冠状动脉微血管疾病的中西医发病机制和治疗进展  

Pathogenesis and Treatment of Coronary Microvascular Disease in Traditional Chinese and Western Medicine:A Review

作　　者：李梓涵 袁蓉[2] 信琪琪 缪宇[2] 丛伟红[2] LI Zihan;YUAN Rong;XIN Qiqi;MIAO Yu;CONG Weihong(Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;National Clinical Research Center for Chinese Medicine Cardiology,Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]天津中医药大学,天津301617 [2]中国中医科学院西苑医院,国家中医心血管病临床医学研究中心,北京100091

出　　处：《中国实验方剂学杂志》2023年第9期252-260,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82004193,82104680);中医科学院科技创新工程重大攻关项目(CI2021A00914)。

摘　　要：近年来,冠状动脉微血管疾病(CMVD)作为缺血性心脏病的主要类型之一,已成为新的研究热点,该病发病率高、诊断率低,因而倍受临床关注。CMVD病因复杂,症状各异,中西医对其发病机制、治疗方案各有分说,西医认为CMVD与冠脉微血管的结构异常(如微血管重塑、血管壁浸润、管腔阻塞、血管稀疏和血管周围纤维化等)、功能异常(如内皮功能障碍、平滑肌细胞功能障碍、微血管缩窄、微血管痉挛、炎症和自主神经功能障碍等)及血管外因素诱导(心率、血压等)有关,临床通常采用常规西药进行经验性的治疗,但效果欠佳;中医认为CMVD属中医学“胸痹”“心痛”“络病”的范畴,常见气虚血瘀、气滞血瘀、气阴两虚、寒凝心脉、心脾两虚、瘀血阻络、痰瘀互结、肝肾亏虚等证,治疗方法丰富多样,中成药、自拟方、传统经方加减治疗、中医特色疗法均取得一定的疗效。文章从CMVD的危险因素、病理机制、中医病因病机、中西医治疗等方面予以综述,以期为CMVD的研究和治疗提供参考。In recent years,coronary microvascular disease(CMVD),a main type of ischemic heart disease with high incidence and low diagnosis rate,has become a new research hotspot and received much clinical attention.The etiology of CMVD is complex and the symptoms are various.Traditional Chinese and Western medicine have different opinions on its pathogenesis and treatment plan.Western medicine believes that CMVD is related to structural abnormalities(such as microvascular remodeling,vascular invasion,lumen obstruction,sparse vascular vessel and perivascular fibrosis)and functional abnormalities(such as endothelial dysfunction,smooth muscle cell dysfunction,microvascular constriction,microvascular spasm,inflammation and autonomic nervous dysfunction)of coronary microvascular vessels as well as the extravascular factors(such as heart rate and blood pressure).In clinics,conventional western medicines are usually used for empirical treatment,but with undesirable effects.Traditional Chinese medicine(TCM)believes that CMVD belongs to the category of"chest impediment","heart pain"and"collateral disease",and the common syndromes include Qi deficiency and blood stasis,Qi stagnation and blood stasis,Qi and Yin deficiency,congealing cold in heart vessel,heart and spleen deficiency,blood stasis obstructing collaterals,combined phlegm and blood stasis,and liver and kidney deficiency,with a variety of treatment methods.Specifically,Chinese patent medicines,self-designed prescriptions,modified classical prescriptions and TCM characteristic therapies have achieved certain effects.This review discussed the risk factors,pathological mechanism,TCM etiology and pathogenesis and traditional Chinese and Western medicine treatment of CMVD,to provide reference for the study and treatment of CMVD.

关 键 词：冠状动脉微血管疾病(CMVD) 缺血性心脏病 冠脉微血管功能异常 微循环 中医药 

分 类 号：R2-0[医药卫生—中医学] R33[文化科学—情报学] G353.11R541.4