介入后冠心病“虚在气、留在瘀”的中医病机认识初探

Concept of"Deficiency in Qi and Retention in Stasis"for Traditional Pathogenesis of Coronary Artery Disease Post-Intervention

在冠状动脉介入治疗前,由于冠状动脉狭窄、血小板活化、血栓形成、炎症反应等病理改变,冠心病患者症状以胸闷、心痛为主,中医学认为此为血脉瘀阻、不通则痛。介入治疗解除冠状动脉狭窄后,多致血管内皮修复延迟、功能障碍,临床症状多表现为情绪低落、气短乏力等,中医病机为“虚在气”;血管内膜损伤诱发的血小板活化、凝血级联反应、微血栓形成、斑块碎屑残留等病理改变,此为“留在瘀”。气虚血瘀是介入后冠心病患者的主要中医证型。益气活血中药可减少介入后患者心血管事件,改善生活质量,其机制与改善内皮损伤、增强抗血小板聚集、减轻炎症反应等作用相关。

Before revascularization,the symptoms of patients with coronary artery disease(CAD)are mainly chest tightness and heartache,due to pathological changes including coronary artery stenosis,platelet activation,thrombosis,and inflammatory reaction.At this time,the pathogenesis of traditional Chinese medicine(TCM)theory was blood stasis leading to pain.After stent implantation is performed to relieve coronary artery stenosis,vascular endothelial repair is delayed,dysfunction of endothelium is developed,and the clinical symptoms are mostly characterized by low mood,shortness of breath,and weakness,which is considered as deficiency of Qi in TCM theory.Pathological changes,such as platelet activation,coagulation cascade reaction,microthrombus formation,and plaque debris residue induced by vascular injury,are considered as blood stasis.Taken together,deficiency of qi and blood stasis might be the main syndrome type in patients with CAD after stenting.TCM for supplementing qi and activating blood circulation could reduce cardiovascular events and improve life quality of patients post angioplasty,and its mechanism might be associate with improved endothelial injury,enhanced anti-platelet aggregation and reduced inflammatory response.