六经辨证理论与慢性心力衰竭神经内分泌激活的相关性探讨  

The relationship between the theory of six meridians syndrome differentiation and neuroendocrine activation in chronic heart failure

作　　者：李晓霞 黄仕沛 关影芳 陈国成 李建强 陈丽霞 彭卉婷 王小艳 匡微 

机构地区：[1]广州市越秀区中医医院,广东广州510030

出　　处：《中医临床研究》2018年第18期53-59,共7页Clinical Journal Of Chinese Medicine

基　　金：广州市中医药和中西医结合科技项目(编号20162A011024)

摘　　要：目的:通过六经辨证,同时运用以方测证之原理,研究慢性心力衰竭六经辨证不同病证、不同心功能分级、不同LVEF值与神经内分泌激活的关系,以及方证对应干预后神经内分泌系统的变化,以总结慢性心力衰竭六经辨证分型规律,进一步探讨慢性心力衰竭六经论证规律。方法:将符合慢性心力衰竭六经辨证西医诊断标准的患者240例按美国纽约心脏病协会(NYHA)心功能(Ⅱ~Ⅳ级)分成太阳病证组20例、阳明病证组17例、少阳病证组19例、太阴病证组50例、少阴病证组100例、厥阴病证组34例,每组根据心功能分级(Ⅱ~Ⅳ级)、性别、年龄、病程随机分成基础治疗组、基础+经方治疗组。4周为1个疗程。用药(基础治疗、基础+经方治疗)前后观察测量指标包括心功能分级、左室射血分数(LVEF)、用放射免疫法测定血浆去甲肾上腺素(NE)、肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)及脑钠肽(BNP)浓度。从心功能、神经内分泌系统激活变化角度探讨六经辨证与慢性心力衰竭神经内分泌激活的相关性。结果:慢性心力衰竭可见太阳病证、阳明病证、少阳病证、太阴病证、少阴病证、厥阴病证;其中太阴病证、少阴病证及厥阴病证为慢性心力衰竭的主要证型。依据慢性心力衰竭的六经证型,治疗上选方较为多样性,但以四逆汤、苓桂术甘汤、真武汤为主要用方。结论:使用六经辨证内服中药汤剂配合口服西药基础治疗慢性心力衰竭的疗效显著,值得临床推广。0bjectiv:The relationship between different syndromes,different cardiac function grades,different LVEF values and neuroendocrine activation of chronic heart failure were studied by using the principle of syndrome differentiation of six meridians,and the changes of neuroendocrine system after corresponding intervention of six meridians,so as to summarize the syndrome differentiation rules of six meridians of chronic heart failure and further explore the syndrome differentiation rules of six meridians of chronic heart failure.Methods:240 patients with chronic heart failure(CHF)were divided into the sun syndrome group(20 cases),the yangming syndrome group(阳明病证)(17 cases),the shaoyang syndrome group(少阳病证组)(19 cases),the Taiyin syndrome group(太阴病证组)(50 cases),the shaoyin syndrome group(少阴病证组)(100 cases)and the Jue yin syndrome group(34 cases)according to the new York heart association(nyha)4 weeks for 1 course of treatment.Before and after medication(basic treatment,basic+prescription treatment),the indexes of cardiac function classification,left ventricular ejection fraction(LVEF),plasma norepinephrine(ne),renin activity(pra),angiotensinⅡ(angⅡ),aldosterone(ALD)and brain natriuretic peptide(BNP)were measured by radioimmunoassay.To investigate the correlation between the six meridians syndrome differentiation and neuroendocrine activation in chronic heart failure from the perspective of cardiac function and neuroendocrine system activation.Result:Chronic heart failure can be seen in the sun syndrome,yang Ming syndrome(阳明病证),shaoyang syndrome(少阳病证),Taiyin syndrome(太阴病证),shaoyin syndrome(少阴病证),Jue yin syndrome(厥阴病证);Among them,Taiyin syndrome(太阴病证),shaoyin syndrome(少阴病证)and Jue yin syndrome(厥阴病证)are the main syndromes of chronic heart failure.According to the six classic syndromes of chronic heart failure,the treatment of choice is more diverse,but with four inverse decoction(四逆汤),lingguizhugan decoction(苓桂

关 键 词：慢性心力衰竭 神经内分泌激活 六经辨证理论 

分 类 号：R256.22[医药卫生—中医内科学]