不稳定性心绞痛危险度分层与其中医证型及血清t-PA、PAI的研究  

Research on the association among TCM syndrome,t-PA and PAI in serum and the risk stratif ication of UA

作　　者：王阶[1] 李霁[1] 杨戈[1] 

机构地区：[1]中国中医科学院广安门医院,北京100053

出　　处：《中华中医药杂志》2009年第9期1133-1136,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：北京市自然基金项目(No.7062058);973课题(No.2003CB517103);优势病种(No.CACMSO5Y0010)

摘　　要：目的:探讨血浆组织型纤溶酶原激活物(t-PA)及纤溶酶原激活物抑制物(PAI)与不稳定型心绞痛危险度分层和中医证型之间的关系。方法:将86例不稳定型心绞痛患者辨证分型,同时进行冠脉造影和危险度分层,并采用Gensini评分系统评定冠脉造影结果,并用血瘀证积分评定血瘀证程度。检测患者的血清t-PA和PAI水平,并进行统计分析。结果:在86例患者中,低危(18例)、中危(44例)和高危(24例)组之间,随着危险分层的递增,血瘀证积分和Gensini积分均增加,经比较各组间有差异性存在(P<0.05)。而单支病变主要出现在低危组,与高危组比较差异显著;三支病变多发生在高危组,与低危组比较差异显著;双支病变及完全闭塞性病变在中、高危组之间经比较差异显著(P<0.05)。血瘀证积分在各证型间经两两比较有差异(P<0.05);Gensini积分按气虚血瘀证(15例)、气滞血瘀证(18例)、痰浊寒凝证(33例)和寒凝血瘀证(20例)顺序升高。在中医证型中,t-PA数值按照痰浊血瘀证、寒凝血瘀证、气虚血瘀证和气滞血瘀证的顺序升高;而PAI数值按痰浊血瘀证、寒凝血瘀证、气虚血瘀证和气滞血瘀证的顺序降低,与t-PA相反,且两组经比较均有差异性(P<0.05)。结论:血瘀证积分、Gensini积分及血清t-PA、PAI数值可提示不稳定性心绞痛危险度分层。Objective： To discuss the relation among t-PA, PAI, unstable angina risk stratification and its TCM syndrome. Methods： Syndrome differentiation, coronary angiography and risk stratification for 86 cases of unstable angina pectoris were carried out, and Gensini scoring system was used to assess the results of coronary angiography, blood stasis score was used to assess the degree of blood stasis. Serum blood serum t-PA and PAI levels were detected for statistical analysis.Results： In 86 cases of patients with low-risk, middle-risk and high-risk groups, with the incremental risk stratification, blood stasis and Gensini score were increased, by comparison among the three groups, the differences was existed （P〈0.05）. Single-vessel lesion occurred mainly in low-risk group, compared with high-risk group, there was significant difference; three-vessels lesions occurred mainly in high- risk group, compared with low-risk group there was significant difference; there were significant difference （P〈0.05） in two-vessel lesions and total occlusion lesions between middle-risk and high-risk group. The paired comparison demonstrated that, there were differences in blood stasis score among all syndromes （P〈0.05）; Gensini score increased in this order： qi deficiency and blood stasis syndrome, qi and blood stasis syndrome, phlegm and coagulated cold syndrome, coagulated cold and blood stasis syndrome. In TCM syndromes, t-PA values increased as followed order： phlegm and blood stasis syndrome, qi deficiency and blood stasis syndrome, coagulated cold and blood stasis syndrome, qi and blood stasis syndrome; while PAl values decreased as： phlegm and blood stasis syndrome, qi deficiency and blood stasis syndrome, coagulated cold and blood stasis syndrome, qi and blood stasis syndrome, just opposite to t-PA values, and there has difference between two groups（P〈0.05）. Conclusion： Blood stasis score, Gensini score and serum t-PA, PAl values indicate risk stratification of unstable angina.

关 键 词：不稳定性心胶痛 危险度分层 血瘀证积分 血浆组织型纤溶酶原激活物 纤溶酶原激活物抑制物 

分 类 号：R259[医药卫生—中西医结合]