代谢影响的比较研究.华中科技大学学报(医学版),2002,31(6):662-664.
[13]葛岚,程晓昱,胡业彬.益气活血解毒汤对实验性动脉粥样硬化家兔血脂及炎症细胞因子的影响.中国中西医结合急救杂志,2007,14(5):306-308.
[14]吴圣贤,吴雪莲,黄政鑫,等.解毒软脉方抗动脉粥样硬化17例初步临床观察.福建中医药,2000,31(5):8-9.
[15]吴智春,吴凯,王浩,等.金匮泻心汤抗动脉粥样硬化的实验研究.中国老年学杂志,2003,23(7):461-462.
[16]程向缨,王拥军,温玫,等.中药总蒽醌粗提物对低密度脂蛋白氧化的抑制作用.中国老年学杂志,2000,20(5):299.
[17]史青,聂淑琴,杨庆.清脂胶囊对热毒血瘀证大鼠内皮功能及血液流变学的影响.中国实验方剂学杂志,2004,10(1):28-31.
[18]熊一力,赵华月,付良武.穿心莲成分 API0134和阿司匹林对内皮细胞抗血栓功能的影响.中华血液学杂志,1998,14(10):530-533.
[19]赵明镜,王硕仁,李秋梅,等.益气活血解毒方抑制家兔经皮血管腔内成形术后再狭窄的实验研究.中国实验方剂学杂志,2007,16(3):32-36.
[20]赵明镜,王硕仁,李秋梅,等.益气活血解毒方和血府逐瘀胶囊抑制再狭窄中细胞外基质的对比研究.中西医结合心脑血管病杂志,2005,12(3):1061-1063.
[21]彭哲,王硕仁,李秋梅,等.解毒活血益气方药物血清对兔血管平滑肌细胞增殖及脂质过氧化的影响.中国医药学报,2004,19(6):341-343.
[22]郭来,田雅茹,丁书文,等.复方莶草合剂对兔动脉粥样硬化内皮细胞一氧化氮合酶基因表达的影响.北京中医药大学学报,2005,16(5):215-217.
[23]邓弈辉,李定祥,喻嵘,等.滋阴活血解毒中药对血管内皮细胞损伤的保护作用.中国中医药信息杂志,2008,15(6):27-29.
[24]彭哲,王春林,祝光礼,等.活血解毒益气方对兔 PTCA 术后血管内皮功能的影响.中华中医药学刊,2008,26(3):600-601.
[25]文川,徐浩,黄启福,等.活血中药对基因缺陷小鼠血脂及动脉粥样硬化斑块炎症反应的影响.中国中西医结合杂志,2005,25(4):345-349.
[26]张京春,陈可冀,郑广娟,等.解毒活血中药配伍对载脂蛋白 E 基因敲除小鼠主动脉 NF-κB 与 MMP-9表达的调控作用.中国中西医结合杂志,2007,27(1):40-44.
[27]周明学,徐浩,陈可冀,等.活血解毒中药有效部位对 ApoE 基因敲除小鼠血脂和动脉粥样硬化斑块炎症反应的影响.中国中西医结合杂志,2008,28(2):126-130.
[28]赵玉霞,刘运芳,张梅.祛瘀消斑胶囊对动脉粥样斑块组织学构成的临床研究.上海中医药杂志,2001,35(12):13-14.
[29]卢笑辉,丁书文.黄连解毒胶囊治疗不稳定型心绞痛临床疗效及作用机制研究.山东中医药大学学报,2005,29(6):24-28.
[30]魏陵博,戎冬梅,彭敏,等.解毒通络合剂治疗不稳定型心绞痛的临床研究.中西医结合心脑血管病杂志,2007,5(7):568-570.
[31]耿立梅,陈分乔,王亚利.解毒活血法治疗冠心病(热毒瘀结型)临床观察及其对 CRP、vwF 的影响.新中医,2006,38(10):30-31.
[1]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[2]胡大一,许玉韵.循证心血管病学.天津:天津科学技术出版社,2001.149.
[3]Arialdi M.Mini(?)o,Melonie P.Heron,Sherry L.Murphy,et al.Deaths:Final data for 2004.National vital statistics reports,2007,55(19):1-120.
[4]American Heart Association.Heart disease and stroke statistics 2008update:A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation,2008,117:e25-e146.
[5]American Heart Association.Heart disease and stroke statistics 2009update:A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation,2009,119:480-486.
[6]陈灏珠.实用内科学.北京:人民卫生出版社,2005.1467.
[7]王薇,赵冬,孙佳艺,等.中国11省市队列人群危险因素与不同类型心血管病发病危险的比较.中华心血管病杂志,2006,34(12):1133-1137.
[8]王薇,赵冬,姚丽,等.北京地区急性冠心病事件病死率的流行病学研究.中华心血管病杂志,2006,28(3):228-231.
[9]陈在嘉,高润霖.冠心病.北京:人民卫生出版社,2002.797.
[10]中华医学会心血管病学分会.不稳定性心绞痛诊断和治疗指南.中华心血管病杂志,2000,28(6):409-412.
[11]中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南.中华心血管病杂志,2001,29(12):705-720.
[12]陈敏章.中华内科学.北京:人民卫生出版社,1999.68.
[13]Wagner GS,Macfarlane P,Wellens H,et al.AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram:Part Ⅵ:Acute ischemia/infarction.JACC,2009,19(2):1-11.
[14]陆再英,钟南山.内科学.北京:人民卫生出版社,2008.285.
[15]Sgarbossa EB,Pinski SL,Barbagelata A,et al.Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle branch block.GUSTO-1(global utilization ofstreptokinase and tissue plasminogen activator for occluded coronary arteries)Investigators.N Engl J Med,1996,334:481-487.
[16]Shlipak MG,Lyons WL,Go AS,et al.Should the electrocardiogram be used to guide therapy for patients with left bundle branch block and suspected myocardial infarction?JAMA,1999,281:714-719.
[17]Wong CK,French JK,Aylward PE,et al.Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes.JACC,2005,46:29-38.
[18]陈文彬,潘祥林.诊断学.北京:人民卫生出版社,2008.391-395.
[19]Kristian Thygesen,Joseph S.Alpert,Harvey D.White.Universal definition of myocardial infarction.JACC,2007,50(22):2173-2195.
[20]Pamela S.Douglas,Raymond F.Stainback,Eric D.Peterson,et aI.ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness criteria for stress echocardiography.JACC,2008,51:1127-1147.
[21]Francis J.Klocke,Michael G.Baird,Beverly H.Lorell,et al.ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging executive summary.Circulation,2003,108;1404-1418.
[22]Christian W.Hamm,Eugene Braunwald.A classification of unstable angina revisited.Circulation,2000,102:118-122.
[23]Antman EM,Cohen M,Bernink PJ,et al.The TIMI risk score for unstable angina/non-ST elevation MI:A method for prognostication and therapeutic decision making.JAMA,2000,284(7):835-842.
[24]Eric Boersma,Karen S.Pieper,Ewout W.Steyerberg,et al.Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation:results from an international trial of 9461 patients.Circulation,2000,101(6):2557-2567.
[25]See R,de Lemos JA.Current status of methods in acute coronary syndromes.Curr Cardiol Rep,2006,8(4):282-288.
[26]Avezum A,Makdisse M,Spencer F,et al.Impact of age on management and outcome of acute coronary syndrome:observations from the global registry of acute coronary events(GRACE).Am Heart J,2005,149(1):67-73.
[27]Peter Libby,Robert 0.Bonow,Douglas L.Mann.Braunwald's heart disease:A Textbook of cardiovascular medicine.Saunders:An imprint of elsevier,2007.1234.
[28]Armstrong,Eric R.Bates,Lee A.Green,et al.2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction.JACC,2008,51(2):210-247.
[29]Chen ZM,Pan HC,Chen YP,et al.Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction:randomised placebo-controlled trial.Lancet,2005,366(9497):1622-32.
[30]Pfeffer MA,McMurray JJ,Velazquez EJ,et al.Valsartan,captopril,or both in myocardial infarction complicated by heart failure,left ventricular dysfunction,or both.N Engl J Med,2003,349(20):1893-1906.
[31]Stone GW,Ohman EM,Miller MF,et al.Contemporary utilization and outcomes Of intra-aortic balloon counterpulsation in acute myocardial infarction:the benchmark registry.JACC,2003,41(11):1940-1945.
[32]ACC/AHA task force on practice guidelines.ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction.JACC,2007,50(7):652-726.
[33]Anselm K.Gitt,Amadeo Betriu.Antiplatelet therapy in acute coronary syndrome.European Heart Journal Supplements,2008,10:A4-A12.
[34]Sean C.Beinart,Paul Kolm,Emir Veledar,et al.Long-Term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention:Results from the clopidogrel for the reduction of events during observation(CREDO)Trial.JACC,2005,46(9):761-769.
[35]Jack Hirsh,Deepak L.Bhatt.Comparative benefits of clopidogrel and aspirin in high-risk patient populations:Lessons from the CAPRIE and CURE studies.Arch Intern Med,2004,164(10):2106-2110.
[36]Cindy L.Grines,Robert 0.Bonow,Donald E.Casey,et al.Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents:A science advisory from the American Heart Association,American College of Cardiology,Society for Cardiovascular Angiography and Interventions,American College of Surgeons,and American Dental Association,With Representation From the American College of Physicians.Circulation,2007,115:813-818.
[37]Mehta SR,Yusuf S,Peters RJ,et al.Effects of pretreatment withclopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention:the PCI-CURE study.Lancet,2001,358:527-33.
[38]Frojmovic M,Labarthe B,Legrand C.Inhibition and reversal of platelet aggregation by alphaⅡbbetaⅢa antagonists depends on the anticoagulant and flow condition differential effects of abciximab and lamifiban.Br J Haematol,2005,131(3):348-355.
[39]Adgey AA.An overview of the results of clinical trials with glycoprotein Ⅱb/Ⅲa inhibitors.Eur Heart J,1998,19:D10-21.
[40]The RESTORE Investigators.Effects of platelet glycoprotein Ⅱb/Ⅲa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty.Circulation,1997,96:1445-1453.
[41]James C.Blankenship,Gudaye Tasissa,J.Conor O'Shea,et al.Effect of glycoprotein Ⅱb/Ⅲa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial.JACC,2001,38(3):653-658.
[42]Julinda Mehilli,Adnan Kastrati,Helmut Schtlhlen,et al.Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel.Circulation,2004,110:3627-3635.
[43]Westerhout CM,Boersma E.Risk-benefit analysis of platelet Glycoprotein Ⅱb/Ⅲa inhibitors in acute coronary syndromes.Expert Opin Drug Saf,2003,2(1):49-58.
[44]Hirsh J,Raschke R.Heparin and low molecular weight heparin:the seventh ACCP conference on antithrombotic and thrombolytic therapy.Chest,2004,126:188S-203S.
[45]Oler A,Whooley MA,Oler J,Grady D.Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina.A meta-analysis.JAMA,1996;276:811-5.
[46]Becker RC,Ball SP,Eisenberg P,et al.A randomized,multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease Antithrombotic therapy consortium investigators.Am Heart J,1999,137:59-71.
[47]Weitz JL Low-molecular-weight heparins.N Engl J Med,1997,337:688-698.
[48]Giraldez RR,Nicolau JC,Corbalan R,et al.Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic:An ExTRACT-TIMI 25 analysis.Eur Heart J,2007,28(23):2952.
[49]Thomas D,Giugliano RP.Antiplatelet therapy in early management of non-ST-segment elevation acute coronary syndrome:the 2002 and 2007 guidelines from north America and Europe.J Cardiovasc Pharmacol,2008,51(5):425-433.
[50]Stone GW,McLaurin BT,Cox DA,et al.Bivalirudin for patients with acute coronary syndromes.N Engl J Med,2006,355:2203-2216.
[51]Barbara S.Wiggins,Sarah Spinier.Antiplatelet and antithrombin therapy for early management of acute coronary syndromes.Journal of Pharmacy Practice,2004,17(10):347-369.
[52]中华医学会心血管病学分会.经皮冠状动脉介入治疗指南.中华心血管病杂志,2002;30(12):707-718.
[53]中华医学会心血管病学分会.经皮冠状动脉介入治疗指南(2009).中华心血管病杂志,2009;37(1):4-25.
[54]Moon JC,Kalra PR,Coats AJ.DANAMI-2:Is primary angioplasty superior to thrombolysis in acute MI when the patients has to be transferred to an invasive centre?Int J Cardiol,2002,85:199-201.
[55]Assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention(ASSENT-4 PCI) investigators.primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction(ASSENT-4PCI)randomized trial.Lancet,2006,367:569-578.
[56]ACC/AHA/SCAI task force on practice guidelines.2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention.JACC,2008,51(2):172-207.
[57]汪曾伟,刘维永,张宝仁.心脏外科学.北京:人民军医出版社,2003.1427.
[58]Peter B.Berger,Michael H.Sketch,Robert M.Califf.Choosing between percutaneous coronary intervention and coronary artery bypass grafting for patients with multivessel disease:What can we learn from the arterial revascularization therapy study(ARTS)? Circulation,2004,109:1079-I081.
[59]Ferguson TB Jr,Hammill BG,Peterson ED,et al.A decade of change—risk profiles and outcomes for isolated coronary artery bypass grafting procedures,1990-1999:a report from the STS NationalDatabase Committee and the Duke Clinical Research Institute.Ann ThoracSurg,2002,73(2):480-489.
[60]胡盛寿.“药物支架时代”冠状动脉旁路移植术的角色与思考.中国医学信息导报,2007,22(13):13-15.
[61]Claude Lenfant,AramV.Chobanian,Daniel W.Jones,et al.The seventh report of the Joint National Committee on prevention,detection,evaluation,and treatment of high blood pressure(JNC 7).Hypertension,2003,41:1178-1179.
[62]NHLB,ACC,AHA.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel Ⅲ guidelines.Circulation,2004,110:227-239.
[63]方圻,王钟林,宁田海,等.血脂异常防治建议.中华心血管病杂志,1997,25(3):169-171.
[64]中国成人血脂异常防治指南联合制定委员会.中国成人血脂异常防治指南.中华心血管病杂志,2007,35(5):390-409.
[65]Stephen DW,Christopher PC,David AM,et al.Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy:A PROVE IT-TIMI 22 substudy.JACC,2005,46(10):1411-1416.
[66]Bertram Pitt,George Bakris,Luis M.Ruilope,et al.Serum potassium and clinical outcomes in the eplerenone post-acute myocardial infarction heart failure efficacy and survival study(EPHESUS).Circulation,2008,118(10):1643-1650.
[67]Andreotti F,Testa L,Blondi-Zoccai,et al.Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes:an updated and comprehensive meta-analysis of 25307 patients.Eur Heart J,2006,27:519-526.
[1]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[2]Armstrong,Eric R.Bates,Lee A.Green,et al.2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction.JACC,2008,51(2):210-247.
[3]中国中西医结合学会活血化瘀专业委员会.血瘀证诊断标准.中西医结合杂志,1987,7(3):129.
[4]中国中西医结合学会心血管病学会.冠心病中医诊断标准.中西医结合杂志,1991,11(5):257.
[5]张志斌,王永炎.辨证方法新体系的建立.北京中医药大学学报,2005,28(1):2-3.
[6]徐浩.活血解毒中药抗炎及稳定易损斑块的探索与思考.中国中西医结合杂志,2008,28(5):393-394.
[7]丁书文,李晓,李运伦.热毒学说在心系疾病中的构建与应用.山东中医药大学学报,2004,28(6):413-416.
[8]吴秀纪,王天芳.中医证候诊断标准的研究思路.新中医,2007,39(3):1-3.
[9]方积乾.医学统计学与电脑实验.上海:上海科学技术出版社,2001.204.
[10]JUPITER Study Group.Rosuvastatin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein.N Engl J Med,2008,359:2195-2207.
[11]Castelli WP.Lipids,risk factors and ischaemic heart disease.Atherosclerosis,1996,124:S1-9.
[12]Kannel WB,Higgins M.Smoking and hypertension as predictors of cardiovascular risk in population studies.Hypertens Suppl,1990,8(5):S3-8.
[13]Nasr CE,Hoogwerf BJ,Faiman C,Reddy SS.United Kingdom Prospective Diabetes Study(UKPDS).Effects of glucose and blood pressure control on complications of type 2 diabetes mellitus.Cleve Clin J Med,1999,66(4):247-53.
[14]Lenderrink T,Boersma E,Heeschen C,et al.Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with fefractory unstable angina,and troponin T predicts benefit of treatment with abcimab in combination with PTCA.Eur Heart J,2003,24(1):77-85.
[15]Antonio Coca,Franz H.Messerli,Athanase Benetos,et al.Predicting Stroke Risk in Hypertensive Patients With Coronary Artery Disease:A Report From the iNVEST.Stroke,2008,39:343-348.
[1]国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组报告.缺血性心脏病的命名及诊断标准.中华内科杂志,1981,20(4):254.
[2]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[3]中国中西医结合学会心血管分会.冠心病中医辨证标准.中国中西医结合杂志,1991,11(5):257.
[4]中国中西医结合学会活血化瘀专业委员会.血瘀证诊断标准.中西医结合杂志,1987,7(3):129.
[5]郑筱萸.中药新药临床研究指导原则(试行).中国医药科技出版社,2002,57-61.
[6]文川,徐浩,黄启福,等.几种活血中药对 ApoE 缺陷小鼠动脉粥样硬化斑块影响的形态学研究.中国病理生理杂志,2005,21(8):864-867.
[7]徐浩.活血解毒中药抗炎及稳定易损斑块的探索与思考.中国中西医结合杂志,2008,28(5):393-394.
[8]Hartford M,Wiklund O,Mattsson Hulten L,et al.C-reactive protein,interleukin-6,secretory phospholipase A_2 group Ⅱ A and intercellular adhension molecule-1 in the prediction of late outcome events after acute coronary syndromes.J Intern Med,2007,262(5):526-536.
[9]JUPITER Study Group.Rosuvastatin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein.N Engl J Med,2008,359:2195-2207.
[10]徐浩,史大卓,殷惠军,等.“瘀毒致变”与急性心血管事件:假说的提出与临床意义.中国中西医结合杂志,2008,28(10):934-938.
[11]陈可冀,史大卓,徐浩,等.活血化瘀中药干预冠心病介入治疗后再狭窄的多中心临床及机理研究.中国中西医结合杂志,2006,26(1):93.
[2]周明学,徐浩,陈可冀.中医脂毒、瘀毒与易损斑块关系的理论探讨.中国中医基础杂志,2007,13(10):737-738.
[3]于俊生,王砚琳.痰瘀毒相关论.山东中医杂志,2000,19(6):323-325.
[4]韩学杰,沈绍功.中医心病痰瘀互结毒损心络的理论渊源.中国中医急症,2007,16(10):1169-1172.
[5]杜武勋,刘长玉,刘梅,等.热瘀痰湿毒与急性心肌梗死发病机理的探讨.辽宁中医杂志,2007,34(4):427-428.
[6]徐浩,史大卓,殷惠军,等.“瘀毒致变”与急性心血管事件:假说的提出与临床意义.中国中西医结合杂志,2008,28(10):934-938.
[7]朱愉,多秀瀛.实验动物的疾病模型.天津:天津科技翻译出版社,1997.163-168.
[8]Naghavi M,Libby P,Falk E,et al.From vulnerable plaque to vulnerable patient:a call for new definitions and risk assessment strategies:Part I.Circulation,2003,108(14):1664-1672.
[9]Zhang SH,Reddick RL,Piedrahita JA,et al.Spontaneous hypercholesterolemia and arterial lesions in mice lacking apolipoproteinE.Science,1992,258(5081):468-471.
[10]Cullen P,Baetta R,Bellosta S,et al.Rupture of the atherosclerotic plaque:does a good animal model exist?Arterioscler Thromb Vasc Biol,2003,23(4):535-542.
[11]杨进,陆平成.家兔“热毒血瘀证”系列动物模型的试制.南京中医药大学学报,1995,11(2):70-72.
[12]陆付耳,冷三华,屠庆年,等.黄连解毒汤与黄连素对2型糖尿病大鼠葡萄 糖和脂质代谢影响的比较研究.华中科技大学学报(医学版),2002,31(6):662-664.
[13]葛岚,程晓昱,胡业彬.益气活血解毒汤对实验性动脉粥样硬化家兔血脂及炎症细胞因子的影响.中国中西医结合急救杂志,2007,14(5):306-308.
[14]吴圣贤,吴雪莲,黄政鑫,等.解毒软脉方抗动脉粥样硬化17例初步临床观察.福建中医药,2000,31(5):8-9.
[15]吴智春,吴凯,王浩,等.金匮泻心汤抗动脉粥样硬化的实验研究.中国老年学杂志,2003,23(7):461-462.
[16]程向缨,王拥军,温玫,等.中药总蒽醌粗提物对低密度脂蛋白氧化的抑制作用.中国老年学杂志,2000,20(5):299.
[17]史青,聂淑琴,杨庆.清脂胶囊对热毒血瘀证大鼠内皮功能及血液流变学的影响.中国实验方剂学杂志,2004,10(1):28-31.
[18]熊一力,赵华月,付良武.穿心莲成分 API0134和阿司匹林对内皮细胞抗血栓功能的影响.中华血液学杂志,1998,14(10):530-533.
[19]赵明镜,王硕仁,李秋梅,等.益气活血解毒方抑制家兔经皮血管腔内成形术后再狭窄的实验研究.中国实验方剂学杂志,2007,16(3):32-36.
[20]赵明镜,王硕仁,李秋梅,等.益气活血解毒方和血府逐瘀胶囊抑制再狭窄中细胞外基质的对比研究.中西医结合心脑血管病杂志,2005,12(3):1061-1063.
[21]彭哲,王硕仁,李秋梅,等.解毒活血益气方药物血清对兔血管平滑肌细胞增殖及脂质过氧化的影响.中国医药学报,2004,19(6):341-343.
[22]郭来,田雅茹,丁书文,等.复方莶草合剂对兔动脉粥样硬化内皮细胞一氧化氮合酶基因表达的影响.北京中医药大学学报,2005,16(5):215-217.
[23]邓弈辉,李定祥,喻嵘,等.滋阴活血解毒中药对血管内皮细胞损伤的保护作用.中国中医药信息杂志,2008,15(6):27-29.
[24]彭哲,王春林,祝光礼,等.活血解毒益气方对兔 PTCA 术后血管内皮功能的影响.中华中医药学刊,2008,26(3):600-601.
[25]文川,徐浩,黄启福,等.活血中药对基因缺陷小鼠血脂及动脉粥样硬化斑块炎症反应的影响.中国中西医结合杂志,2005,25(4):345-349.
[26]张京春,陈可冀,郑广娟,等.解毒活血中药配伍对载脂蛋白 E 基因敲除小鼠主动脉 NF-κB 与 MMP-9表达的调控作用.中国中西医结合杂志,2007,27(1):40-44.
[27]周明学,徐浩,陈可冀,等.活血解毒中药有效部位对 ApoE 基因敲除小鼠血脂和动脉粥样硬化斑块炎症反应的影响.中国中西医结合杂志,2008,28(2):126-130.
[28]赵玉霞,刘运芳,张梅.祛瘀消斑胶囊对动脉粥样斑块组织学构成的临床研究.上海中医药杂志,2001,35(12):13-14.
[29]卢笑辉,丁书文.黄连解毒胶囊治疗不稳定型心绞痛临床疗效及作用机制研究.山东中医药大学学报,2005,29(6):24-28.
[30]魏陵博,戎冬梅,彭敏,等.解毒通络合剂治疗不稳定型心绞痛的临床研究.中西医结合心脑血管病杂志,2007,5(7):568-570.
[31]耿立梅,陈分乔,王亚利.解毒活血法治疗冠心病(热毒瘀结型)临床观察及其对 CRP、vwF 的影响.新中医,2006,38(10):30-31.
[1]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[2]胡大一,许玉韵.循证心血管病学.天津:天津科学技术出版社,2001.149.
[3]Arialdi M.Mini(?)o,Melonie P.Heron,Sherry L.Murphy,et al.Deaths:Final data for 2004.National vital statistics reports,2007,55(19):1-120.
[4]American Heart Association.Heart disease and stroke statistics 2008update:A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation,2008,117:e25-e146.
[5]American Heart Association.Heart disease and stroke statistics 2009update:A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation,2009,119:480-486.
[6]陈灏珠.实用内科学.北京:人民卫生出版社,2005.1467.
[7]王薇,赵冬,孙佳艺,等.中国11省市队列人群危险因素与不同类型心血管病发病危险的比较.中华心血管病杂志,2006,34(12):1133-1137.
[8]王薇,赵冬,姚丽,等.北京地区急性冠心病事件病死率的流行病学研究.中华心血管病杂志,2006,28(3):228-231.
[9]陈在嘉,高润霖.冠心病.北京:人民卫生出版社,2002.797.
[10]中华医学会心血管病学分会.不稳定性心绞痛诊断和治疗指南.中华心血管病杂志,2000,28(6):409-412.
[11]中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南.中华心血管病杂志,2001,29(12):705-720.
[12]陈敏章.中华内科学.北京:人民卫生出版社,1999.68.
[13]Wagner GS,Macfarlane P,Wellens H,et al.AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram:Part Ⅵ:Acute ischemia/infarction.JACC,2009,19(2):1-11.
[14]陆再英,钟南山.内科学.北京:人民卫生出版社,2008.285.
[15]Sgarbossa EB,Pinski SL,Barbagelata A,et al.Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle branch block.GUSTO-1(global utilization ofstreptokinase and tissue plasminogen activator for occluded coronary arteries)Investigators.N Engl J Med,1996,334:481-487.
[16]Shlipak MG,Lyons WL,Go AS,et al.Should the electrocardiogram be used to guide therapy for patients with left bundle branch block and suspected myocardial infarction?JAMA,1999,281:714-719.
[17]Wong CK,French JK,Aylward PE,et al.Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes.JACC,2005,46:29-38.
[18]陈文彬,潘祥林.诊断学.北京:人民卫生出版社,2008.391-395.
[19]Kristian Thygesen,Joseph S.Alpert,Harvey D.White.Universal definition of myocardial infarction.JACC,2007,50(22):2173-2195.
[20]Pamela S.Douglas,Raymond F.Stainback,Eric D.Peterson,et aI.ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 Appropriateness criteria for stress echocardiography.JACC,2008,51:1127-1147.
[21]Francis J.Klocke,Michael G.Baird,Beverly H.Lorell,et al.ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging executive summary.Circulation,2003,108;1404-1418.
[22]Christian W.Hamm,Eugene Braunwald.A classification of unstable angina revisited.Circulation,2000,102:118-122.
[23]Antman EM,Cohen M,Bernink PJ,et al.The TIMI risk score for unstable angina/non-ST elevation MI:A method for prognostication and therapeutic decision making.JAMA,2000,284(7):835-842.
[24]Eric Boersma,Karen S.Pieper,Ewout W.Steyerberg,et al.Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation:results from an international trial of 9461 patients.Circulation,2000,101(6):2557-2567.
[25]See R,de Lemos JA.Current status of methods in acute coronary syndromes.Curr Cardiol Rep,2006,8(4):282-288.
[26]Avezum A,Makdisse M,Spencer F,et al.Impact of age on management and outcome of acute coronary syndrome:observations from the global registry of acute coronary events(GRACE).Am Heart J,2005,149(1):67-73.
[27]Peter Libby,Robert 0.Bonow,Douglas L.Mann.Braunwald's heart disease:A Textbook of cardiovascular medicine.Saunders:An imprint of elsevier,2007.1234.
[28]Armstrong,Eric R.Bates,Lee A.Green,et al.2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction.JACC,2008,51(2):210-247.
[29]Chen ZM,Pan HC,Chen YP,et al.Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction:randomised placebo-controlled trial.Lancet,2005,366(9497):1622-32.
[30]Pfeffer MA,McMurray JJ,Velazquez EJ,et al.Valsartan,captopril,or both in myocardial infarction complicated by heart failure,left ventricular dysfunction,or both.N Engl J Med,2003,349(20):1893-1906.
[31]Stone GW,Ohman EM,Miller MF,et al.Contemporary utilization and outcomes Of intra-aortic balloon counterpulsation in acute myocardial infarction:the benchmark registry.JACC,2003,41(11):1940-1945.
[32]ACC/AHA task force on practice guidelines.ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction.JACC,2007,50(7):652-726.
[33]Anselm K.Gitt,Amadeo Betriu.Antiplatelet therapy in acute coronary syndrome.European Heart Journal Supplements,2008,10:A4-A12.
[34]Sean C.Beinart,Paul Kolm,Emir Veledar,et al.Long-Term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention:Results from the clopidogrel for the reduction of events during observation(CREDO)Trial.JACC,2005,46(9):761-769.
[35]Jack Hirsh,Deepak L.Bhatt.Comparative benefits of clopidogrel and aspirin in high-risk patient populations:Lessons from the CAPRIE and CURE studies.Arch Intern Med,2004,164(10):2106-2110.
[36]Cindy L.Grines,Robert 0.Bonow,Donald E.Casey,et al.Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents:A science advisory from the American Heart Association,American College of Cardiology,Society for Cardiovascular Angiography and Interventions,American College of Surgeons,and American Dental Association,With Representation From the American College of Physicians.Circulation,2007,115:813-818.
[37]Mehta SR,Yusuf S,Peters RJ,et al.Effects of pretreatment withclopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention:the PCI-CURE study.Lancet,2001,358:527-33.
[38]Frojmovic M,Labarthe B,Legrand C.Inhibition and reversal of platelet aggregation by alphaⅡbbetaⅢa antagonists depends on the anticoagulant and flow condition differential effects of abciximab and lamifiban.Br J Haematol,2005,131(3):348-355.
[39]Adgey AA.An overview of the results of clinical trials with glycoprotein Ⅱb/Ⅲa inhibitors.Eur Heart J,1998,19:D10-21.
[40]The RESTORE Investigators.Effects of platelet glycoprotein Ⅱb/Ⅲa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty.Circulation,1997,96:1445-1453.
[41]James C.Blankenship,Gudaye Tasissa,J.Conor O'Shea,et al.Effect of glycoprotein Ⅱb/Ⅲa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial.JACC,2001,38(3):653-658.
[42]Julinda Mehilli,Adnan Kastrati,Helmut Schtlhlen,et al.Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel.Circulation,2004,110:3627-3635.
[43]Westerhout CM,Boersma E.Risk-benefit analysis of platelet Glycoprotein Ⅱb/Ⅲa inhibitors in acute coronary syndromes.Expert Opin Drug Saf,2003,2(1):49-58.
[44]Hirsh J,Raschke R.Heparin and low molecular weight heparin:the seventh ACCP conference on antithrombotic and thrombolytic therapy.Chest,2004,126:188S-203S.
[45]Oler A,Whooley MA,Oler J,Grady D.Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina.A meta-analysis.JAMA,1996;276:811-5.
[46]Becker RC,Ball SP,Eisenberg P,et al.A randomized,multicenter trial of weight-adjusted intravenous heparin dose titration and point-of-care coagulation monitoring in hospitalized patients with active thromboembolic disease Antithrombotic therapy consortium investigators.Am Heart J,1999,137:59-71.
[47]Weitz JL Low-molecular-weight heparins.N Engl J Med,1997,337:688-698.
[48]Giraldez RR,Nicolau JC,Corbalan R,et al.Enoxaparin is superior to unfractionated heparin in patients with ST elevation myocardial infarction undergoing fibrinolysis regardless of the choice of lytic:An ExTRACT-TIMI 25 analysis.Eur Heart J,2007,28(23):2952.
[49]Thomas D,Giugliano RP.Antiplatelet therapy in early management of non-ST-segment elevation acute coronary syndrome:the 2002 and 2007 guidelines from north America and Europe.J Cardiovasc Pharmacol,2008,51(5):425-433.
[50]Stone GW,McLaurin BT,Cox DA,et al.Bivalirudin for patients with acute coronary syndromes.N Engl J Med,2006,355:2203-2216.
[51]Barbara S.Wiggins,Sarah Spinier.Antiplatelet and antithrombin therapy for early management of acute coronary syndromes.Journal of Pharmacy Practice,2004,17(10):347-369.
[52]中华医学会心血管病学分会.经皮冠状动脉介入治疗指南.中华心血管病杂志,2002;30(12):707-718.
[53]中华医学会心血管病学分会.经皮冠状动脉介入治疗指南(2009).中华心血管病杂志,2009;37(1):4-25.
[54]Moon JC,Kalra PR,Coats AJ.DANAMI-2:Is primary angioplasty superior to thrombolysis in acute MI when the patients has to be transferred to an invasive centre?Int J Cardiol,2002,85:199-201.
[55]Assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention(ASSENT-4 PCI) investigators.primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction(ASSENT-4PCI)randomized trial.Lancet,2006,367:569-578.
[56]ACC/AHA/SCAI task force on practice guidelines.2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention.JACC,2008,51(2):172-207.
[57]汪曾伟,刘维永,张宝仁.心脏外科学.北京:人民军医出版社,2003.1427.
[58]Peter B.Berger,Michael H.Sketch,Robert M.Califf.Choosing between percutaneous coronary intervention and coronary artery bypass grafting for patients with multivessel disease:What can we learn from the arterial revascularization therapy study(ARTS)? Circulation,2004,109:1079-I081.
[59]Ferguson TB Jr,Hammill BG,Peterson ED,et al.A decade of change—risk profiles and outcomes for isolated coronary artery bypass grafting procedures,1990-1999:a report from the STS NationalDatabase Committee and the Duke Clinical Research Institute.Ann ThoracSurg,2002,73(2):480-489.
[60]胡盛寿.“药物支架时代”冠状动脉旁路移植术的角色与思考.中国医学信息导报,2007,22(13):13-15.
[61]Claude Lenfant,AramV.Chobanian,Daniel W.Jones,et al.The seventh report of the Joint National Committee on prevention,detection,evaluation,and treatment of high blood pressure(JNC 7).Hypertension,2003,41:1178-1179.
[62]NHLB,ACC,AHA.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel Ⅲ guidelines.Circulation,2004,110:227-239.
[63]方圻,王钟林,宁田海,等.血脂异常防治建议.中华心血管病杂志,1997,25(3):169-171.
[64]中国成人血脂异常防治指南联合制定委员会.中国成人血脂异常防治指南.中华心血管病杂志,2007,35(5):390-409.
[65]Stephen DW,Christopher PC,David AM,et al.Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy:A PROVE IT-TIMI 22 substudy.JACC,2005,46(10):1411-1416.
[66]Bertram Pitt,George Bakris,Luis M.Ruilope,et al.Serum potassium and clinical outcomes in the eplerenone post-acute myocardial infarction heart failure efficacy and survival study(EPHESUS).Circulation,2008,118(10):1643-1650.
[67]Andreotti F,Testa L,Blondi-Zoccai,et al.Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes:an updated and comprehensive meta-analysis of 25307 patients.Eur Heart J,2006,27:519-526.
[1]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[2]Armstrong,Eric R.Bates,Lee A.Green,et al.2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction.JACC,2008,51(2):210-247.
[3]中国中西医结合学会活血化瘀专业委员会.血瘀证诊断标准.中西医结合杂志,1987,7(3):129.
[4]中国中西医结合学会心血管病学会.冠心病中医诊断标准.中西医结合杂志,1991,11(5):257.
[5]张志斌,王永炎.辨证方法新体系的建立.北京中医药大学学报,2005,28(1):2-3.
[6]徐浩.活血解毒中药抗炎及稳定易损斑块的探索与思考.中国中西医结合杂志,2008,28(5):393-394.
[7]丁书文,李晓,李运伦.热毒学说在心系疾病中的构建与应用.山东中医药大学学报,2004,28(6):413-416.
[8]吴秀纪,王天芳.中医证候诊断标准的研究思路.新中医,2007,39(3):1-3.
[9]方积乾.医学统计学与电脑实验.上海:上海科学技术出版社,2001.204.
[10]JUPITER Study Group.Rosuvastatin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein.N Engl J Med,2008,359:2195-2207.
[11]Castelli WP.Lipids,risk factors and ischaemic heart disease.Atherosclerosis,1996,124:S1-9.
[12]Kannel WB,Higgins M.Smoking and hypertension as predictors of cardiovascular risk in population studies.Hypertens Suppl,1990,8(5):S3-8.
[13]Nasr CE,Hoogwerf BJ,Faiman C,Reddy SS.United Kingdom Prospective Diabetes Study(UKPDS).Effects of glucose and blood pressure control on complications of type 2 diabetes mellitus.Cleve Clin J Med,1999,66(4):247-53.
[14]Lenderrink T,Boersma E,Heeschen C,et al.Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with fefractory unstable angina,and troponin T predicts benefit of treatment with abcimab in combination with PTCA.Eur Heart J,2003,24(1):77-85.
[15]Antonio Coca,Franz H.Messerli,Athanase Benetos,et al.Predicting Stroke Risk in Hypertensive Patients With Coronary Artery Disease:A Report From the iNVEST.Stroke,2008,39:343-348.
[1]国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组报告.缺血性心脏病的命名及诊断标准.中华内科杂志,1981,20(4):254.
[2]中华医学会心血管病学分会.不稳定性心绞痛和非 ST 段抬高心肌梗死诊断与治疗指南.中华心血管病杂志,2007,35(4):295-304.
[3]中国中西医结合学会心血管分会.冠心病中医辨证标准.中国中西医结合杂志,1991,11(5):257.
[4]中国中西医结合学会活血化瘀专业委员会.血瘀证诊断标准.中西医结合杂志,1987,7(3):129.
[5]郑筱萸.中药新药临床研究指导原则(试行).中国医药科技出版社,2002,57-61.
[6]文川,徐浩,黄启福,等.几种活血中药对 ApoE 缺陷小鼠动脉粥样硬化斑块影响的形态学研究.中国病理生理杂志,2005,21(8):864-867.
[7]徐浩.活血解毒中药抗炎及稳定易损斑块的探索与思考.中国中西医结合杂志,2008,28(5):393-394.
[8]Hartford M,Wiklund O,Mattsson Hulten L,et al.C-reactive protein,interleukin-6,secretory phospholipase A_2 group Ⅱ A and intercellular adhension molecule-1 in the prediction of late outcome events after acute coronary syndromes.J Intern Med,2007,262(5):526-536.
[9]JUPITER Study Group.Rosuvastatin to Prevent Vascular Events in Men and Women With Elevated C-Reactive Protein.N Engl J Med,2008,359:2195-2207.
[10]徐浩,史大卓,殷惠军,等.“瘀毒致变”与急性心血管事件:假说的提出与临床意义.中国中西医结合杂志,2008,28(10):934-938.
[11]陈可冀,史大卓,徐浩,等.活血化瘀中药干预冠心病介入治疗后再狭窄的多中心临床及机理研究.中国中西医结合杂志,2006,26(1):93.
© 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 |