加味五苓散干预脾虚痰浊型血脂异常的临床观察
|
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。
Objective
in 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.
Methods
diagnosed 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) changes
Results
1. 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.
Gonclusion
this 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.
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。
Objective
in 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.
Methods
diagnosed 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) changes
Results
1. 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.
Gonclusion
this 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.
引文
[1]陈国伟.血脂异常与冠心病[J].中国实用内科杂志,2004,245：26.
[2]刘静,赵冬,吴兆苏,等.低密度脂蛋白胆固醇与心血管病发病关系的前瞻性研究[J].中华心血管病杂志,2001：299：561-565.
[3]李莹,陈志红,周北凡,等.血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用[J].中华心血管病杂志,2004;327：643-647.
[4]中华医学会糖尿病分会.代谢综合征诊断标准出台[J].山东中医志,2004：23(8)：507.
[5]祝之明.代谢综合征的诊断能否应用于临床实践[J].中华老年心脑血管病杂志,2007：98：505-507.
[6]Isomaab. Almgrenp. Tuomit. etal. Cardiovasentar morbidity and Mortality associaonted with the metabolie syndrome Diabetes eare,2001;24(4):683-689.
[7]孙丽英,焦亚斌,康广盛.高脂血症的病因病机研究进展[J].中医药学报,2004;32(2):35.
[8]李赛美,李家庚.伤寒论案例版,北京：科学出版社,2007,2：84-85.
[9]徐学功.降脂轻身胶囊干预痰浊阻遏型血脂异常临床观察[J].世界中西医结合杂志,2009：(1)：12-15.
[10]黄锐.中医对血脂异常的认识和治疗[J].中国现代医药杂志,2006：8(7)：107.
[11]陈云.山东中医学院,河北医学院校释.黄帝内经校释.北京：人民卫生出版社.
[12]王永炎,沈绍功.今日中医内科1卷.人民卫生出版社,2001,(1).45.
[13]赵林,赵军绩.参葛降脂宁治疗冠心病高脂血症疗效观察[J].湖北中医志,1999：21(9)：395-396.
[14]钱小琦.论高脂血症的病因病机其证治[J].中医药学刊,2003：21(7)：1150.
[15]赵水平.《中国成人血脂异常防治指南》药物治疗部分解读[J].临床药物治疗杂志,2007;5(5)：5-10.
[16]叶任高,陆再英.内科学[M],北京：人民卫生出版社,2007,(6)：821-831.
[17]姚品芳,钱禹林,范红心,等.血脂异常对心率变异性的影响[J].中国心血管病研究,2009：76：441.
[18]潘长玉.代谢综合征认识和防治的新进展评《国际糖尿病联盟关于代谢综合征定义的全球共识》[J].中华内分泌代谢杂志,2005;21(4)：298-300.
[19]吴伟,郑晓伟,陈燕,等.血脂康对血脂和血管内皮细胞活性物质的影响.中国动脉硬化杂志,2003：11(5)：419-422.
[20]孙丽英,焦亚斌,康广盛.高脂血症的病因病机研究进展[J].中医药学报,2004;32(2)：35.
[21]Norhammar A, Malmberg K, Tornvall P, et al. The unfavorableprognosis in diabetes patients with acute myocardial infarctiorelates to under utilization of evidence based treatment[J]. Circulation,2001;104:2962.
[22]Jose AS, Alvaro E, Tyrone J,et al. Unstable angina a comparisonof angioscopic findings between diabetic and nondiabetic patients[J]. Circulation,1995;92:1732-1734.
[23]陈国伟.血脂异常与冠心病[J].中国实用内科,2004;2261.
[24]袁晓华,马军.血脂异常与相关疾病[J].中国临床医药研究,2004;(2)：1281.
[25]Chin JH, Azhar S, Hofftsan BB. inactirelaxing factor by oxidized lipoprot[J]. J Clin Invest,2002;89(1):10.
[26]Ferrier KE, MuhlmannMH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertensionA[J]. J Am CollCardiol,2002;39 6:1020-1025.
[27]Giannattasio C, Mangoni AA, Failla M, et al. Combined effects ofhypertension and hypercholesterolemia on radial artery function[J]. Hypertension,1997;292:583-586.
[28]AvolioAP, Fa QuanD, Wei QiangL, et al. Effectsof agingon arterial distensibility in populations with high and low prevalence ofhypertension: comparison between urban and rural communities inChina[J]. Circulation,1985;71 2:202-210.
[29]闫振成,沈成义,钟健,等.代谢综合征患者过氧化物酶体增殖物激活受体基因多态性与血脂、肥胖和左室肥厚的关系[J].中华心血管病杂志,2005;336：529-533.
[30]冯兰玲.血脂分析及血流变学测定对青年脑梗死预防的意义.中国学校卫生,2006;26(8)：733.
[31]钱学贤.致动脉粥样硬化脂蛋白谱与代谢综合征.中华内科杂志,2000;39(2)：79-80.
[32]Gerdon T, Castellli UP, Hortland MC, et al, High density Iipoop ro tein as a p rotective factor against coronary heart disease. Am JMed,1997;95 (1):69275.
[33]孟丽苹,张坚,满青青,等.中国20岁及以上人群高胆固醇血症及胆固醇边缘升高流行病学研究[J].中华流行病学杂志,2007；28(8)：729-733.
[34]赵文华,张坚,由悦,等.中国18岁及以上人群血脂异常流行特点研究[J].中华预防医学杂志,2005；39(5)：306-310.
[35]武阳丰,赵冬,周北凡,等.中国成人血脂异常诊断和危险分层方案的研究[J].中华心血管病杂志,2007：35(5)：428-433.
[36]谢宗林,陈卫玲.中青年男性体重指数与血压、血脂、血糖的关系分析[J].现代预防医学,2006;33(6)：903-904.
[37]张子祥.BMI对血压、血糖、血脂的影响[J].中国医药导报,2007;4(16)：104.
[38]国家“九五”科技攻关课题协作组.我国中年人群心血管病危险因素流行现状及从80年代初至90年代末的变化趋势[J].中华心血管病杂志,2001,29(2)：74-79.
[39]翟屹,赵文华.肥胖疾病负担的研究现状[J].中华流行病学杂志,2007;28(1)：95-97.
[40]中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值：适宜体重指数和腰围切入点的研究[J].中华流行病学杂志,2002：23(1)：5-10.
[41]National Cholesterol Education Program (NCEP) Exper Panel on Detection, Evaluation and Treatment of HighBlood Cholesterol in Adults (Adult Treatment Panel Ⅲ). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (AdultTreatment Panel Ⅲ) final report[J]. Circulation,2002;106 (25):3143-3412.
[42]He J, Gu D, Wu X, et al. Major causes of death amongmen and women in China [J]. N Engl J Med,2005; 353 (11):1124-1134.
[43]Calle E, Thun M. Body-mass index and mortality in a prospective cohort of US adults [J]. New Engl J Med,1999; 341 (15):1097-1105.
[44]徐学功.降脂轻身胶囊干预痰浊阻遏型血脂异常临床观察[J]：世界中西医结合杂志2009：01：50.
[45]熊原.加味半夏白术天麻汤治疗高血压并高脂血症的临床研究[J].河北中医,2005：27(10)：751-752.
[46]甄昭红.六味地黄汤加味治疗高脂血症168例[J].国医论坛,2000;15(1).
[47]陈苏宁,杨积武,张放,等.血府逐瘀汤加减治疗高脂血症100例[J].辽宁中医杂志,2001：28(6)：364-365.
[48]陆新.加味天麻钩藤饮治疗高脂血症的临床观察[J].湖北中医杂志,2004；26(4)：13-14.
[49]李正兰,王笑梅,杜宗礼,等.血脂康联合龙胆泻肝汤化裁方治疗高脂血症临床分析[J].实用中医药杂志,2005;21(10)：583-584.
[50]应瑛.中医药干预性治疗脂肪肝的临床研究[J].浙江中医药大学学报,2008;32(2)：226-227.
[51]张琦.苓桂术甘加味汤对高脂血症大鼠脂代谢及血液流变学实验研究[J].中国中医基础医学杂志,2003;9(9)：36.
[52]张金生,王阶.中药降脂途径及机理探要[J].辽宁中医杂志,2007;34(10)：13.
[53]张霄霖,何小琦.中医对调脂治疗的认识[J].中国临床康复,2005;9(3)：13.
[54]黄永艳,李春旺.中医药治疗血脂异常实验研究进展[J].中医药导报,2006：12(1)：77.
[55]王默然.中医药治疗血脂异常研究进展[J].辽宁中医学院学报,2006;8(3)：51-52.
[56]张莉.中医药治疗血脂异常研究进展与展望[J].河北中医,2007;29(4)：376.
[57]潘涛,施广飞.血脂异常的中医研究进展[J].中西医结合心脑血管病杂志,2008;6(1)：51-53.
[58]魏卓红,何剑荣.中医药治疗血脂异常的思路[J].时珍国医国药,2007;18(9)：2300.
[59]王宇辉,周超凡.中药降脂研究进展[J].中国中药杂志,1999;24(3)：184-186.
[60]张小艺,张敏,孔伟.中西医结合治疗血脂异常研究进展[J].山东中医药大学学报,2005：29(1)：76-78.
[61]赵峥,范中有.中西医结合治疗高血脂症127例疗效观察[J].四川中医,2005;23(10)：56.
[62]杨仕彬,党庆先.中西医结合治疗血脂异常疗效观察[J].实用中医药杂志,2006;2(1)：17.
[63]刘汉丹,张清.中西药联合降脂的临床疗效观察[J].四川中医,2005;23(1)：46.
[64]冯蓉.中西医结合治疗血脂异常56例临床观察[J].四川中医,2005;23(1)：56.
[65]刘志成.针灸减肥的临床观察及其降脂的研究[J].中国康复,1999;(3)：111
[66]Cleeman JI. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel Ⅲ). JAMA,2001:285:2486-2497.
[67]The Scandinavian Simvastatin Survival Study Group. Randomised trial of lowering in 4444 patients with coronary heart disease:the Scandinavian Simvastatin Survival Study (4S). Lancet,1994;344:1383-1389.
[68]胡大一.中国胆固醇教育全国培训教材[M],上海：同济大学出社,2005：122.
[69]董砚奉,张秀英.他汀类药物非降脂作用临床研究进展[J].中国社区医师医学,2008：10(182)：728.
[70]Farmer JA Torre AG. Comparative tolerability the HMGCoA reductase inhibitors[J]. Drug Safety,2000;23 (3):197.
[71]Grundy SM. The issue of statin safety where do we stand [J].Circulation,2005;111:3016.
[72]杨诗杰,苏汝好.降血脂药的应用现状及研究进展[J].医药论坛杂志,2006;27(1)：90292.
[73]Shepherd J, Cobbe SM, Ford I,et al. Prevention of coronary heart disease with pravastin in men with hypercholeterolemia. N Engl J Med, 1995:333:1301-1307
[74]Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med,1996;335:1001-1009.
[75]The Long-Term Intervention with Pravastatin in ischaemic disease (LIPID) study group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial choleesterol levels. N Engl J Med,1998;339:1349-1357.
[76]Doans JR, Clearfield M, Whitey E, et al. Primary prevention acute coronary events with lovastatin in men and women with aeverage cholesterol levels. Results of AFCAPS/TexCAPS. JAMA,1998;279:1615-1622.
[77]Lauer MS, Fontanarosa PB. Updated guidelines for cholesterol management. JAMA,2001:285:2508-2509.
[78]Pitt B, Waters D, Brown MV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med,1999:341:70-76.
[79]Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in actue coronary syndromes. JAMA,2001;285:1711-1718.
[80]刘颖望,赵水平.他汀类药物的当代展望.循环(中文版),2001;1：33-40.
[81]赵水平.《中国成人血脂异常防治指南》药物治疗部分解读[J].临床药物治疗杂志,2007：5(5)：5-10.
[82]韩启定.超重与血脂异常相关性研究[J].大理学院学报,2009;(10)：4.
[83]Sasaki S, Higashi Y, Nakagawa K, et al.A low-calorie diet improves endothelium-dependent vasodilation in obese patients with essential hypertension[J]. Am J Hyperten,2002;15(4):302-309.
[84]Mccarty MF. Does postpradial storage of triglycerides in endothelial cells contribute to the endothelial dysfunction associated with insulin resistance and fatty diets[J]. Med Hypotheses,2003;61(2):167-172.
[85]Stewart KJ, Bacher AC, Turner K, et al. Exercise and risk factors associated with metabolic syndrome in older adults[J]. Am J Prev Med,2005;28(1):9-18.
[86]Freed MI, Ratner R, Marcovina SM, et al. Effects of rosiglitazone alone and in combination with atorvastatin on the metabolic abnormalities in type 2 diabetes mellitus[J]. Am J Cardiol,2002;90(3):947-952.
[87]王侃,秦霖.气候因素对中医学形成和发展的影响[J].中华医史杂志,2004：02：15.
[88]熊曼琪.伤寒学,北京：中国中医药出版社,2007,1：100.
[89]李贵海.山楂降血脂有效成分的实验研究[J].中草药,2002;33(1)：50-52.
[90]邓琪,钱光南.降脂合剂治疗脂肪肝的疗效观察[J].现代中西医结合急救杂志,2002：11(18)：1784.
[91]金智生.健脾降脂灵对高血脂症大鼠血脂的影响[J].现代中西医结合急救杂志,2002：9(1)：41.
[92]吕圭源.白术抗衰老作用研究[J].现代应用要学,1996;13(5)：266.
[93]陶晋兴.泽泻对实验性大鼠、家兔的降血脂作用及抑制家兔动脉粥样硬化作用[J].北京中医学院学报,1991：(6)：51.
[94]李赛美,李家庚.伤寒论案例版,北京：科学出版社,2007,2：84-85.
[2]刘静,赵冬,吴兆苏,等.低密度脂蛋白胆固醇与心血管病发病关系的前瞻性研究[J].中华心血管病杂志,2001：299：561-565.
[3]李莹,陈志红,周北凡,等.血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用[J].中华心血管病杂志,2004;327：643-647.
[4]中华医学会糖尿病分会.代谢综合征诊断标准出台[J].山东中医志,2004：23(8)：507.
[5]祝之明.代谢综合征的诊断能否应用于临床实践[J].中华老年心脑血管病杂志,2007：98：505-507.
[6]Isomaab. Almgrenp. Tuomit. etal. Cardiovasentar morbidity and Mortality associaonted with the metabolie syndrome Diabetes eare,2001;24(4):683-689.
[7]孙丽英,焦亚斌,康广盛.高脂血症的病因病机研究进展[J].中医药学报,2004;32(2):35.
[8]李赛美,李家庚.伤寒论案例版,北京：科学出版社,2007,2：84-85.
[9]徐学功.降脂轻身胶囊干预痰浊阻遏型血脂异常临床观察[J].世界中西医结合杂志,2009：(1)：12-15.
[10]黄锐.中医对血脂异常的认识和治疗[J].中国现代医药杂志,2006：8(7)：107.
[11]陈云.山东中医学院,河北医学院校释.黄帝内经校释.北京：人民卫生出版社.
[12]王永炎,沈绍功.今日中医内科1卷.人民卫生出版社,2001,(1).45.
[13]赵林,赵军绩.参葛降脂宁治疗冠心病高脂血症疗效观察[J].湖北中医志,1999：21(9)：395-396.
[14]钱小琦.论高脂血症的病因病机其证治[J].中医药学刊,2003：21(7)：1150.
[15]赵水平.《中国成人血脂异常防治指南》药物治疗部分解读[J].临床药物治疗杂志,2007;5(5)：5-10.
[16]叶任高,陆再英.内科学[M],北京：人民卫生出版社,2007,(6)：821-831.
[17]姚品芳,钱禹林,范红心,等.血脂异常对心率变异性的影响[J].中国心血管病研究,2009：76：441.
[18]潘长玉.代谢综合征认识和防治的新进展评《国际糖尿病联盟关于代谢综合征定义的全球共识》[J].中华内分泌代谢杂志,2005;21(4)：298-300.
[19]吴伟,郑晓伟,陈燕,等.血脂康对血脂和血管内皮细胞活性物质的影响.中国动脉硬化杂志,2003：11(5)：419-422.
[20]孙丽英,焦亚斌,康广盛.高脂血症的病因病机研究进展[J].中医药学报,2004;32(2)：35.
[21]Norhammar A, Malmberg K, Tornvall P, et al. The unfavorableprognosis in diabetes patients with acute myocardial infarctiorelates to under utilization of evidence based treatment[J]. Circulation,2001;104:2962.
[22]Jose AS, Alvaro E, Tyrone J,et al. Unstable angina a comparisonof angioscopic findings between diabetic and nondiabetic patients[J]. Circulation,1995;92:1732-1734.
[23]陈国伟.血脂异常与冠心病[J].中国实用内科,2004;2261.
[24]袁晓华,马军.血脂异常与相关疾病[J].中国临床医药研究,2004;(2)：1281.
[25]Chin JH, Azhar S, Hofftsan BB. inactirelaxing factor by oxidized lipoprot[J]. J Clin Invest,2002;89(1):10.
[26]Ferrier KE, MuhlmannMH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and large artery stiffness in isolated systolic hypertensionA[J]. J Am CollCardiol,2002;39 6:1020-1025.
[27]Giannattasio C, Mangoni AA, Failla M, et al. Combined effects ofhypertension and hypercholesterolemia on radial artery function[J]. Hypertension,1997;292:583-586.
[28]AvolioAP, Fa QuanD, Wei QiangL, et al. Effectsof agingon arterial distensibility in populations with high and low prevalence ofhypertension: comparison between urban and rural communities inChina[J]. Circulation,1985;71 2:202-210.
[29]闫振成,沈成义,钟健,等.代谢综合征患者过氧化物酶体增殖物激活受体基因多态性与血脂、肥胖和左室肥厚的关系[J].中华心血管病杂志,2005;336：529-533.
[30]冯兰玲.血脂分析及血流变学测定对青年脑梗死预防的意义.中国学校卫生,2006;26(8)：733.
[31]钱学贤.致动脉粥样硬化脂蛋白谱与代谢综合征.中华内科杂志,2000;39(2)：79-80.
[32]Gerdon T, Castellli UP, Hortland MC, et al, High density Iipoop ro tein as a p rotective factor against coronary heart disease. Am JMed,1997;95 (1):69275.
[33]孟丽苹,张坚,满青青,等.中国20岁及以上人群高胆固醇血症及胆固醇边缘升高流行病学研究[J].中华流行病学杂志,2007；28(8)：729-733.
[34]赵文华,张坚,由悦,等.中国18岁及以上人群血脂异常流行特点研究[J].中华预防医学杂志,2005；39(5)：306-310.
[35]武阳丰,赵冬,周北凡,等.中国成人血脂异常诊断和危险分层方案的研究[J].中华心血管病杂志,2007：35(5)：428-433.
[36]谢宗林,陈卫玲.中青年男性体重指数与血压、血脂、血糖的关系分析[J].现代预防医学,2006;33(6)：903-904.
[37]张子祥.BMI对血压、血糖、血脂的影响[J].中国医药导报,2007;4(16)：104.
[38]国家“九五”科技攻关课题协作组.我国中年人群心血管病危险因素流行现状及从80年代初至90年代末的变化趋势[J].中华心血管病杂志,2001,29(2)：74-79.
[39]翟屹,赵文华.肥胖疾病负担的研究现状[J].中华流行病学杂志,2007;28(1)：95-97.
[40]中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值：适宜体重指数和腰围切入点的研究[J].中华流行病学杂志,2002：23(1)：5-10.
[41]National Cholesterol Education Program (NCEP) Exper Panel on Detection, Evaluation and Treatment of HighBlood Cholesterol in Adults (Adult Treatment Panel Ⅲ). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (AdultTreatment Panel Ⅲ) final report[J]. Circulation,2002;106 (25):3143-3412.
[42]He J, Gu D, Wu X, et al. Major causes of death amongmen and women in China [J]. N Engl J Med,2005; 353 (11):1124-1134.
[43]Calle E, Thun M. Body-mass index and mortality in a prospective cohort of US adults [J]. New Engl J Med,1999; 341 (15):1097-1105.
[44]徐学功.降脂轻身胶囊干预痰浊阻遏型血脂异常临床观察[J]：世界中西医结合杂志2009：01：50.
[45]熊原.加味半夏白术天麻汤治疗高血压并高脂血症的临床研究[J].河北中医,2005：27(10)：751-752.
[46]甄昭红.六味地黄汤加味治疗高脂血症168例[J].国医论坛,2000;15(1).
[47]陈苏宁,杨积武,张放,等.血府逐瘀汤加减治疗高脂血症100例[J].辽宁中医杂志,2001：28(6)：364-365.
[48]陆新.加味天麻钩藤饮治疗高脂血症的临床观察[J].湖北中医杂志,2004；26(4)：13-14.
[49]李正兰,王笑梅,杜宗礼,等.血脂康联合龙胆泻肝汤化裁方治疗高脂血症临床分析[J].实用中医药杂志,2005;21(10)：583-584.
[50]应瑛.中医药干预性治疗脂肪肝的临床研究[J].浙江中医药大学学报,2008;32(2)：226-227.
[51]张琦.苓桂术甘加味汤对高脂血症大鼠脂代谢及血液流变学实验研究[J].中国中医基础医学杂志,2003;9(9)：36.
[52]张金生,王阶.中药降脂途径及机理探要[J].辽宁中医杂志,2007;34(10)：13.
[53]张霄霖,何小琦.中医对调脂治疗的认识[J].中国临床康复,2005;9(3)：13.
[54]黄永艳,李春旺.中医药治疗血脂异常实验研究进展[J].中医药导报,2006：12(1)：77.
[55]王默然.中医药治疗血脂异常研究进展[J].辽宁中医学院学报,2006;8(3)：51-52.
[56]张莉.中医药治疗血脂异常研究进展与展望[J].河北中医,2007;29(4)：376.
[57]潘涛,施广飞.血脂异常的中医研究进展[J].中西医结合心脑血管病杂志,2008;6(1)：51-53.
[58]魏卓红,何剑荣.中医药治疗血脂异常的思路[J].时珍国医国药,2007;18(9)：2300.
[59]王宇辉,周超凡.中药降脂研究进展[J].中国中药杂志,1999;24(3)：184-186.
[60]张小艺,张敏,孔伟.中西医结合治疗血脂异常研究进展[J].山东中医药大学学报,2005：29(1)：76-78.
[61]赵峥,范中有.中西医结合治疗高血脂症127例疗效观察[J].四川中医,2005;23(10)：56.
[62]杨仕彬,党庆先.中西医结合治疗血脂异常疗效观察[J].实用中医药杂志,2006;2(1)：17.
[63]刘汉丹,张清.中西药联合降脂的临床疗效观察[J].四川中医,2005;23(1)：46.
[64]冯蓉.中西医结合治疗血脂异常56例临床观察[J].四川中医,2005;23(1)：56.
[65]刘志成.针灸减肥的临床观察及其降脂的研究[J].中国康复,1999;(3)：111
[66]Cleeman JI. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel Ⅲ). JAMA,2001:285:2486-2497.
[67]The Scandinavian Simvastatin Survival Study Group. Randomised trial of lowering in 4444 patients with coronary heart disease:the Scandinavian Simvastatin Survival Study (4S). Lancet,1994;344:1383-1389.
[68]胡大一.中国胆固醇教育全国培训教材[M],上海：同济大学出社,2005：122.
[69]董砚奉,张秀英.他汀类药物非降脂作用临床研究进展[J].中国社区医师医学,2008：10(182)：728.
[70]Farmer JA Torre AG. Comparative tolerability the HMGCoA reductase inhibitors[J]. Drug Safety,2000;23 (3):197.
[71]Grundy SM. The issue of statin safety where do we stand [J].Circulation,2005;111:3016.
[72]杨诗杰,苏汝好.降血脂药的应用现状及研究进展[J].医药论坛杂志,2006;27(1)：90292.
[73]Shepherd J, Cobbe SM, Ford I,et al. Prevention of coronary heart disease with pravastin in men with hypercholeterolemia. N Engl J Med, 1995:333:1301-1307
[74]Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med,1996;335:1001-1009.
[75]The Long-Term Intervention with Pravastatin in ischaemic disease (LIPID) study group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial choleesterol levels. N Engl J Med,1998;339:1349-1357.
[76]Doans JR, Clearfield M, Whitey E, et al. Primary prevention acute coronary events with lovastatin in men and women with aeverage cholesterol levels. Results of AFCAPS/TexCAPS. JAMA,1998;279:1615-1622.
[77]Lauer MS, Fontanarosa PB. Updated guidelines for cholesterol management. JAMA,2001:285:2508-2509.
[78]Pitt B, Waters D, Brown MV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med,1999:341:70-76.
[79]Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in actue coronary syndromes. JAMA,2001;285:1711-1718.
[80]刘颖望,赵水平.他汀类药物的当代展望.循环(中文版),2001;1：33-40.
[81]赵水平.《中国成人血脂异常防治指南》药物治疗部分解读[J].临床药物治疗杂志,2007：5(5)：5-10.
[82]韩启定.超重与血脂异常相关性研究[J].大理学院学报,2009;(10)：4.
[83]Sasaki S, Higashi Y, Nakagawa K, et al.A low-calorie diet improves endothelium-dependent vasodilation in obese patients with essential hypertension[J]. Am J Hyperten,2002;15(4):302-309.
[84]Mccarty MF. Does postpradial storage of triglycerides in endothelial cells contribute to the endothelial dysfunction associated with insulin resistance and fatty diets[J]. Med Hypotheses,2003;61(2):167-172.
[85]Stewart KJ, Bacher AC, Turner K, et al. Exercise and risk factors associated with metabolic syndrome in older adults[J]. Am J Prev Med,2005;28(1):9-18.
[86]Freed MI, Ratner R, Marcovina SM, et al. Effects of rosiglitazone alone and in combination with atorvastatin on the metabolic abnormalities in type 2 diabetes mellitus[J]. Am J Cardiol,2002;90(3):947-952.
[87]王侃,秦霖.气候因素对中医学形成和发展的影响[J].中华医史杂志,2004：02：15.
[88]熊曼琪.伤寒学,北京：中国中医药出版社,2007,1：100.
[89]李贵海.山楂降血脂有效成分的实验研究[J].中草药,2002;33(1)：50-52.
[90]邓琪,钱光南.降脂合剂治疗脂肪肝的疗效观察[J].现代中西医结合急救杂志,2002：11(18)：1784.
[91]金智生.健脾降脂灵对高血脂症大鼠血脂的影响[J].现代中西医结合急救杂志,2002：9(1)：41.
[92]吕圭源.白术抗衰老作用研究[J].现代应用要学,1996;13(5)：266.
[93]陶晋兴.泽泻对实验性大鼠、家兔的降血脂作用及抑制家兔动脉粥样硬化作用[J].北京中医学院学报,1991：(6)：51.
[94]李赛美,李家庚.伤寒论案例版,北京：科学出版社,2007,2：84-85.