冠心病“痰瘀”证素特征的临床研究

Clinical Study of the Characteristics of the Phlegm and Blood Stasis Syndrome Element on Coronary Heart Disease

目的:探讨冠心病由"痰凝"至"痰瘀"病性证素变化对冠心病形成的影响。方法:对冠心病痰瘀痹阻证组120例、痰凝心脉证组98例、非痰非瘀证组92例、健康人对照组30例进行血脂、血液流变学、血糖、胰岛素敏感性指数及相关基因表达的检测分析。结果:冠心病血脂痰凝心脉证组与非痰非瘀证组、正常组均有显著差异(P<0.01);由非痰非瘀证→痰凝心脉证→痰瘀痹阻证血液流变学各项指标均增加;FINS、ISI值呈健康对照<非痰非瘀证组<痰凝心脉证组<痰瘀痹阻证组递进趋势(均P<0.01);由非痰非瘀→痰凝心脉→痰瘀痹阻的病理演变中,患者c-myc mRNA和PDGF-AmRNA的表达量均逐渐增加。结论:痰瘀痹阻证血液流变学指标均显著高于非痰非瘀证、痰凝心脉证,提示血液流变学异常是血脉瘀阻的客观指证;IR可能是产生"痰瘀"并由"痰"到"瘀"演变的重要内在生化物质基础;IR与冠状动脉脉病变严重程度呈正相关,提示IR可作为预测冠心病严重程度的参考指标之一;冠心病"痰瘀"证素变化的分子机制与c-myc、PDGF-AmRNA异常表达有关。

Objective ： To investigate the effects on coronary heart disease （CHD） for the syndrome element change of the nature of disease from ＂the Phlegm＂ to ＂the Phlegm and Blood Stasis＂. Methods ： To detect the blood -fat, blood rheology, blood glucose, insulin sensitivity index （ISI） and the expression of related genes from 120 CHD patients with syndrome of blockage of phlegm and blood stasis （ Group 1 ） , 98 CHD patients with syndrome of stagnation of phlegm in blood vessel （ Group 2）, 92 CHD patients with syndrome of non phlegm and non blood stasis （Group 3 ） and 30 healthy persons for control group （Control group）. Results： Group 2 have significant differences compared with Group 3 and Control group （P 〈 0. 01 ）. All indexs of blood rheology have gradual increase from Group 3, Group 2 to Group I. Similarly, FINS （ Fasting blood insulin） and ISI both have a increased tendency from Control group, Group 3, Group 2 to Group 1 too （P 〈0. 01）. In the process of pathologic evolution, from Group 3, Group 2 to Group 1, the expression amount of c - myc mRNA and PDGF - A mRNA have progressive increase. Conclusion： First, the abnormality of blood rheology is the objective index of stagnation of blood vessel. Second, IR is the important inner biochemistry basic, which produces ＂the Phlegm and Blood Stasis＂, also develops ＂the Phlegm＂ to ＂the Blood Stasis＂. Third, there is a positive correlation between IR and pathological changes＇degree of coronary artery, which indicates that IR can be used as a indication to predict CHD. Last, the changes of the Phlegm and Blood Stasis syndrome element of CHD relates to abnormal expression of c - myc, PDGF - A mRNA.