益气、行气活血法在冠心病心血瘀阻证中的作用机理探讨

An Exploration on the Mechanism of Qi-Benefiting, Qi-Promoting and Blood - Circulation-Activating Therapies on the Syndrome of Heart - Blood Stagnation in Coronary Heart Disease

目的:初步探讨行气活血法和益气活血法在冠心病心血瘀阻证的作用机理。方法:从冠心病患者中随机选择气滞心血瘀阻证30例和气虚心血瘀阻证30例,并随机分配到行气活血法组和益气活血法组中治疗,检测治疗前后的一氧化氮(NO)、内皮素(ET)、血栓素B2(TXB2)、6-酮-前列腺素(6-Keto-PGF1α)的变化。结果:气虚心血瘀阻证患者的血管内皮细胞的损伤程度比气滞心血瘀阻证患者严重,ET与NO间的平衡遭到更严重的破坏,平衡明显倾向于ET;气虚心血瘀阻证患者TXB2、6-keto-PGF1α失衡严重于气滞心血瘀阻证患者;行气活血法和益气活血法都可以改善患者ET与NO和TXB2与6-Keto-PGF1α间的平衡;2种治法对证治疗时,效果最佳。结论:辨证论治能发挥治疗的最大效应。益气活血法、行气活血法治疗冠心病血瘀阻证的作用机理可能与其修复受损的内皮细胞,调节NO与ET、TXB2与6-Keto-PGF1α间的平衡有关。

Objective: The mechanism of qi - promoting and blood - circulation - activating therapy (QPBA) and qi - benefiting and blood - circulation - activating therapy (QBBA) for syndrome of heart - blood stagnation (HBS) in coronary heart disease (CHD) was explored. Methods: 30 cases of HBS with qi - stagnation and 30 cases of HBS qi - deficiency were selected from cases of CHD and allocated randomly to QPBA group and QBBA group respectively. Blood nitric oxide (NO), endothelin (ET), thromboxane B2(TXB2)and 6 - Keto - prostaglandin (6 - Keto - PGF1a) were determined before and after treatment. Results: The damage of vascular endothelial cells was more severe in HBS with qi-deficiency than in that with qi - stagnation and the balance between ET and NO more destroyed with a tendency toward ET. The imbalance between TXB2 and 6 - Keto - PGF1a was more marked in those with qi - deficiency than those with qi -stagnation and the QPBA and QBBA therapy can improve the balance between ET and NO and between TXB2 and 6 - Keto - PGF1a, especially when adopted in accordance with the syndrome. Conclusion: Treatment according to syndrome differentiation can bring about the best effect. The mechanism of QPBA and QBBA therapy for HBS in CHD may be related to the repair of damaged endothelial cells and the regulation of balance of NO and ET as well as TXB2 and 6 - Keto - PGF1a.