中医络风内动证的病变特征和炎症标志物的检测  

Angiographic morphology of coronary artery lesions and level of plasma inflammatory markers in patients with endogenous collateral wind

作　　者：王显[1] 胡大一[1] 沙鸥[1] 

机构地区：[1]北京军区总医院心血管内科,北京100700

出　　处：《心脏杂志》2008年第5期619-621,626,共4页Chinese Heart Journal

基　　金：北京中医药科技基金项目资助(2002WX)

摘　　要：目的采用冠状动脉造影（CAG）结合测定患者血浆炎症标志物水平，初步探讨中医络风内动证的病变特征和炎症机制。方法入选CAG显示为单支血管病变的冠心病患者／20例，按中医辨证分为血瘀证组（30例）、痰阻血瘀证组（30例）和络风内动证组（60例）。采用酶联免疫吸附法测定患者血浆高敏C反应蛋白（hs—CRP）、金属基质蛋白酶-2，-9（MMP-2，MMP-9）、CD40配体（CD40L）和妊娠相关蛋白-A（PAPP—A）水平。使用软件包SPSS11．0对3组资料进行统计学处理。结果络风内动证组血管狭窄程度以95％-99％为主，主要表现ACC／AHA的B2、C型病变以及Levin分型的Ⅱ型病变，与血瘀证组和痰阻血瘀证组比较差异显著（P〈0．05）。络风内动证组患者血浆MMP-2、MMP-9和PAPP-A水平均显著高于血瘀证组（P〈0．01）和痰阻血瘀证组（P〈0．05）。络风内动证组线性相关分析表明：MMP-2与hs—CRP（r=0．486，P〈0．05）、PAPP—A（r=0．544，P〈0．05）均呈显著正相关，CD40L与PAPP—A也呈显著正相关（r=0．766，P〈0．01）。结论络风内动证组与其它证组相比，患者冠状动脉病变严重而复杂，血浆炎症标志物水平高。AIM To study the features of coronary artery lesions by coronary angiography （CAG） and the inflammatory mechanisms by the levels of plasma inflammatory markers in patients with endogenous collateral wind differentiated by traditional Chinese medicine （TCM）. METHODS One hundred and twenty consecutive patients with single blood vessel lesions confirmed by CAG were randomly divided into 3 groups based on the different types of syndrome differentiated by TCM： blood stasis group （n = 30） , blood stasis due to phlegm obstruction group （n = 30） and endogenous collateral wind group （n = 60）. The levels of plasma inflammatory markers such as high sensitivity C-reactive protein （hs-CRP）, matrix metalloproteinase （MMP, including MMP-2 and MMP-9） , CD40 ligand （CD40L） and pregnancy associated plasma protein-A （PAPP-A） were measured by enzyme linked immunosorbent assay （ELISA）. Analyses were performed by statistical package SPSS11. 0. RESULTS Angiostenosis in endogenous collateral wind group was 90%-95% , mainly of B2, C of ACC/AHA type lesion and Ⅱ Levin type lesion, which were higher than those in the other two groups （P 〈 0. 05 respectively）. The levels of plasma MMP-2, MMP-9 and PAPP-A in endogenous collateral wind group were significantly higher than those in blood stasis group （P 〈0.01 ） and blood stasis due to phlegm obstruction group （P 〈0. 05）. In endogenous collateral wind group, linear correlation analysis manifested that MMP-2 was positively and significantly associated with hs-CRP （ r = 0. 486, P 〈 0. 05 ） and PAPP-A （ r = 0. 544, P 〈 0.05 ）. CD40L was also positively and significantly associated with PAPP-A （ r = 0. 766, P 〈 0. 01 ）. CONCLUSION Compared with those in blood stasis group and blood stasis due to phlegm obstruction group, the coronary artery lesions are more severe and complex and the levels of plasma inflammatory markers are higher in endogenous collateral wind group.

关 键 词：冠状动脉疾病 冠状动脉造影 血浆炎症标志物水平 中医辨证分型 

分 类 号：R541.4[医药卫生—心血管疾病]