冠心病中医证候与炎症因子关系的临床研究

Clinical Studies on Relationship Between TCM Syndromes of Coronary Heart Disease and Inflammatory Factors

[目的]探讨冠心病中医证候与炎症指标的相关关系,为临床辨证论治提供客观依据。[方法]将524例冠心病患者 按照中国中西医结合学会心血管分会1990年10月修订的冠心病中医辨证标准进行辨证分型,并分别检测患者的血中白细 胞计数(nWBC)、C-反应蛋白(CRP)含量(ρCRP)、肿瘤坏死因子(TNF-α)含量(ρTNF-α)、白细胞介素-6(IL-6)含量 (ρIL-6)、纤维蛋白原(FIB)含量(ρFIB)及血脂等指标,按中医基本证候出现的频数,对各证候的相应资料作分类统计。 [结果]①痰热血瘀和气虚血瘀为冠心病的常见中医证候,血瘀、痰热、气虚、气滞、痰浊证是冠心病的常见基本证候,血 瘀证、痰热证是最常见的基本证候。②冠心病血瘀证和痰热证不论是急性冠脉综合征(ACS)组还是非ACS组nWBC、ρCRP、 ρIL-6、ρTNF-α等炎症指标均升高,ACS组升高更为显著,表明冠心病存在炎症反应,中医证候与炎症因子密切相关。③冠心 病死亡者较非死亡者血中CRP、IL-6、TNF-α等炎症指标含量均升高。[结论]血CRP、IL-6、TNF-α等炎症指标含量可作为 冠心病辨证的参考指标。

[ Objective ] To investigate the relationship between TCM syndromes of coronary heart disease ( CHD) and inflammatory factors (IF) and to provide the evidence for syndromes differentiation and treatment. [Methods] Five hundred and twenty-four cases of CHD were differentiated according to the syndrome differentiation criteria of CHD issued in October, 1990 by the Cardiovascular Branch of China Association of the Integration of Chinese and Western Medicine. White blood cells (WBC) counting and serum levels of C-reactive protein (CRP), tumor necrosis factor (TNF-α), interleukin 6 (IL-6), fibrinogen (FIB) and blood lipid in the cases were detected, and syndrome patterns were analyzed according to the occurrence frequency of symptoms and signs. [Results] (1) In CHD, the basic syndromes were blood stasis, phlegm heat, Qi deficiency, Qi stagnation and turbid phlegm; blood stasis and phlegm heat were the most common basic syndromes. (2) WBC counting, serum levels of CRP, IL-6 and TNF-α were increased in the cases of acute coronary syndrome (ACS) and non-ACS, in particular in ACS cases, which indicated the existence of inflammatory reaction in CHD and the close relationship between TCM syndromes and inflammatory factors. (3) Serum levels of CRP, IL-6 and TNF-α were obviously increased in the dead cases as compared with those in the survival cases. [Conclusion] Serum levels of CRP, IL-6 and TNF-a can be used as the reference indexes for the syndrome differentiation of CHD.