摘要
目的：客观评价少林内功治疗稳定型劳力性心绞痛证属痰瘀互阻型患者的有效性和安全性,初步探讨少林内功促进本病患者缺血心肌侧支循环建立的可能机制。
方法：将符合疾病证候诊断标准、纳入标准和排除标准的60例患者,使用随机数字表随机分为少林内功组与对照组,每组30例。对照组单纯使用药物治疗,少林内功组在药物治疗基础上进行少林内功训练。少林内功所有发力动作维持30秒,每个动作间间歇1分钟,每天训练2次,每周训练5天,疗程为3个月。对比观察治疗前后患者的心绞痛发作情况、静息性电图表现,应用6分钟步行试验(6MWT)和功能独立性评定量表(FIM)评估患者的心功能及运动耐量、日常生活功能独立性的变化,并记录不良事件发生；同时检测患者外周血的内皮祖细胞(EPCs)和血管内皮生长因子(VEGF)的单位数量和水平。
结果：
(1)治疗过程中共有10名患者脱落或终止实验,最后参加统计共50例,少林内功组24例,对照组26例。试验前两组患者性别、年龄、病情、心功能等基线水平一致。
(2)经治疗,两组患者基本无心绞痛症状发生,静息心电图得到改善,均取得良好的总体疗效。少林内功组经干预后总体疗效明显优于对照组(P<0.05)。
(3)经治疗,少林内功组患者的6MWT结果由治疗前的(331.458-±41.971)米提高到(420.500±58.386米),差异有统计学意义(P<0.05)。而对照组患者治疗前后的6MWT结果没有显著性差异(P>0.05)。治疗后少林内功组患者的6分钟步行距离明显长于对照组,差异有统计学意义(P<0.05)。
(4)经治疗,两组患者的FIM评分均有显著提高,较治疗前差异有统计学意义(P均<0.05)。治疗后,少林内功组患者的FIM评分明显高于对照组,差异有统计学意义(P<0.05)。
(5)经治疗,少林内功组患者外周血的EPCs表达数量及VEGF水平较治疗前均有明显提高,差异有统计学意义(P均<0.05)。而对照组对患者外周血的EPCs表达数量及VEGF水平没有影响。
(6)少林内功组经治疗后的6MWT结果与FIM评分有显著相关性(P<0.05),两者呈显著正相关(R2=0.955)。同时其外周血EPCs的表达数与6MWT结果也有显著相关性(P<0.05)。
结论：
(1)少林内功能有效改善冠心病稳定型劳力性心绞痛患者的心绞痛发作情况、静息性心电图,提高药物治疗稳定型劳力性心绞痛的临床疗效。
(2)少林内功能有效改善冠心病稳定型劳力性心绞痛患者的心功能及运动耐量,能提高患者的日常生活功能独立性,能改善患者生活质量、减轻家庭和社会负担,有利于患者更好地重返社会。
(3)少林内功治疗本病安全有效,有良好的社会经济价值,值得临床推广。
(4)少林内功作为一种等长收缩运动模式能使肢体产生安全有效的生理性缺血,进而动员骨髓中的内皮祖细胞进入外周血,并通过血管内皮因子的促进作用,促使缺血心肌侧枝新生,形成侧枝循环,可能是其治疗冠心病稳定型劳力性心绞痛的可能效应机制。
Objective:Appraises the effect of Qigong from Shaolin to patients who belonged to TCM syndrome of entangled phlegm and blood stasis with angina pectoris of effort and spontaneous angina pectoris, in order to explore the possible mechanisms of myocardial ischemia and collateral circulation establishing.
Methods:
Totally60cases of patients diagnosed coronary heart disease who met diagnostic criteria and inclusion criteria were randomly divided into Qigong group and control group with30for each. Qigong Group was given the treatment of Shaolinneigong combined drug therapy comparing with the control group treated by drug only. In the treatment of Qigong, patients trained for5days a week, twice a day,30seconds for sustained contraction and1minutes for pause between two contractions,3months continuously. Vital signs, type、extent and incidence of adverse event, angina pectoris, ECG,6-minute walk test, evaluation of FIM (functional independence movement), the measurements of EPCs (endothelial the progenitor of cells), VEGF(vascular endothelial growth factor), ET (peripheral blood endothelial prime), TXB2(peripheral blood thromboxane B2) and6-K-PGFla(6-keto-prostaglandin the F-la)were recorded before and after treatment to evaluate effect of Qigong from Shaolin to patients with unstability angina pectoris, ECG,6-minute walk test, FIM assessment,EPCs and VEG, and make correlation analysis between those indexes to explore the possible mechanisms of collateral circulation establishing.
Results:
1. Each group had non-significant differences on ages, sex, courses(P>0.05), can compare with each other.
2.50cases (the Qigong group had24cases, the control group had26cases) had no adverse events during the treatment.
3. There were significant differences on the overall effect, ECG,6-minute walk test, FIM assessment, EPCs and VEG between the two groups after the treatment.
4. There is significant correlation among6-minute walk test, FIM assessment, EPCs,VEGand6-k-PGF la,what's more, there is positively related among6-minute walk test, FIM assessment and EPCs.
Conclusion:
1.By comprehensive analysis of improvement of overall effect, ECG,6-minute walk test, FIM assessment,EPCs and VEG after the treatment, it confirmed that the Qigong from Shaolin which was safe and effective to the coronary heart disease and better than the control group(P<0.05)an effective way to reduce unstability angina pectoris's attack, myocardial ischemia on ECG, improve patient's ability of walking, FIM,EPCs and VEG to prevention and cure.
2.EPCs is only and highly correlated with FIM and6-minute walk test which can increase number of EPCs to a certain extent, suggesting there is highly related between improving cardiac function and functional independence; There is significant correlation between EPCs and VEGF which is promoted secretion by angiogenesis in increasing collateral circulation and improving cardiac microenvironment.
3.As the Qigong being a long-term movement approach used to health care in the treatment of ischemic heart disease like angina pectoris of effort and spontaneous angina,it made good use of the advantages of integrated tcm-wm to improve the cardiac function and the quality of life, raise treatment efficiency, integrate medicine resources effectively,add treatment target points, shorten patients' length of stay and saved treatment cost.
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