陈镜合教授冠心病学术思想研究
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摘要
冠状动脉性心脏病(coronary heart disease,CHD),简称冠心病,亦称缺血性心脏病,是冠状动脉粥样硬化性心脏病和冠状动脉痉挛的统称。根据WHO的统计,冠心病是世界上最常见的死亡原因之一,其发病率和死亡率在中国均呈显著上升趋势,严重威胁着人类健康。如何防治和减少冠心病的发病率和病死率始终是心血管病研究领域的重点和热点之一。该病属于中医学“胸痹”范畴。近年来,随着科研的进一步深入,中医药对该病的辨证论治取得了很大成绩。本论文拟从以下几方面对中医药诊疗冠心病的研究进行了详细论述:
1.详细论述中医学对该病的病因、病机、诊治以及近年来的临床及实验研究进展等,并且对当代名家治疗冠心病的经验进行了归纳。
2.对目前现代医学关于该病病因、病机、诊断及治疗等方面的研究进展等进行了总结,同时将目前临床常用冠心病诊断手段及各自对冠心病诊断价值进行了分析。
3.本人师从广州中医药大学首席教授、国家级名中医陈镜合教授,跟诊学习三年,亲聆教诲,受益颇深,本论文对导师陈镜合教授论治冠心病的学术思想进行了初步总结。
4.对近年来中医药治疗冠心病规范化研究以及所存在的问题以、今后的研究方向进行了探讨。
Coronary Heart Disease(CHD) is a common cardiovascular disease.The disease occurs following coronary atherosclerosis which causes lumen of blood vessel narrow, followed by such clinical symptoms as insufficiency of blood supply from coronary artery, acute myocardial infarction,transient ischemia,and anoxia.The disease belongs to the thoracic obstruction in traditional Chinese medicine.
With the rapid development of modern science and technology,Chinese medicine using determination of treatment based in pathogennesis obtained through differentiation of symptoms and signs treating the disease from macro to micro aspects such as patients with dysfunctions of microcirculation and abnormal hemorheology,damaged blood vessel endothelium and other aspects,has addressed this condition and achieved certain results.
This dissertation addresses some aspects in details about coronary artery disease treated with Chinese medicine and modern western medicine.
1.To discuss the etiology,pathogennesis,dialectical grouping,and treatment method of coronary heart disease.The experience of famous contemporary physicians in terms of treating Thoracic obstruction was also discussed in this paper.
2.Along with the fact that clinical examination method for the coronary diseases, increasingly plentiful nuclide of myocardial perfusion imaging,especially the CAG coronary arteriography.The latter has been considered as the "Gold standard" coronary artery disease diagnosis method for its directness,precision,accuracy,and reliability.
3.Under the close supervision of famous Professor Chen Jinghe for 3 years,in treatment of cardia-cerebrovascular diseases in Chinese medicine,I initially synthesized his experience in treating this disease.
4.To explain the latest diagnostic methods and their values in diagnosis and treatment of coronary artery diseases and investigate the research orientation in this field.
1.详细论述中医学对该病的病因、病机、诊治以及近年来的临床及实验研究进展等,并且对当代名家治疗冠心病的经验进行了归纳。
2.对目前现代医学关于该病病因、病机、诊断及治疗等方面的研究进展等进行了总结,同时将目前临床常用冠心病诊断手段及各自对冠心病诊断价值进行了分析。
3.本人师从广州中医药大学首席教授、国家级名中医陈镜合教授,跟诊学习三年,亲聆教诲,受益颇深,本论文对导师陈镜合教授论治冠心病的学术思想进行了初步总结。
4.对近年来中医药治疗冠心病规范化研究以及所存在的问题以、今后的研究方向进行了探讨。
Coronary Heart Disease(CHD) is a common cardiovascular disease.The disease occurs following coronary atherosclerosis which causes lumen of blood vessel narrow, followed by such clinical symptoms as insufficiency of blood supply from coronary artery, acute myocardial infarction,transient ischemia,and anoxia.The disease belongs to the thoracic obstruction in traditional Chinese medicine.
With the rapid development of modern science and technology,Chinese medicine using determination of treatment based in pathogennesis obtained through differentiation of symptoms and signs treating the disease from macro to micro aspects such as patients with dysfunctions of microcirculation and abnormal hemorheology,damaged blood vessel endothelium and other aspects,has addressed this condition and achieved certain results.
This dissertation addresses some aspects in details about coronary artery disease treated with Chinese medicine and modern western medicine.
1.To discuss the etiology,pathogennesis,dialectical grouping,and treatment method of coronary heart disease.The experience of famous contemporary physicians in terms of treating Thoracic obstruction was also discussed in this paper.
2.Along with the fact that clinical examination method for the coronary diseases, increasingly plentiful nuclide of myocardial perfusion imaging,especially the CAG coronary arteriography.The latter has been considered as the "Gold standard" coronary artery disease diagnosis method for its directness,precision,accuracy,and reliability.
3.Under the close supervision of famous Professor Chen Jinghe for 3 years,in treatment of cardia-cerebrovascular diseases in Chinese medicine,I initially synthesized his experience in treating this disease.
4.To explain the latest diagnostic methods and their values in diagnosis and treatment of coronary artery diseases and investigate the research orientation in this field.
引文
[1]张三林,赵京生,张海涛,等.冠心病患者中医证型与甲皱微循环变化的相关性研究[J].微循环学杂志,1999,9(2):46-47.
[2]吕中,施赛珠,祝光礼.冠心病患者单核细胞凝血/纤溶活性改变与中医证型的关系[J].中国中医基础医学杂志,2001,7(3):59261.
[3]陈炳旺,蔺德明.冠心病中医实证血液流变学变化的临床研究[J].福建中医学院学报,2000,10(1):1-2.
[4]李莘田,唐福明.冠心病心绞痛患者尿中前列腺素含量与中医证型的相关研究[J].山东中医学院学报,1995,19(4):231-234.
[5]刘家骏,董文芳,曹玉山,等.气滞血瘀与气虚血瘀患者病理生理学特征的初步研究[J].中医杂志,1991,32(9):46-47.
[6]方显明.益气化痰通瘀法治疗老年冠心病35例[J].辽宁中医杂志.1990,14(1):34-35.
[7]林金忠,蔺德明.冠心病辩证属实证者左心室功能和结构变化研究[J].实用中医药杂志,2001,17(12):325.
[8]陈伯钧,张文清,张敏洲.冠心病中医分型与心律失常及心功能关系分析[J].现代中西医结合杂志,2000,9(19):1857-185.
[9]马晓昌,尹太英,陈可冀,等.冠心病中医辨证分型与冠状动脉造影所见相关性比较研究[J].中国中西医结合杂志,2001,21(9):654-656.
[10]李佃贵,李俊峡,李振彬,等.冠心病患者病变程度与中医证型的关系[J].中国中医药信息杂志,2001,8(12):57-58.
[11]李峰,李秀云,王长海.冠心病冠状动脉病变与中医证型关系分析[J].陕西中医,1996,17(9):393-395.
[12]尹克春,罗翌,张北平等.急性心肌梗死65例辨证分型特点及预后分析.实用中医药杂志.2001,17(1):3-4.
[13]丁邦晗,陈方,张敏州等.冠心病介入治疗后冠状动脉再狭窄的中医证候特点-附33例病例资料分析.中国中西医结合急救杂志.2004,11(2):110-111.
[14]邹旭.冠状动脉血管成形术后再狭窄的中医证候初探.广州中医药大学学报.2001,18(4):293-307.
[15]尹克春,汤湘江,罗翌等.有痛性与无痛性急性心肌梗死中医临床特点分析.实用中医药杂志.2001,17(7):4-5.
[16]陈贵延,薛赛琴.最新国内外疾病诊疗标准[S].北京:学苑出版社,1992:209-212.
[17]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002
[18]旷惠桃,潘远根.冠心病心绞痛临床证型分类探讨[J],中医杂志,1997,38(12):742.
[19]陈容.冠心病的中医证治体会[J],中国中医急症,2004,13(11):782.
[20]申永合,冠心病中医辨证治疗[J]河南中医药学刊,2000年第15卷第5期,
[21]康路景.辨证论治冠心病.内蒙中医药,2006(12):5-7.
[22]梁秀香.中药治疗胸痹心痛26例临床观察.北京中医,1997(3):23-25.
[23]郝惠莉,王明亮.辨证分型治疗冠心病心绞痛172例[J].浙江中医杂志,1996,31(1):13.
[24]王宝珍,等.冠心病化瘀八法.黑龙江中医药,2001,(2):4.
[25]于志强,等.从肝论治胸痹心痛.中国中医急症,2005,(4):177.
[26]杨森,吴积海.冠心病心绞痛从肝论治体会.河南中医,2005,25(1):47
[27]路志正.路志正经验集.北京,1998.
[28]陈萍,刘桂廷.从肺论治冠心病心绞痛经验[J].陕西中医,2002,22(8):720-721
[29]徐浩,等.胸痹心痛从肺论治.中医杂志,2006,(12):719-720.
[30].阎俊被,等.灵枢饮治疗胸痹心痛68例.天津中医,1999,(6):256-257.
[31]竺培华,泰志仁.补肾益气活血法治疗冠心病的临床观察[J].中成药,2004,26(5):1-11.
[32]吴以岭.从络病学说论治冠心病心绞痛[J]中国中医基础医学杂志,2001,7(4):71
[33]朱有银.胸痹心痛从腑论治辨析.湖南中医药导报,1997,3(6):60-61.
[34]邦国庆.风药治血与冠心病心绞痛证治[J]中医药学报,1999,(4):14-16.
[35]李锡东,等.通心络胶囊治疗冠心病心绞痛血瘀证的临床观察.中国中医基础医学杂志,1999,5(8):41.
[36]徐建峰.益气活血汤治疗不稳定型心绞痛50例观察[J].中西医结合心脑血管病杂志,2005,3(4):325-376
[37]沈娟,李风云,王峥蝾,等.血府逐瘀汤改善心肌缺血的观察与研究[J].河北中医药学报,2006,21(3):17-19…
[38]丁斗,董小君.加味丹参饮治疗冠心病心绞痛41例[J].长春中医药大学学报,2007,23(3):23
[39]王忠建.心痛失笑散治疗冠心病心绞痛疗效观察[J].中医药临床杂志,2006,18(3):265-266
[40]苏诚炼.胸痹心痛证治与研究[M上海:上海中医学院出版社.1991:67.
[41]孙成翔,郝伟,冯利营.祛瘀化痰汤治疗冠心病心绞痛51例.实用中医内科杂志.2008,22(5):23-24
[42]兰仓峰,杨彩虹.益气活血化痰汤治疗冠心病心绞痛50例.陕西中医.2005,26(11):1140-1141
[43]方显明,益气化痰通瘀法治疗冠心病心绞痛44例疗效观察.中医药研究,1995,(4):11.
[44]李明君.自拟益气祛瘀方治疗冠心病心绞痛47例临床观察.医药世界.2007,2:102-103
[45]杨晓兰.栝蒌薤白白酒汤加味治疗冠心病32例.上海中医药杂志,2006,(8):10
[46]韩学杰.高脂血症(痰瘀互结证)是冠心病心绞痛的始动和诱发因素[J].中华综合临床医学杂志,2003,5(8):46.
[47]孙元莹,张海峰,王暴魁.张琪从痰瘀交阻治疗疑难病经验[J].辽宁中医杂志,2007,34(1):1
[48]孟庆宏.自拟化痰活淤汤治疗冠心100例[J].内蒙古中医药,1997,(4):10.
[49]田养年.从痰淤论治冠心病[J].辽宁中医杂志,2003,(1):25.
[50]王晓峰.沈宝藩教授痰淤同治法治疗冠心病脑中风病的经验[J].陕西中医,2005,16(9):405.
[51]沈绍功,等.心痛气雾剂治疗胸痹心痛临床速效观察[J].中医杂志,2006,27(3):187.
[52]上海中医学院曙光医院,等.冠心苏合丸治疗心绞痛118例临床疗效观察[J].新医药学杂志,2005,14(2):28.
[53]刘忠铭,等.麝香心脑乐治疗345例冠心病的临床及实验研究[J].中西医结合杂志,2004,8(6):338-340.
[54]苏诚炼、胸痹心痛证治与研究[M]、上海:上海中医学院出版社.1991、62-64.
[55]温兴韬,王欢,方朝晖.益气养阴活血法治疗糖尿病性冠心病35例观察.中医药临床杂.2008,20(4):384-385.
[56]王蓉晖.参麦注射液治疗气阴两虚血瘀型冠心病心绞痛临床观察.光明中医.2008,23(4):452-455
[57]牛惠志,等.生脉胶囊治疗冠心病心绞痛临床疗效观察.中国中西医结合杂志,2000,20(4):290.
[58]秦培森,范丽娟,刘克英,等.复方丹参丸治疗冠状动脉粥样硬化性心脏病心绞痛临床观察[J].中成药,2000,22(9):630-632.
[59]曹志军,等.大剂量黄芪注射液治疗冠心病心绞痛68例临床观察.北京中医,1997.3:27.
[60]徐标,刘俊,周利民.银杏叶片治疗冠心病心绞痛及对血液流变性影响[J].安 徽中医学院学报,2000,19(4):16-17.
[61]杨焕斌,罗陆一,吴泽铭,等.地黄饮子对冠心病心绞痛患者NO、NOS、SOD 影响的研究.中国中医药科技,2002,9(6):325-326.
[62]刘加和,林甲宜.葛根素治疗冠心病心绞痛[J].广西中医学院学报,2000,17(4):24-25.
[63]张京春.陈可冀院士治疗冠心病心绞痛学术思想与经验.中酉医结合心脑血管病杂志,2005,3(8):20-21.
[64]杜少华,等.路志正老中医芳香化浊治疗心绞痛经验.新疆中医药,2003,21(2):38.
[65]吴伟康,邓铁涛.邓老“痰瘀相关”理论与冠心病防治.深圳中西医结合杂志,2006,16(1):13-20.
[66]刘善新,等.杜家经治疗冠心病心绞痛经验.湖北中医杂志2004,26(5):19.
[67]李家庚.李培生辨治冠心病的经验.湖北中医杂志.2003,21(10):440-443.
[68]张振千.李锡光教授治疗胸痹特色撮要.广西中医药,2002,25(2):36-38.
[69]刘春芳,等.梁贻俊教授治疗冠心病心绞痛的经验.辽宁中医杂,2004,26(6):239-242.
[70]王吉耀.内科学北京:人民卫生出版社,2005年8月第一版:257.
[71]高少杰A型性格与冠心病.中华中西医学杂志,2008,6(3):128.
[72]Pier MM.yon Willebrand factor:A marker of endothelium amage[J].Arterioscler Thromb Vasc Bi01,1998,18:1359-1362.
[73]Chong AY,Lann ADB,Lip GYH.Assessment of endothelial damage and dysfunction:Observation in relation to heart failure[J]Q J Med,2003,96:253-267.
[74]MiriamG,Carla Z,RobertaD,el al Fluid shear stress modulates yon Willebrand factor release from human vascular endothelium[J].Blood,1997,90:1558-1564.
[75]Heper G,Bayraktatoglu M.The importance of the yon Willebrand factor level an d heart rate change in acute coronary syn drom es:A comparison with choronic ischerimic conditions[J].Angiology,2003,54:287-299.
[76]Bogaty P,Poirier P,Simard S,el al.Biological profiles in subjects with recurrent acute coronary events compared with subjects with long-standing stable angina[J].Circulation,2001,103:3026-3038.
[77]Du J,Hui Y,Cheung Y,et al.The possible role of hydrogen sulfide as a smooth muscle cell proliferation inhibitor in rat cultured cells.Heart Vessels,2004,19:75.
[78]陈灏珠.实用内科学.第12版.北京:人民卫生出版社。2005.1469-1491.
[79]韩文章.蔡尚郎.实用医药杂志,2007,24(5):513-514.
[80]Choussat,R,MontalescotG,ColletJ,etal.Efect of prior exposure to chlamydia pneumoniae,helicobacter pylori,or cytomegalovirus on the degree of inflammation and one-year prognosis of patients with unstable angina peetoris or non-Q-wave acute myocardial infarction.Am J Cardiol,2000,86(4):379-384.
[81]Roivainen M,Viik-Kajander M,Palosuo T,et al.Infections inflammation,and the risk of coronary heart diseasa Circulation,2000,101:252-257.
[82]Jackson LA,Campbell LA,Kuo CC,et al.Isolation of chlamydia pneumoniae from a carotid endartereetomy specimen.J Infect Dis,1997,176:192-195.
[83]Muhlestein JB,Andemon JL,Hammond EH,et al.Infection with Chlamydia pneumoniae accelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model.Circulation,1998,97:633-636.
[84]Higgins JP,Mphil.Chlamydia neumoniae and coronary artery disease:the antibiotic trials.Mayo Clinic Proceedings,2003,78(3):321-332.
[85]Kolltveit KM,Eriksen HM Is the observed assdciatlen betwteen periodontitis and atherosclerosis causal[J].Eur J Oral Sci,2001,109(3):65.
[86]Ross R.The pathogenesis of atherosclerosis:a perspective for the 1990s.Nature,1993,362(29):801-809.
[87]Benditt EP.Evidence for amonoclonal origin of human atheroselerotie plaques:the role of altered gene experession.Arch Pathot Lab Med,1988,1 12:997-1005.
[88]GordonT,Kannel WB,Castelli WP.et al Lipoproteins,cardiovascular disease,and death,The Framingham study[J].Arch Intern Med。2001.141:1128-1131.
[89]李延辉.冠心病的概念和诊断.人民军医,2007,50(7):413-414.
[90]朱明军、王建忠、王永霞.冠心病检查指标的评价.中西医结合心脑血管病杂志,2007,5(2):139-141).
[91]孟繁超,杨巍.体表心电图诊断急性心肌梗死的价值[J].中国实用内科杂 志,2002,22(8):451.
[92]陈在嘉,徐义枢,孔华宇.临床冠心病学[M].北京:人民军医出版社,1994.209.
[93]曹婉燕.沈美娥.心电图与冠脉造影诊断冠心病的临床对比分析.中国现代临床医学.2008,7(12):29-30.
[94]黎桃园.葛郁芝.刘艳阳等.冠脉造影与12导联常规心电图对冠心病诊断的对比分析.现代诊断与治疗.2008,19(6):326-329.
[95]陆红,贾传鲁.无症状性心肌缺血动态心电图分析[J].济宁医学院学报,2008,31(2):150-151.
[96]周宏峰.动态心电图对诊断无症状心肌缺血的研究[D].吉林大学,2006.
[97]刘晓春,邱悦群,盂灵.动态心电图监测无症状性心肌缺血的临床评价{J].赣南医学院学报,2007,27(4):586-587.
[98]陈文.动态心电图对冠心病无症状性心肌缺血的诊断价值.亚太传统医药,2008,4(12):74-75.
[99]许庆波.动态心电图ST段改变在无症状冠心病诊断中的临床意义.河北医学,2009,15(1):24-25.
[100]贾耀勤.326例动态心电图ST段分析[J].中华医学实践杂志,2007,6(4):324-325.
[101]赵小平,王兴.动态心电图联合运动试验对冠心病的诊断价值.临床心电学杂志,2008,17(6)
[102]赵小平.12导联动态心电图与平板运动试验诊断冠心病心肌缺血的比较[J],2006,8(15):4.
[103]白桦,卢贺,陈东毅等.12导联动态心电图与平板运动试验诊断冠心病心肌缺血的比较分析.宁夏医学杂志,2008,30(9):832-833.
[104]陈力秀,李若谷,关韶峰等.动态心电图与平板运动试验对冠心病的诊断价值.中国临床医学,2008,15(4):464-466.
[105]程静.莫绯华.彭进刚.心电图活动平板运动试验在诊断冠心病中的应用.现代保健:医学创新研究,2008,5(12):87-88.
[106]王海燕,黄伟剑,孙丽卿等.心电图活动平板运动试验对诊断冠心病的价值.江西医药,2008,43(2):101-103.
[107]邵耕.主编.现代冠心病.第1版.北京:北京医科大学中国协和医科大学联合出版社.1994.208.
[108]蒙秋云.平板运动试验诊断冠心病影响因素分析.华夏医学。2007,20(4):689-691.
[109]Robert AR,DetryJR.Logistic discriminent analysis improves diagnostic accuracy of exersice testing for coronary antery diseases in women.Circulation,1991,83:1202.
[110]Morise AP.Comparison of logistic regession and bayesianbased algorithms to estimate posttest probability in patients with suspected coronary artery disease undergoing exersice EEG.J Electrocardiol,1992,25:80.
[111]周永昌,郭万学.超声医学[M].4版.北京:科学技术文献出版社,2004:614-615.
[112]高敬,华琦,王彩荣等.实时三维超声心动图评价冠心病患者左心功能.首都医科大学学报,2008,29(4):487-489.
[113]岳松,田凤石.超声心动图和冠状动脉造影对冠心病诊断的比较观察.哈尔滨医药,2208,28(1):3-5.
[114]夏红梅,高云华,杨成业.彩色室壁运动技术评价冠心病阶段性室壁运动的临床研究[J].中国超声医学杂志,2000,16:420-422.
[115]Jin—Won J,Myung H J,Kyeong H Y,et al.Echocardiographic Epicardial Fat Thickness and Coronary Anery Disease[J].Circ J 2007,71:536-539.
[116]FreyaW,Hodgson JM,Muller C,et al.Ultrasound-guided strategy for provisional stenting with focal balloon combination catheter:results from the randomized strategy for intracoronary ultrasound—guided PTCA and stenting(SIPS)trial[J].Circulation,2000,102(20):2497-2502.
[117]倪祝华,杨新春,王乐丰,等.中等程度冠状动脉狭窄的血管内超声特点与治疗决策选择[J].中国介入影像与治疗学,2005,2(1)15-18.
[118]周俊才.血管内超声在冠心病诊断中的应用价值.现代中西医结合杂志,2007,16(14):1971-1972.
[119]Rieber J,cOckeI K,Koschvk D,et.Application,feasibility,and eficacy of a eombined intravascular ultrasound and stent delivery system:results from a prospective muhicenter trial[JJ.J Interv Cardiol,2005,18(5):367-374.
[120]汪斌,朱中生.血管内超声在冠心病诊断中的应用观察.临床和实验医学杂志,2006,12(5):1900-1901.
[121]李占全.冠脉造影法在冠心病诊断中的价值[J].医师进修杂志,2003,26(9):9-10.
[122]李占全,金元哲.冠状动脉造影与临床[M].第2版,沈阳:辽宁科学技术出版杜,2007:176-183.
[123]Prem S,Raymond TE,GordonD,et al.Enhanced detection of reversible perfusion defect s by Tc299m sestamibi compared to99 Tc2mtetrofo smin during vasod ilato r stress SPECT imaging inmild to moderate coronary artery disease[J].J Am Coll Card iol,,2001,37(2):458-462.
[124]L eonard S,Martial GB.Evaluation of patients with chest pain and normal co ronary angiograms[J].Arch Intern Med,2001,161(15):1825-1833.
[125]孙长喜.冠状动脉造影与无创性检查在冠心病诊断中的对比研究.实用心脑肺血管病杂,2008,16(3):161-164.
[126]姜婕,虞华鹏,赵成等.冠状动脉造影和血管内超声诊断冠心病的对比研究.山东医药,2008,48(20):28,38.
[127]姚稚明,刘秀杰,张少雄等.心肌灌注断层显像和电子束CT检查不同年龄冠心病的比较研究.中华核医学杂志,2000,20(2):62-64.
[128]王秀芝,杨波,孙显东等.64排CT在冠状动脉粥样硬化性心脏病中的临床应用.内蒙古医学杂志,2008,40(9):1254-1256.
[129]李忠银.冠状动脉螺旋CT成像与冠状动脉造影的对比性研究.中国实用医刊,2008,35(18):13-15.
[130]Van der Wall EE,Vliegen HW,Hofman MBI,et al.Magnetic resonance imaging in coronary artery disease[J].Cireulation,1995,92:2723.
[131]Nakanishi T,Imazu M,Yamakido M,et al.Evaluation of coronary artery atenosi using electron—beam CT and maltiplanar reformation[J].J Cornput Assist Tomogr,1997,21:121.
[132]Choi HS,et al.Pitfalls,artifacts,and remedies in muhidetector row CT coronary angiography.Radiographics,2004,24:787-800.
[133]Lau GT,et al.Coronary artery stenoses:detection with calcium SCO —ring,CT angiography,and both methods combined.Radiology,2005,235:415-422.
[134]Sebastian Leschka,et al.Accuracy of MSCT coronary angiography with 64—slice technology:first experience.EHJ,2005.26:1482-1487.
[135]李天然.PET—CT在冠心病中应用价值的研究进展.实用医技杂志,2004,11(4):529-531.
[136]胡大一,马长生.主编.心脏病学实践2007-新进展与临床案例人民卫生出版社2007年10月第一版:37.
[137]Boden WE,O' Rourke RA,Teo KK,etal.Optimal medical therapy with or without PCI for stable coronary disease.N Engl Med,2007:26.
[138]于树国.中西医结合治疗冠心病38例临床分析[J].中华中西医学杂志,2007,5(3):42-43.
[139]张玉.冠心病的中西医结合治疗[J].中国中医急症,2007,16(4):493.
[140]付艳萍.参麦注射液联合舒血宁注射液治疗冠心病心绞痛疗效观察[J].实用药物与临床,2007,10(1):27-28.
[141]李思宁,叶志中,单继军.开心胶囊Ⅱ号治疗心脏神经官能症疗效观察.中国中医急症,2005,14(5):402-403
[142]陈镜合.现代中医之路.新中医,2001,33(9):3-5.
[2]吕中,施赛珠,祝光礼.冠心病患者单核细胞凝血/纤溶活性改变与中医证型的关系[J].中国中医基础医学杂志,2001,7(3):59261.
[3]陈炳旺,蔺德明.冠心病中医实证血液流变学变化的临床研究[J].福建中医学院学报,2000,10(1):1-2.
[4]李莘田,唐福明.冠心病心绞痛患者尿中前列腺素含量与中医证型的相关研究[J].山东中医学院学报,1995,19(4):231-234.
[5]刘家骏,董文芳,曹玉山,等.气滞血瘀与气虚血瘀患者病理生理学特征的初步研究[J].中医杂志,1991,32(9):46-47.
[6]方显明.益气化痰通瘀法治疗老年冠心病35例[J].辽宁中医杂志.1990,14(1):34-35.
[7]林金忠,蔺德明.冠心病辩证属实证者左心室功能和结构变化研究[J].实用中医药杂志,2001,17(12):325.
[8]陈伯钧,张文清,张敏洲.冠心病中医分型与心律失常及心功能关系分析[J].现代中西医结合杂志,2000,9(19):1857-185.
[9]马晓昌,尹太英,陈可冀,等.冠心病中医辨证分型与冠状动脉造影所见相关性比较研究[J].中国中西医结合杂志,2001,21(9):654-656.
[10]李佃贵,李俊峡,李振彬,等.冠心病患者病变程度与中医证型的关系[J].中国中医药信息杂志,2001,8(12):57-58.
[11]李峰,李秀云,王长海.冠心病冠状动脉病变与中医证型关系分析[J].陕西中医,1996,17(9):393-395.
[12]尹克春,罗翌,张北平等.急性心肌梗死65例辨证分型特点及预后分析.实用中医药杂志.2001,17(1):3-4.
[13]丁邦晗,陈方,张敏州等.冠心病介入治疗后冠状动脉再狭窄的中医证候特点-附33例病例资料分析.中国中西医结合急救杂志.2004,11(2):110-111.
[14]邹旭.冠状动脉血管成形术后再狭窄的中医证候初探.广州中医药大学学报.2001,18(4):293-307.
[15]尹克春,汤湘江,罗翌等.有痛性与无痛性急性心肌梗死中医临床特点分析.实用中医药杂志.2001,17(7):4-5.
[16]陈贵延,薛赛琴.最新国内外疾病诊疗标准[S].北京:学苑出版社,1992:209-212.
[17]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002
[18]旷惠桃,潘远根.冠心病心绞痛临床证型分类探讨[J],中医杂志,1997,38(12):742.
[19]陈容.冠心病的中医证治体会[J],中国中医急症,2004,13(11):782.
[20]申永合,冠心病中医辨证治疗[J]河南中医药学刊,2000年第15卷第5期,
[21]康路景.辨证论治冠心病.内蒙中医药,2006(12):5-7.
[22]梁秀香.中药治疗胸痹心痛26例临床观察.北京中医,1997(3):23-25.
[23]郝惠莉,王明亮.辨证分型治疗冠心病心绞痛172例[J].浙江中医杂志,1996,31(1):13.
[24]王宝珍,等.冠心病化瘀八法.黑龙江中医药,2001,(2):4.
[25]于志强,等.从肝论治胸痹心痛.中国中医急症,2005,(4):177.
[26]杨森,吴积海.冠心病心绞痛从肝论治体会.河南中医,2005,25(1):47
[27]路志正.路志正经验集.北京,1998.
[28]陈萍,刘桂廷.从肺论治冠心病心绞痛经验[J].陕西中医,2002,22(8):720-721
[29]徐浩,等.胸痹心痛从肺论治.中医杂志,2006,(12):719-720.
[30].阎俊被,等.灵枢饮治疗胸痹心痛68例.天津中医,1999,(6):256-257.
[31]竺培华,泰志仁.补肾益气活血法治疗冠心病的临床观察[J].中成药,2004,26(5):1-11.
[32]吴以岭.从络病学说论治冠心病心绞痛[J]中国中医基础医学杂志,2001,7(4):71
[33]朱有银.胸痹心痛从腑论治辨析.湖南中医药导报,1997,3(6):60-61.
[34]邦国庆.风药治血与冠心病心绞痛证治[J]中医药学报,1999,(4):14-16.
[35]李锡东,等.通心络胶囊治疗冠心病心绞痛血瘀证的临床观察.中国中医基础医学杂志,1999,5(8):41.
[36]徐建峰.益气活血汤治疗不稳定型心绞痛50例观察[J].中西医结合心脑血管病杂志,2005,3(4):325-376
[37]沈娟,李风云,王峥蝾,等.血府逐瘀汤改善心肌缺血的观察与研究[J].河北中医药学报,2006,21(3):17-19…
[38]丁斗,董小君.加味丹参饮治疗冠心病心绞痛41例[J].长春中医药大学学报,2007,23(3):23
[39]王忠建.心痛失笑散治疗冠心病心绞痛疗效观察[J].中医药临床杂志,2006,18(3):265-266
[40]苏诚炼.胸痹心痛证治与研究[M上海:上海中医学院出版社.1991:67.
[41]孙成翔,郝伟,冯利营.祛瘀化痰汤治疗冠心病心绞痛51例.实用中医内科杂志.2008,22(5):23-24
[42]兰仓峰,杨彩虹.益气活血化痰汤治疗冠心病心绞痛50例.陕西中医.2005,26(11):1140-1141
[43]方显明,益气化痰通瘀法治疗冠心病心绞痛44例疗效观察.中医药研究,1995,(4):11.
[44]李明君.自拟益气祛瘀方治疗冠心病心绞痛47例临床观察.医药世界.2007,2:102-103
[45]杨晓兰.栝蒌薤白白酒汤加味治疗冠心病32例.上海中医药杂志,2006,(8):10
[46]韩学杰.高脂血症(痰瘀互结证)是冠心病心绞痛的始动和诱发因素[J].中华综合临床医学杂志,2003,5(8):46.
[47]孙元莹,张海峰,王暴魁.张琪从痰瘀交阻治疗疑难病经验[J].辽宁中医杂志,2007,34(1):1
[48]孟庆宏.自拟化痰活淤汤治疗冠心100例[J].内蒙古中医药,1997,(4):10.
[49]田养年.从痰淤论治冠心病[J].辽宁中医杂志,2003,(1):25.
[50]王晓峰.沈宝藩教授痰淤同治法治疗冠心病脑中风病的经验[J].陕西中医,2005,16(9):405.
[51]沈绍功,等.心痛气雾剂治疗胸痹心痛临床速效观察[J].中医杂志,2006,27(3):187.
[52]上海中医学院曙光医院,等.冠心苏合丸治疗心绞痛118例临床疗效观察[J].新医药学杂志,2005,14(2):28.
[53]刘忠铭,等.麝香心脑乐治疗345例冠心病的临床及实验研究[J].中西医结合杂志,2004,8(6):338-340.
[54]苏诚炼、胸痹心痛证治与研究[M]、上海:上海中医学院出版社.1991、62-64.
[55]温兴韬,王欢,方朝晖.益气养阴活血法治疗糖尿病性冠心病35例观察.中医药临床杂.2008,20(4):384-385.
[56]王蓉晖.参麦注射液治疗气阴两虚血瘀型冠心病心绞痛临床观察.光明中医.2008,23(4):452-455
[57]牛惠志,等.生脉胶囊治疗冠心病心绞痛临床疗效观察.中国中西医结合杂志,2000,20(4):290.
[58]秦培森,范丽娟,刘克英,等.复方丹参丸治疗冠状动脉粥样硬化性心脏病心绞痛临床观察[J].中成药,2000,22(9):630-632.
[59]曹志军,等.大剂量黄芪注射液治疗冠心病心绞痛68例临床观察.北京中医,1997.3:27.
[60]徐标,刘俊,周利民.银杏叶片治疗冠心病心绞痛及对血液流变性影响[J].安 徽中医学院学报,2000,19(4):16-17.
[61]杨焕斌,罗陆一,吴泽铭,等.地黄饮子对冠心病心绞痛患者NO、NOS、SOD 影响的研究.中国中医药科技,2002,9(6):325-326.
[62]刘加和,林甲宜.葛根素治疗冠心病心绞痛[J].广西中医学院学报,2000,17(4):24-25.
[63]张京春.陈可冀院士治疗冠心病心绞痛学术思想与经验.中酉医结合心脑血管病杂志,2005,3(8):20-21.
[64]杜少华,等.路志正老中医芳香化浊治疗心绞痛经验.新疆中医药,2003,21(2):38.
[65]吴伟康,邓铁涛.邓老“痰瘀相关”理论与冠心病防治.深圳中西医结合杂志,2006,16(1):13-20.
[66]刘善新,等.杜家经治疗冠心病心绞痛经验.湖北中医杂志2004,26(5):19.
[67]李家庚.李培生辨治冠心病的经验.湖北中医杂志.2003,21(10):440-443.
[68]张振千.李锡光教授治疗胸痹特色撮要.广西中医药,2002,25(2):36-38.
[69]刘春芳,等.梁贻俊教授治疗冠心病心绞痛的经验.辽宁中医杂,2004,26(6):239-242.
[70]王吉耀.内科学北京:人民卫生出版社,2005年8月第一版:257.
[71]高少杰A型性格与冠心病.中华中西医学杂志,2008,6(3):128.
[72]Pier MM.yon Willebrand factor:A marker of endothelium amage[J].Arterioscler Thromb Vasc Bi01,1998,18:1359-1362.
[73]Chong AY,Lann ADB,Lip GYH.Assessment of endothelial damage and dysfunction:Observation in relation to heart failure[J]Q J Med,2003,96:253-267.
[74]MiriamG,Carla Z,RobertaD,el al Fluid shear stress modulates yon Willebrand factor release from human vascular endothelium[J].Blood,1997,90:1558-1564.
[75]Heper G,Bayraktatoglu M.The importance of the yon Willebrand factor level an d heart rate change in acute coronary syn drom es:A comparison with choronic ischerimic conditions[J].Angiology,2003,54:287-299.
[76]Bogaty P,Poirier P,Simard S,el al.Biological profiles in subjects with recurrent acute coronary events compared with subjects with long-standing stable angina[J].Circulation,2001,103:3026-3038.
[77]Du J,Hui Y,Cheung Y,et al.The possible role of hydrogen sulfide as a smooth muscle cell proliferation inhibitor in rat cultured cells.Heart Vessels,2004,19:75.
[78]陈灏珠.实用内科学.第12版.北京:人民卫生出版社。2005.1469-1491.
[79]韩文章.蔡尚郎.实用医药杂志,2007,24(5):513-514.
[80]Choussat,R,MontalescotG,ColletJ,etal.Efect of prior exposure to chlamydia pneumoniae,helicobacter pylori,or cytomegalovirus on the degree of inflammation and one-year prognosis of patients with unstable angina peetoris or non-Q-wave acute myocardial infarction.Am J Cardiol,2000,86(4):379-384.
[81]Roivainen M,Viik-Kajander M,Palosuo T,et al.Infections inflammation,and the risk of coronary heart diseasa Circulation,2000,101:252-257.
[82]Jackson LA,Campbell LA,Kuo CC,et al.Isolation of chlamydia pneumoniae from a carotid endartereetomy specimen.J Infect Dis,1997,176:192-195.
[83]Muhlestein JB,Andemon JL,Hammond EH,et al.Infection with Chlamydia pneumoniae accelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model.Circulation,1998,97:633-636.
[84]Higgins JP,Mphil.Chlamydia neumoniae and coronary artery disease:the antibiotic trials.Mayo Clinic Proceedings,2003,78(3):321-332.
[85]Kolltveit KM,Eriksen HM Is the observed assdciatlen betwteen periodontitis and atherosclerosis causal[J].Eur J Oral Sci,2001,109(3):65.
[86]Ross R.The pathogenesis of atherosclerosis:a perspective for the 1990s.Nature,1993,362(29):801-809.
[87]Benditt EP.Evidence for amonoclonal origin of human atheroselerotie plaques:the role of altered gene experession.Arch Pathot Lab Med,1988,1 12:997-1005.
[88]GordonT,Kannel WB,Castelli WP.et al Lipoproteins,cardiovascular disease,and death,The Framingham study[J].Arch Intern Med。2001.141:1128-1131.
[89]李延辉.冠心病的概念和诊断.人民军医,2007,50(7):413-414.
[90]朱明军、王建忠、王永霞.冠心病检查指标的评价.中西医结合心脑血管病杂志,2007,5(2):139-141).
[91]孟繁超,杨巍.体表心电图诊断急性心肌梗死的价值[J].中国实用内科杂 志,2002,22(8):451.
[92]陈在嘉,徐义枢,孔华宇.临床冠心病学[M].北京:人民军医出版社,1994.209.
[93]曹婉燕.沈美娥.心电图与冠脉造影诊断冠心病的临床对比分析.中国现代临床医学.2008,7(12):29-30.
[94]黎桃园.葛郁芝.刘艳阳等.冠脉造影与12导联常规心电图对冠心病诊断的对比分析.现代诊断与治疗.2008,19(6):326-329.
[95]陆红,贾传鲁.无症状性心肌缺血动态心电图分析[J].济宁医学院学报,2008,31(2):150-151.
[96]周宏峰.动态心电图对诊断无症状心肌缺血的研究[D].吉林大学,2006.
[97]刘晓春,邱悦群,盂灵.动态心电图监测无症状性心肌缺血的临床评价{J].赣南医学院学报,2007,27(4):586-587.
[98]陈文.动态心电图对冠心病无症状性心肌缺血的诊断价值.亚太传统医药,2008,4(12):74-75.
[99]许庆波.动态心电图ST段改变在无症状冠心病诊断中的临床意义.河北医学,2009,15(1):24-25.
[100]贾耀勤.326例动态心电图ST段分析[J].中华医学实践杂志,2007,6(4):324-325.
[101]赵小平,王兴.动态心电图联合运动试验对冠心病的诊断价值.临床心电学杂志,2008,17(6)
[102]赵小平.12导联动态心电图与平板运动试验诊断冠心病心肌缺血的比较[J],2006,8(15):4.
[103]白桦,卢贺,陈东毅等.12导联动态心电图与平板运动试验诊断冠心病心肌缺血的比较分析.宁夏医学杂志,2008,30(9):832-833.
[104]陈力秀,李若谷,关韶峰等.动态心电图与平板运动试验对冠心病的诊断价值.中国临床医学,2008,15(4):464-466.
[105]程静.莫绯华.彭进刚.心电图活动平板运动试验在诊断冠心病中的应用.现代保健:医学创新研究,2008,5(12):87-88.
[106]王海燕,黄伟剑,孙丽卿等.心电图活动平板运动试验对诊断冠心病的价值.江西医药,2008,43(2):101-103.
[107]邵耕.主编.现代冠心病.第1版.北京:北京医科大学中国协和医科大学联合出版社.1994.208.
[108]蒙秋云.平板运动试验诊断冠心病影响因素分析.华夏医学。2007,20(4):689-691.
[109]Robert AR,DetryJR.Logistic discriminent analysis improves diagnostic accuracy of exersice testing for coronary antery diseases in women.Circulation,1991,83:1202.
[110]Morise AP.Comparison of logistic regession and bayesianbased algorithms to estimate posttest probability in patients with suspected coronary artery disease undergoing exersice EEG.J Electrocardiol,1992,25:80.
[111]周永昌,郭万学.超声医学[M].4版.北京:科学技术文献出版社,2004:614-615.
[112]高敬,华琦,王彩荣等.实时三维超声心动图评价冠心病患者左心功能.首都医科大学学报,2008,29(4):487-489.
[113]岳松,田凤石.超声心动图和冠状动脉造影对冠心病诊断的比较观察.哈尔滨医药,2208,28(1):3-5.
[114]夏红梅,高云华,杨成业.彩色室壁运动技术评价冠心病阶段性室壁运动的临床研究[J].中国超声医学杂志,2000,16:420-422.
[115]Jin—Won J,Myung H J,Kyeong H Y,et al.Echocardiographic Epicardial Fat Thickness and Coronary Anery Disease[J].Circ J 2007,71:536-539.
[116]FreyaW,Hodgson JM,Muller C,et al.Ultrasound-guided strategy for provisional stenting with focal balloon combination catheter:results from the randomized strategy for intracoronary ultrasound—guided PTCA and stenting(SIPS)trial[J].Circulation,2000,102(20):2497-2502.
[117]倪祝华,杨新春,王乐丰,等.中等程度冠状动脉狭窄的血管内超声特点与治疗决策选择[J].中国介入影像与治疗学,2005,2(1)15-18.
[118]周俊才.血管内超声在冠心病诊断中的应用价值.现代中西医结合杂志,2007,16(14):1971-1972.
[119]Rieber J,cOckeI K,Koschvk D,et.Application,feasibility,and eficacy of a eombined intravascular ultrasound and stent delivery system:results from a prospective muhicenter trial[JJ.J Interv Cardiol,2005,18(5):367-374.
[120]汪斌,朱中生.血管内超声在冠心病诊断中的应用观察.临床和实验医学杂志,2006,12(5):1900-1901.
[121]李占全.冠脉造影法在冠心病诊断中的价值[J].医师进修杂志,2003,26(9):9-10.
[122]李占全,金元哲.冠状动脉造影与临床[M].第2版,沈阳:辽宁科学技术出版杜,2007:176-183.
[123]Prem S,Raymond TE,GordonD,et al.Enhanced detection of reversible perfusion defect s by Tc299m sestamibi compared to99 Tc2mtetrofo smin during vasod ilato r stress SPECT imaging inmild to moderate coronary artery disease[J].J Am Coll Card iol,,2001,37(2):458-462.
[124]L eonard S,Martial GB.Evaluation of patients with chest pain and normal co ronary angiograms[J].Arch Intern Med,2001,161(15):1825-1833.
[125]孙长喜.冠状动脉造影与无创性检查在冠心病诊断中的对比研究.实用心脑肺血管病杂,2008,16(3):161-164.
[126]姜婕,虞华鹏,赵成等.冠状动脉造影和血管内超声诊断冠心病的对比研究.山东医药,2008,48(20):28,38.
[127]姚稚明,刘秀杰,张少雄等.心肌灌注断层显像和电子束CT检查不同年龄冠心病的比较研究.中华核医学杂志,2000,20(2):62-64.
[128]王秀芝,杨波,孙显东等.64排CT在冠状动脉粥样硬化性心脏病中的临床应用.内蒙古医学杂志,2008,40(9):1254-1256.
[129]李忠银.冠状动脉螺旋CT成像与冠状动脉造影的对比性研究.中国实用医刊,2008,35(18):13-15.
[130]Van der Wall EE,Vliegen HW,Hofman MBI,et al.Magnetic resonance imaging in coronary artery disease[J].Cireulation,1995,92:2723.
[131]Nakanishi T,Imazu M,Yamakido M,et al.Evaluation of coronary artery atenosi using electron—beam CT and maltiplanar reformation[J].J Cornput Assist Tomogr,1997,21:121.
[132]Choi HS,et al.Pitfalls,artifacts,and remedies in muhidetector row CT coronary angiography.Radiographics,2004,24:787-800.
[133]Lau GT,et al.Coronary artery stenoses:detection with calcium SCO —ring,CT angiography,and both methods combined.Radiology,2005,235:415-422.
[134]Sebastian Leschka,et al.Accuracy of MSCT coronary angiography with 64—slice technology:first experience.EHJ,2005.26:1482-1487.
[135]李天然.PET—CT在冠心病中应用价值的研究进展.实用医技杂志,2004,11(4):529-531.
[136]胡大一,马长生.主编.心脏病学实践2007-新进展与临床案例人民卫生出版社2007年10月第一版:37.
[137]Boden WE,O' Rourke RA,Teo KK,etal.Optimal medical therapy with or without PCI for stable coronary disease.N Engl Med,2007:26.
[138]于树国.中西医结合治疗冠心病38例临床分析[J].中华中西医学杂志,2007,5(3):42-43.
[139]张玉.冠心病的中西医结合治疗[J].中国中医急症,2007,16(4):493.
[140]付艳萍.参麦注射液联合舒血宁注射液治疗冠心病心绞痛疗效观察[J].实用药物与临床,2007,10(1):27-28.
[141]李思宁,叶志中,单继军.开心胶囊Ⅱ号治疗心脏神经官能症疗效观察.中国中医急症,2005,14(5):402-403
[142]陈镜合.现代中医之路.新中医,2001,33(9):3-5.
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