Impact of continuous care on cardiac function in patients with lung cancer complicated by coronary heart disease

BACKGROUND Despite sharing similar pathogenic factors,cancer and coronary heart disease(CHD)occur in comparable populations at similar ages and possess similar susceptibility factors.Consequently,it is increasingly commonplace for patients to experience the simultaneous occurrence of cancer and CHD,a trend that is steadily rising.AIM To determine the impacts of continuing care on lung cancer patients with CHD following percutaneous coronary intervention(PCI).METHODS There were 94 lung cancer patients with CHD following PCI who were randomly assigned to the intervention group(n=38)and the control group(n=41).In the intervention group,continuing care was provided,while in the control group,routine care was provided.An evaluation of cardiac and pulmonary function,medication compliance,a 6-min walk test,and patient quality of life was performed.RESULTS Differences between the two groups were significant in left ventricular ejection fraction,6-min walk test,oxygen uptake,quality of life and medication compliance(P<0.05).In comparison with the control group,the enhancement in the intervention group was more significant.The intervention group had more patients with high medication compliance than the control group,with a statistically significant difference(P<0.05).CONCLUSION After undergoing PCI,lung patients with CHD could benefit from continued care in terms of cardiac and pulmonary function,medications compliance,and quality of life.

Treatment of Coronary Heart Disease from the Perspective of Liver Controlling Dispersion

The liver is in charge of distributing and regulating the movement of qi throughout the whole body,coordinating the transportation and transformation of the internal organs in the middle part of the body,promoting the biochemical circulation of qi,blood,and body fluids,and regulating emotions.Liver dysfunction can disrupt the transportation and transformation of qi,blood,and body fluids,causing phlegm turbidity,blood stasis,and other unwanted symptoms.Poor regulation of emotion further aggravates the accumulation of pathological substances,resulting in the obstruction of heart vessels,and ultimately coronary heart disease(CHD).Through regulating lipid metabolism,inflammatory reaction,vasoactive substances,platelet function,neuroendocrine,and other factors,liver controlling dispersing qi plays a comprehensive role in the prognosis of atherosclerosis,the primary cause of CHD.Therefore,it is recommended to treat CHD from the perspective of liver-controlling dispersion.

The Effect of Atorvastatin on Liver Function among Patients with Coronary Heart Disease in Gaza Strip

Statins, which are inhibitors of 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, are considered as one of the most important drugs and the drug of choice for reducing an abnormal cholesterol level. Statins are normally used to decrease the risk of coronary heart disease (CHD), but they tend to be associated with liver adverse effects. The objective of this prospective study was to investigate the effect of atorvastatin therapy on the liver function in patients with CHD. Study comprised of 66 newly diagnosed CHD patients who were selected from UNRWA clinics in the Gaza Strip. The patients were clinically examined and treated with atorvastatin (10 - 40 mg/day). A questionnaire was used to collect the data concerning patient’s characteristics. Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), liver enzymes tests such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and total and direct blood bilirubin were measured before starting treatment and after 3 and 6 months of treatment. The results showed a significant increase in the mean values of ALT, AST, total bilirubin and direct bilirubin levels after 3 months then decreased after the next 3 months, but they were higher than the baseline with insignificant association.

Clinical efficacy and significance of serum fibroblast growth factor-21 and ghrelin in the treatment of type 2 diabetes complicated with coronary heart disease with integrated traditional Chinese and western medicine

Objective: To treat the patients with type 2 diabetes mellitus complicated with coronary heart disease, to explore the clinical efficacy and mechanism of conventional western medicine combined with Yiqi Yangyin Huoxue herbs, and to detect the level of serum fibroblast growth factor-21 (FGF-21) and Ghrelin. Changes and significance. Methods: A randomized control method was used to collect 100 patients with type 2 diabetes mellitus complicated with coronary heart disease who were diagnosed and treated in our hospital from March 2015 to March 2018.They were randomly divided into two groups according to the random number table method: 50 patients separately. The patients in the control group were treated with conventional western medicine and basic treatment;the observation group was treated with the addition and subtraction of traditional Chinese medicine formulas on the basis of the control group;the clinical curative effect was evaluated after two months of treatment, and the treatment efficiency and scores of traditional Chinese medicine symptoms were observed in the two groups. Basic laboratory indicators were improved, and serum levels of FGF-21 and Ghrelin in patients were measured and the difference between the results of the tests was compared with the condition and efficacy. Results: After treatment, the total effective rate of the observation group (86.0%) was significantly higher than that of the control group (68.0%) (P<0.05), suggesting that the combination of Chinese and Western medicine treatment can significantly improve the clinical efficacy;before treatment,there is no difference between the two groups of Chinese medicine symptom scores (P>0.05). After treatment, the symptom scores of the two groups were significantly improved after treatment (P<0.05). The observation group was better among the two groups (P<0.05).After treatment, the basic biochemical indicators were improved. The observation group was better than the control group (P<0.05);Serum FGF-21 levels were significantly lower in both groups after treatment (P<0.05), and Ghrelin levels were significantly increased. There was a statistically significant difference between the two groups (P<0.05). Conclusion: The use of conventional western medicine in combination with Yiqi Yangyin Huoxue Chinese medicine for the treatment of type 2 diabetes mellitus patients with coronary heart disease can significantly improve the clinical efficacy, effectively promote the improvement of symptoms, and can be used in clinical work through serum FGF-21, Ghrelin levels combined detection of the value of Abnormal changes to predict the severity of type 2 diabetes mellitus with coronary heart disease severity and treatment effect should be widely used in clinical diagnosis and treatment.

Coronary heart disease:Significance of liver X receptor α genomics

Crosstalk between lipid peroxidation and inflammation is known to be a pathognomonic feature for the development of coronary heart disease(CHD).In this regard ligand activated liver X receptor(LXR)-α has emerged as a key molecular switch by its inherent ability to modulate an array of genes involved in these two fundamental cellular processes.In addition,LXR-α has also been found to play a role in hepatic lipogenesis and innate immunity.Although several lines of evidence in experimental model systems have established the atheroprotective nature of LXR-α,human subjects have been reported to possess a paradoxical situation in which increased blood cellular LXR-α gene expression is always accompanied by increased coronary occlusion.This apparent paradox was resolved recently by the finding that CHD patients possess a deregulated LXR-α transcriptome due to impaired ligand-receptor interaction.This blood cellular mutated LXR-α gene ex- pression correlated specifically with the extent of coro- nary occlusion and hence need is felt to devise new synthetic ligands that could restore the function of this mutated LXR-αprotein in order to modulate genes involved in reverse cholesterol transport and suppression of the inflammatory response leading to the effective treatment of CHD.

Relationship between non-alcoholic fatty liver disease and coronary heart disease

Non-alcoholic fatty liver disease(NAFLD)is the leading cause of chronic liver disease and considered a liver manifestation of metabolic syndrome.It is in close relationship with insulin resistance,obesity,diabetes mellitus,all of which increase risk of cardiovascular disease(CVD).Besides,many studies point out that NAFLD independently contributes to the development of atherosclerosis and CHD.On the other hand,CVDs are the leading cause of death in NAFLD patients.Many pathophysiological changes and molecular mechanisms play an important role in NAFLD for CVD formation.Atherosclerosis is common in NAFLD,which also mainly contributes to the CVD formation and CHD.Many studies linking atherosclerotic CHD and NAFLD are present in the literature.Subclinical CHD,mainly detected by coronary computed tomography views,have been detected more common in NAFLD patients.Presence of NAFLD has been found to be more common in patients with severe CHD and in stable CHD,NAFLD has been found to be associated with more diffuse disease.In acute coronary syndromes,especially in acute myocardial infarction,patients with NAFLD have been found to have poor prognosis when compared with NAFLD free patients.In this review,our aim is to evaluate the relationship between NAFLD and CHD in detail and go over the pathophysiological mechanisms underlying this relationship.

Nursing care of a patient with programmed cell death protein-1 immunotherapy-related myocarditis combined with coronary heart disease

This report introduced and summarized the nursing care experience for a senior patient with lung cancer and developed programmed cell death protein 1(PD-1)immunotherapy-related myocarditis combined with coronary heart disease(CHD)after receiving said treatment.In this case,immune myocarditis with CHD occurred shortly after implementing the PD-1 immunotherapy,yet the patient presented no clinical symptoms.Frequent nursing attention and close observation are so required for monitoring the patient’s status and updating the physicians for a swift control of the myocarditis.For this case,nursing care procedures vital for the successful recovery of the patient included condition observation,position management,pre-and postcoronary angiography care,infection prevention,hemorrhage prevention,venous access port maintenance,pain care,trachea care,psychological care,diet care,environment management,and health education.After receiving effective,successful treatment and care,the patient was discharged after 13 days of treatment with generally satisfying overall conditions.

Risk of cardiovascular,cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)has emerged as a public health problem of epidemic proportions worldwide.Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease(CHD),abnormalities of cardiac function and structure(e.g.,left ventricular dysfunction and hypertrophy,and heart failure),valvular heart disease(e.g.,aortic valve sclerosis)and arrhythmias(e.g.,atrial fibrillation).Experimental evidence suggests that NAFLD itself,especially in its more severe forms,exacerbates systemic/hepatic insulin resistance,causes atherogenic dyslipidemia,and releases a variety of pro-inflammatory,pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications.Collectively,these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications.The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular,cardiac and arrhythmic complications,to briefly examine the putative biological mechanisms underlying this association,and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications.

Blood cellular mutant LXR-α protein stability governs initiation of coronary heart disease

AIM: To investigate the role of [breast and ovarian cancer susceptibility 1（BRCA1）-associated RING domain 1（BARD1）]/BRCA1 E3-ubiquitin ligase complex in governing the stability of mutant liver X receptor-（LXR-α） protein in coronary heart disease（CHD） subjects.METHODS: The expression analysis of various genes was carried out by quantitative real time polymerase chain reaction and western blotting within blood mononuclear cells of human CHD subjects at various stages of coronary occlusion and their corresponding normal healthy counterparts.Immunoprecipitation experiments were performed to establish protein interactions between LXR-αand BARD1.Peripheral blood mononuclear cells were cultured and exposed to Vitamin D3 and Cisplatin to validate the degradation of mutant LXR-αprotein in CHD subjects by BARD1/BRCA1 complex.RESULTS: The expression of mutant LXR-αprotein in CHD subjects was found to decrease gradually with the severity of coronary occlusion exhibiting a strong negative correlation,r =-0.975 at P 【 0.001.Further,the expression of BARD1 and BRCA1 also increased with the disease severity,r = 0.895 and 0.873 respectively（P 【 0.001）.Immunoprecipitation studies established that BARD1/BRCA1 complex degrades mutant LXR-αvia ubiquitination.The absence of functional LXR-αprotein resulted in increased expression of inflammatory cytokines such as interleukin（IL）-6,IL-8 and interferon-and decreased expression of ABCA1（ATP-binding cassette A1）（r = 0.932,0.949,0.918 and-0.902 with respect to Gensini score;P 【 0.001）.Additionally,cell culture experiments proved that Vitamin D3 could prevent the degradation of mutant LXR-αand restore its functional activity to some extent.CONCLUSION: Mutant LXR-αprotein in CHD subjects is degraded by BARD1/BRCA1 complex and Vitamin D3 can rescue and restore its function.

Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease

AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.

Role of cardiovascular intervention as a bridge to liver transplantation

End stage liver disease(ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may pro-foundly influence diagnostic and management strate-gies in the preoperative period. This review focuses on evidence-based diagnosis and management of coro-nary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifi-cally, we address the underlying prevalence of cardio-vascular disease states in the ESLD population, and relevant diagnostic criteria thereof. We highlight tradi-tional and non-traditional predictors of cardiovascular outcomes following liver transplant, as well as data to guide risk-factor based diagnostic strategies. We go on to discuss the alterations in cardiovascular physiology which influence positive- and negative-predictive values of standard noninvasive testing modalities in the ESLD population, and review the data regarding the safetyand efficacy of invasive testing in the face of ESLD and its co-morbidities. Finally, based upon the totality of available data, we outline an evidence-based ap-proach for the management of ischemia, heart failure and pulmonary vascular disease in this population. It is our hope that such evidence-driven strategies can be employed to more safely bridge appropriate candidates to liver transplant, and to improve their cardiovascular health and outcomes in the peri-operative period.

基于“心-脉-神”互言探讨肝心同治冠心病合并抑郁(双心疾病)的理论研究

双心疾病作为“血脉之心”与“神明之心”同病的复合疾病,已经成为现代社会影响人类健康的主流问题之一,其中的冠心病合并抑郁属于临床中常见的发病类型。冠心病是一种严重威胁健康的心血管疾病,焦虑和抑郁是其不良预后的潜在危险因素。冠心病合并抑郁属中医“胸痹”“郁证”范畴,“心藏脉,脉舍神”,心脏对生命活动具有重要的控制和调节作用,“从心论治”使机体心主神明、心主血脉功能正常发挥。心血管疾病与情志病是密不可分的,胸痹患者心脉不畅,肝失疏泄,痰瘀互结,气机郁滞加重,由此引发情志的改变。双心疾病与中医的“心主血脉”“心主神明”“肝主藏血”“肝主疏泄”功能失常密切相关,“心”与“肝”的状态失衡是导致疾病进展的主要因素,故“肝心同治”是调节关键病机-肝心失调的必由之法,以疏肝解郁、调气和血为主。基于对“从心论治”“心-脉-神”与“肝心同治”的理论探讨,结合现代科学技术,旨在为防治冠心病合并抑郁提供新的思路与机制预测。

达格列净治疗糖尿病合并冠心病老年患者的效果及对心功能的影响

目的探讨达格列净治疗糖尿病合并冠心病老年患者的效果及对心功能的影响。方法选取2021年7月至2022年12月抚州市第一人民医院收治的80例糖尿病合并冠心病老年患者作为研究对象,按照随机数字表法分为观察组(40例)与对照组(40例),观察组采用达格列净治疗,对照组采用二甲双胍治疗。比较两组的治疗总有效率、氨基末端pro脑钠肽(NT-proBNP)、超敏C反应蛋白(hs-CRP)、心功能水平。结果观察组治疗后总有效率高于对照组,差异有统计学意义(P<0.05);观察组治疗后NT-proBNP水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后hs-CRP水平低于对照组,差异有统计学意义(P<0.05);观察组治疗后左室舒张末期内径(LVEDD)低于对照组,观察组治疗后左室射血分数(LVEF)、舒张早期和舒张晚期二尖瓣口最大血流速度之比(E/A)、6 min步行距离高于对照组,差异有统计学意义(P<0.05)。结论达格列净治疗投入临床糖尿病合并冠心病老年患者治疗中,所得干预的评估结果更好。在实施治疗之后,患者的症状得到较好的改善,且NT-proBNP、hs-CRP指数减少,患者心功能水平得到一定的改善,值得被临床应用推广。

正念减压疗法在支架植入术治疗晚期肝癌合并冠心病患者中的应用效果

目的探讨正念减压疗法(MBSR)在支架植入术治疗晚期肝癌合并冠心病患者中的应用效果。方法根据干预方法的不同将90例晚期肝癌合并冠心病患者分为对照组(n=48)和MBSR组(n=42),对照组患者采取常规干预,MBSR组患者在对照组的基础上采取MBSR干预。比较两组患者的自我感受负担[自我感受负担量表(SPBS)]、生活质量[肝病患者生命质量测定量表(LDQOL)]及心血管不良事件发生情况。结果干预后,两组患者SPBS各维度评分均低于本组干预前,MBSR组患者SPBS各维度评分均低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者LDQOL各维度评分均高于本组干预前,MBSR组患者LDQOL各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。术后3个月,MBSR组患者心血管不良事件总发生率低于对照组,差异有统计学意义(P﹤0.05)。结论MBSR应用于支架植入术治疗的晚期肝癌合并冠心病患者,可降低自我感受负担,提高生活质量,减少心血管不良事件。

李永寿教授治疗内科杂病临床经验撷菁

李永寿教授致力于内科杂病研究50年,注重医经理论和运用医方治疗各种常见病、疑难病。在中西医结合治疗内科常见病、疑难病方面有较深的造诣,特别擅长慢性胃肠炎、脱发及肝病的诊治,尤其治疗传染性肝炎,疗效显著。

地奥心血康软胶囊联合依那普利对冠心病合并心房颤动患者血压测量波动性的影响

目的:探讨地奥心血康软胶囊联合依那普利对冠心病合并心房颤动患者血压测量波动性的影响。方法:选取2021年1月~2021年10月就诊于九江市第一人民医院的136例冠心病合并持续性非瓣膜性心房颤动患者,计算分析包括年龄、性别、合并疾病、合并用药等参数在内的各项因素和血压波动的相关性,并就是否联合使用地奥心血康软胶囊在管理血压波动方面的价值进行探索。结果:年龄、性别、合并疾病(高血压、糖尿病、卒中、心力衰竭、高脂血症)、合并用药[血管紧张素转化酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、钙离子通道阻滞剂(CCB)、利尿剂、抗凝药、抗血小板药、他汀]与基线水平血压波动之间的相关性差异无统计学意义(P>0.05);在将计算血压波动结点值设置为“6 mmHg”这一前提下,总体研究对象的血压波动达标率为29.4%,联药组在随访过程中的血压波动达标率呈逐渐上升趋势,单药组的血压波动达标率也呈现了波动性,单药组对应时间节点的血压波动达标率较之于联药组均偏低。结论:地奥心血康软胶囊与血压管理具有良好的相关性且能够降低血压的波动性,可以考虑联合依那普利作为降压控压方案。

腹腔镜下胃癌根治术和内镜黏膜下剥离术治疗早期胃癌合并冠心病患者的效果比较

目的比较腹腔镜下胃癌根治术(LRG)和内镜黏膜下剥离术(ESD)治疗早期胃癌合并冠心病患者的效果。方法根据治疗方式的不同将98例早期胃癌合并冠心病患者分为LRG组(n=47,LRG治疗)和ESD组(n=51,ESD治疗),比较两组患者的围手术期指标、疼痛情况[视觉模拟评分法(VAS)]、心功能指标[肌酸激酶同工酶MB(CK-MB)、心肌肌钙蛋白(ⅠcTnⅠ)、左室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]、应激反应指标[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、肾上腺素(EP)]以及术后心脏并发症发生情况。结果ESD组患者手术时间、首次排气时间、胃管拔除时间、进食恢复时间、住院时间均短于LRG组,术中出血量少于LRG组,术后心脏并发症总发生率低于LRG组,差异均有统计学意义(P﹤0.05)。术后6 h、1天、3天、7天,两组患者VAS评分均低于本组术前,ESD组患者VAS评分均低于LGR组,差异均有统计学意义(P﹤0.05)。术后12 h,两组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均高于本组术前,LRG组患者LVEF、CI、CO均低于本组术前,ESD组患者CK-MB、cTnⅠ、hs-CRP、TNF-α、IL-6、Cor、ACTH、EP均低于LRG组,LVEF、CI、CO均高于LRG组,差异均有统计学意义(P﹤0.05)。结论与LRG比较,ESD治疗早期胃癌合并冠心病患者的安全性高、手术时间短、术中出血量少、手术创伤小、术后疼痛程度轻,因此患者术后应激反应更轻,对患者心功能的不良影响更小,术后恢复更快。

疼痛管理联合加速康复外科理念在肺癌合并冠心病患者围手术期的应用效果

目的探讨疼痛管理联合加速康复外科理念在肺癌合并冠心病患者围手术期的应用效果。方法根据干预方式的不同将62例肺癌合并冠心病手术患者分为观察组(n=33)和对照组(n=29),对照组患者围手术期给予常规干预,观察组患者在对照组的基础上给予疼痛管理联合加速康复外科理念。比较两组患者的围手术期指标、疼痛情况[视觉模拟评分法(VAS)]、负性情绪[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)]及术后并发症发生情况。结果观察组患者首次排气时间、首次排便时间、引流管拔除时间、住院时间均短于对照组,术后并发症总发生率低于对照组,差异均有统计学意义(P﹤0.05)。术后1天、3天、1周,两组患者VAS评分均呈下降趋势,且观察组患者VAS评分均低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者HAMA、HAMD评分均低于本组干预前,观察组患者HAMA、HAMD评分均低于对照组,差异均有统计学意义(P﹤0.05)。结论疼痛管理联合加速康复外科理念应用于肺癌合并冠心病患者围手术期,能够减轻术后疼痛、改善负性情绪、降低术后并发症发生率,并且促进患者术后恢复。

基于隐结构模型探讨冠心病合并高血压糖尿病患者中医证候特征

目的基于隐结构模型探讨冠心病合并高血压糖尿病患者的中医证候特征。方法采用多中心横断面研究的方法,使用本课题组研制的《冠心病中医四诊采集量表》收集患者中医四诊信息,建立临床数据库。结合频次分析和专家意见筛选四诊信息构建隐结构模型。结果共收集冠心病合并高血压糖尿病患者702例,筛选得到高频四诊症状40个,隐结构模型分析得到18个隐变量,模型贝叶斯信息准则评分为-17604.38。对模型中隐变量进行综合聚类,发现冠心病合并高血压糖尿病患者病位证素主要有心、肝、肾等,病性证素主要有气虚、阴虚、气滞、痰浊、血瘀等,归纳其证型主要有痰瘀互结证、脾肾阳虚证、肝郁气滞证、肝肾阴虚证、湿热内蕴证5类,并提示各证型与四诊信息间的互信息及信息覆盖度。结论隐结构模型分析可为冠心病合并高血压糖尿病患者的证候分类提供一定的定性定量依据。

基于“肝受气于心,传之于脾”探讨血流剪切力调控冠心病的相关机制

“肝受气于心,传之于脾”包括肝脾同治的理念。肝脾居中焦,调节各脏腑之气机升降出入,正所谓“气有余,则制己所胜而侮所不胜”,肝脾功能失衡,可祸及于心。研究发现疏肝健脾祛痰法能够调节miR-155水平,上调胆固醇跨血管内皮转运主要受体ABCA1,减少胆固醇沉积,改善冠脉血流量,但具体机制尚不明确。新近研究表明,血流剪切应力感受器Integrin激活可致miR-155核内启动下游基因转录。基于前期基础结合国内外研究进展,关注环境因素和生活方式对冠心病形成的作用,提出“肝郁脾虚,痰浊内生”乃AS重要病机,揭示《内经》藏象理论心病防治新策略的科学内涵,为中医从肝脾防治冠心病提供科学依据。