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冠心病的流行趋势及预防对策
冠心病(Coronary heart disease,CHD)是严重威胁中老年人健康长寿的重要疾病.1969年WHO宣布CHD是全球大的流行病之一.在许多发达国家中占死亡原因的第一位.美国、芬兰、新西兰等国家从50年代到60年代中后期CHD死亡率逐年增高,但自60年代采取了强有力的预防干预措施之后,60年代后期死亡率显著下降,美国80年代比70年代下降了35%.尽管如此,据美国国家健康统计中心公布(1988)CHD仍占死亡总人数的24.1%,居前10位死因之首.
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略谈近年来冠心病的诊治进展
冠心病的范围包括(1)静寂性(即无痛性)心肌缺血,(2)慢性稳定型心绞痛,(3)不稳定型心绞痛,(4)非透壁性心肌梗死及(5)急性透壁性心肌梗死等五种.近年研讨的热点为不稳定型心绞痛及急性心肌梗死的临床诊断及治疗.
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Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.
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To observe the relationship between TCM Syndrome-type and insulin resistance (ISR) in coronary heart disease (CHD). Methods: Fifty patients were divided into 3 groups according to the Syndrome Differentiation-typing in TCM, the Heart blood stasis (HBS) Syndrome group, the Phlegm-Turbid stagnation (PTS) Syndrome group and both Qi-Yin Deficiency (QYD) Syndrome group. The fasting blood glucose (FBG), fasting blood insulin (Ins), insulin antibody (IAA), islet cell antibody (ICA), glutamic acid decarboxylase antibody (GAD-Ab) and related blood lipid parameters in patients were determined and insulin sensitive index (ISI) was calculated simultaneously. Then the above-mentioned data were compared with those determined in 20 healthy control subjects. Results: The levels of FBG and Ins in CHD group were higher than those in the healthy control group significantly (P<0.05), but ISI level was obviously lower (P<0.01). Moreover, the positive percentage of IAA (40%) was higher in CHD group than that in the control group (5%) significantly (P<0.01). Comparison between the 3 TCM Syndrome-type groups and the control group showed that ISI level in HBS and PTS group was obviously lower than that in the control and the QYD (P<0.05) respectively, and the IAA positive percentage in the former 2 groups (50%, 47.37%) was higher than that in the latter two (5%,P<0.01 and 15.38%, P<0.05) markedly. While Ins level increased only in the HBS group (P<0.05). Besides, patients of HBS and PTS Syndrome were accompanied by lipid metabolic disturbance. Conclusion: ISR presents in part of CHD patients particularly in those with HBS and PTS Syndrome, which was partly due to the existence of serum IAA in patients.
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To observe the relationship between TCM Syndrome-type and insulin resistance (ISR) in coronary heart disease (CHD). Methods: Fifty patients were divided into 3 groups according to the Syndrome Differentiation-typing in TCM, the Heart blood stasis (HBS) Syndrome group, the Phlegm-Turbid stagnation (PTS) Syndrome group and both Qi-Yin Deficiency (QYD) Syndrome group. The fasting blood glucose (FBG), fasting blood insulin (Ins), insulin antibody (IAA), islet cell antibody (ICA), glutamic acid decarboxylase antibody (GAD-Ab) and related blood lipid parameters in patients were determined and insulin sensitive index (ISI) was calculated simultaneously. Then the above-mentioned data were compared with those determined in 20 healthy control subjects. Results: The levels of FBG and Ins in CHD group were higher than those in the healthy control group significantly (P<0.05), but ISI level was obviously lower (P<0.01). Moreover, the positive percentage of IAA (40%) was higher in CHD group than that in the control group (5%) significantly (P<0.01). Comparison between the 3 TCM Syndrome-type groups and the control group showed that ISI level in HBS and PTS group was obviously lower than that in the control and the QYD (P<0.05) respectively, and the IAA positive percentage in the former 2 groups (50%, 47.37%) was higher than that in the latter two (5%,P<0.01 and 15.38%, P<0.05) markedly. While Ins level increased only in the HBS group (P<0.05). Besides, patients of HBS and PTS Syndrome were accompanied by lipid metabolic disturbance. Conclusion: ISR presents in part of CHD patients particularly in those with HBS and PTS Syndrome, which was partly due to the existence of serum IAA in patients.
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Arteriosclerosis is a major common vascular disorder of diabetes mellitus (DM), and as the life-span of DM patients prolonged, the incidence increased, arteriosclerotic coronary heart disease (CHD) and cerebrovascular diseases have become the principal causes of death of DM. Therefore, improving the disturbance of glucose and lipid metabolism, and preventing chronic complication are the key links in the treatment of DM. The authors used Jiangtang capsule (降糖胶囊, JTC) in treating DM type 2. While treating hypoglycemia, promising effect in improving lipid metabolism disturbance is also obtained. It is reported as follows.
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OU Ming, male, was born in Shunde City of Guangdong Province, December 1924. After graduating from Medical College of Lingnan University in 1948, he was served as a physician in Chinese People's Liberation Army, government organization and Zhongshan Medical College. In 1956, he was appointed the post of participating in the founding of a new medical college, Guangzhou College of Traditional Chinese Medicine, and has worked there ever since, acting in the past as department head of internal medicine, deputy director of the affiliated hospital, director of teaching administration office and vice-president of the college successively and now as a full professor. Cardiovascular disease is his speciality and he has devoted to the scientific study of integration of traditional and western medicine in his field since then. He has taken charge of various national research projects, including “Clinical and Experimental Studies of the Effect of Ilexonin A on Congestive Heart Failure”, “The Molecular Biological Basis of Deficiency Syndrome in Traditional Chinese Medicine”, “Clinical and Experimental Studies of the Effect of Kaixin Capsule on Asymptomatic Myocardial Ischemia”, etc., and acted as the head of national collaborating group studying the treatment of cardiovascular diseases by traditional Chinese medicine and the integration of traditional and western medicine, a national key project of medicine in the 7th Five-Year Plan. Many achievements in scientific research have been obtained, which were appraised by experts as the achievements of advanced level in the country. A total of thirteen prizes (science and technology progress prize and commendation prize) has been awarded to him by Ministry of Science and Technology, Ministry of Health, State Administration of Traditional Chinese Medicine and Guangdong Commission of Science and Technology. His writings are abundant. More than ten monographs concerning traditional Chinese medicine have been published for most of which he acted as the chief-editor, including Concised Dictionary of Traditional Chinese Medicine (The People's Health Publishing House, 1979), Chinese-English Dictionary of Traditional Chinese Medicine (Hong Kong Three-Joint Book Company, 1982), New Compilation of Traditional Chinese Medicine (Shanghai Science and Technology Publishing House, 1991), Series of Traditional Chinese Medicine (in English)(Hong Kong Haifeng Publishing House, 1991-1994), Syndrome Differentiation, Treatment and Recent Research of Coronary Heart Disease (Qingdao People's Publishing House, 1994), Big Dictionary of Traditional Chinese Medicine (The People's Health Publishing House, 1995), etc. Furthermore, more than 20 academic papers have been published in the well-known Chinese medical journals, such as Chinese Journal of Integrated Traditional and Western Medicine, Journal of Traditional Chinese Medicine, Chinese Journal of Herbal Medicine, Traditional Chinese Drug Research and Clinical Pharmacology, Journal of Guangzhou University of Traditional Chinese Medicine, etc.
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麝香保心丸治疗冠心病无症状心肌缺血的疗效观察
麝香保心丸具有扩张冠状动脉、改善心肌缺血程度、缩小心肌梗死范围、调节脂质代谢、降低血液粘滞度及改善微循环等药理作用,临床上已广泛用于冠心病、心绞痛的治疗.2001年10月~2002年4月,笔者观察了麝香保心丸治疗冠心病无症状性心肌缺血的临床疗效,现将结果报道如下.
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冠心病介入治疗后的中医药干预研究进展
1977年9月Gruentzig进行了世界上第1例经皮冠状动脉腔内成形术(percutaneous transluminal coronary angioplasty,PTCA),开创了介入心脏病学的新纪元[1].此后,以PTCA术和冠脉内支架植入术为基础的冠心病介入治疗技术(percutaneous coronary intervention,PCI)迅速发展,冠心病介入治疗的适应证不断拓宽,复杂病变介入治疗成功率不断提高,目前PCI已成为冠心病血运重建治疗的重要手段[2].据估计,2001年全世界各种PCI治疗约260万例,仅在美国即有89万例.我国于1984年开展PTCA,1999年完成PCI术8 000例,2 000年完成1.2万例,2001年1.6万例,2005年完成9万例,且每年以30%~40%的速度增长,近几年发展十分迅速[2].尤其是药物涂层支架(drug eluting stent,DES)的出现,使得再狭窄事件发生显著降低,将PCI术推向新的高潮,介入心脏病学已经成为心脏病界发展快的学科.
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从冠心病中医防治的若干进展探讨结合点
自20世纪90年代以来,冠心病研究在许多方面取得重大进展(1),中医药防治同样也获得一些可喜的苗头.本文将作简介并对中西医结合在此领域内研究的可能性结合点略加探讨.
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冠心病心阳虚证动物造模若干问题的思考
关于"证"的研究,一直是学术界希冀籍此能对中医基础理论研究有所突破,继而揭开中医药诊疗疾病奥秘所在的重大命题.
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中西医优势互补治疗冠心病心绞痛
冠心病是由于冠状动脉粥样硬化(atherosclerosis, AS)斑块的基础上形成血管狭窄、痉挛或血栓形成,导致心肌供血不足,临床出现一系列心肌缺血症状的一类疾病,为人类死亡和致残的一个主要原因.冠心病尽管有许多分类方法,但目前一般分为稳定性心绞痛(stable angina, SA)和急性冠脉综合征(acute coronary syndrome, ACS),其中ACS又可分为不稳定性心绞痛(unstable angina, UA)、非ST段抬高心肌梗死(non-ST-segment elevation myocardial infarction, NSTEMI)和ST段抬高心肌梗死(ST-segment elevation myocardial infarction, STEMI).
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中西医结合防治冠心病的回顾与展望
经过新中国几代中西医结合工作者的努力,冠心病中西医结合的理论已经形成体系,对冠心病病因病机的认识逐渐趋于一致.目前认为冠心病属于本虚标实,其中本虚为气血阴阳亏虚,标实为气滞、血瘀、痰浊、寒凝.病位在心,涉及肺、脾、肾.冠心病的病症结合分析发现:冠心病急性冠脉综合征多属于气滞、血瘀、寒凝闭阻心脉,不通则痛;冠心病稳定期则正虚邪实并存.劳力型心绞痛:劳则气耗,病机多为气虚血瘀;不稳定性心绞痛因血小板激活、微血栓形成、斑块不稳定、凝血酶原激活、血纤维蛋白水平升高,其病机以血瘀为主,其中自发性心绞痛多为阳虚、寒凝、气滞.急性心肌梗死除上述因素外,多兼有热毒、瘀毒和浊毒内结.
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血府逐瘀汤加减治疗冠心病疗效观察及体会
目的:探讨采用益气活血,祛痰通络法治疗冠心病的疗效.方法:采用血府逐瘀汤临证加减治疗冠心病60例.结果:坚持中药治疗,总有效率91.67%.结论:益气活血,祛痰通络法能有效缓解心绞痛及临床其他症状,对临床气虚血瘀痰凝型冠心病较为适宜.
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The therapeutic principle of clearing away the heart-heat to induce tranquilization was adopted in 107 middle-aged and senile patients with ventricular premature beat of coronary heart disease on the basis of pathogenic features of phlegm, heat, blood stasis and deficiency in this condition. Qing Xin An Shen Fang (清心安神方a formula for clearing away the heart-heat to induce tranquilization) was used in the treatment group and compared with mexiletine and Fu Fang Dan Shen Tablets (复方丹参片Compound Salvia Tablets) used in the control group. The results turned to be that the markedly effective rate was 85.1% and the total effective rate 96.3% in the treated group, better than that in the control group, with the former having a good antihypertensive and antihyperlipemic effect and an effect of improving microcirculation and clinical symptoms.
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冠心病病人载脂蛋白E与血脂水平的相关性
人类载脂蛋白E(apo E)有三种主要异构体E2、E3、E4,是由三个等位基因编码,不同的apo E异构体受体结合活性不同,从而影响了脂蛋白的代谢,出现异常的脂蛋白血症.本实验研究探讨天津地区汉族人群apo E等位基因的频率分布及对血脂水平的影响,分析正常人与冠心病病人apo E基因分布频率的差异.
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急性冠状动脉综合征患者血清SAA、hs-CRP和IL-6水平的变化及其临床意义
近年的研究表明,冠状动脉粥样硬化斑块破裂及伴随附壁血栓可能是急性冠状动脉综合征(acutecoronary syndrome,ACS)的主要发病机制,而炎性反应的激活可能是导致动脉粥样斑块不稳定的主要因素[1,2].血清淀粉样蛋白A(serum amyloid A,SAA)和高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)一样,均为主要的急性时相性蛋白(acute phase protein,APP),是反映动脉粥样硬化斑块稳定性的炎症标志[3].它们在肝内的合成受多种细胞因子调控,尤以白细胞介素6(interleukin-6,1L-6)为重要[1].因此,本研究采用酶联免疫吸附法(ELISA)法检测48例急性冠状动脉综合征(acute coronary syndrome,ACS)、38例稳定性冠心病(stable coronary heart disease,SCHD)患者与30例对照者血清中SAA和hs-CRP水平,旨在探讨血清SAA利hs-CRP在ACS患者中的变化及其与IL-6的关系.
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存活心肌检测对冠心病血运重建治疗决策的影响
存活心肌是心肌缺血后的一种特殊存在形式,特点为经治疗其功能部分或完全恢复,从而逆转左心室功能,改善患者预后.冠状动脉血运重建术[经皮冠状动脉介入术(PCI)和冠状动脉搭桥术(CABG)]是目前治疗冠心病的主要手段之一,其效果得到临床公认,而存活心肌是影响手术效果的主要因素,前瞻性检测存活心肌对冠心病患者的临床决策具有重要意义.近年来,随着大规模临床试验结果的相继公布及相关指南的制定,存活心肌对冠心病患者PCI和CABG决策的影响日益受到临床医师的关注.
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斑点追踪显像技术评价冠心病患者左心室心肌功能异常
斑点追踪显像(speckle tracking imaging,STI)技术是新近发展起来的超声定量分析工具,不受声束角度限制,能对心室长轴的纵向、短轴的径向、周向、旋转及扭转运动进行定量检测,为评价心肌功能及深入了解心脏机械运动的机制提供了新手段,有着广泛的临床应用前景.
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基于PCR、LDR和ELISA法检测冠心病患者APOE112位点基因型
SNP是继限制性片段长度多态性(RFLP)、短串联重复序列(STR)后的第三代分子遗传标记,目前检测SNP的方法有基因测序[1]、单链构象多态性(SSCP)[2]、RFLP[3]、高效液相[4]、基因芯片[5]、LDR[6-14]等,但都需要比较复杂的仪器进行检测.