目的:探讨miR-320b激动剂对心肌梗死大鼠心室重塑的影响.方法:建立心肌梗死大鼠模型,将大鼠随机分为假手术组、模型组、阴性对照组、miR-320b过表达组.RT-PCR检测miR-320b、MHC-α、MHC-β mRNA水平;TTC染色检测心肌梗死面积;超声心动图检测左心室收缩压峰值(LVSP)、左心室舒张末期压(LVEDP)、左心室短轴缩短率(LVFS)和左心室射血分数(LVEF);H-E染色检测心肌组织形态学;TUNEL染色检测心肌细胞凋亡;免疫印迹检测凋亡相关蛋白表达水平;ELISA检测肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平.结果:与假手术组比较,模型组大鼠miR-320b、MHC-α mRNA水平降低,MHC-βmRNA水平和心肌梗死面积升高,LVEF、LVFS、LVSP降低,LVEDP升高,心肌组织细胞凋亡率升高,Bax/Bcl-2、cleaved caspase-3/caspase-3、cleaved caspase-9/caspase-9 比值升高,TNF-α、IL-1β、IL-6水平升高,差异均有统计学意义.与模型组比较,miR-320b过表达组大鼠miR-320b、MHC-α mRNA水平升高,MHC-β mRNA水平和心肌梗死面积降低,LVEF、LVFS、LVSP升高,LVEDP降低,心肌组织病理损伤程度明显改善,心肌组织细胞凋亡率降低,Bax/Bcl-2、cleaved caspase-3/caspase-3、cleaved caspase-9/caspase-9 比值降低,TNF-α、IL-1β、IL-6水平降低,差异均有统计学意义.结论:miR-320b过表达可改善心肌梗死大鼠模型心室重塑.

冠心病是临床常见的心血管疾病,有多种临床表现形式,根据临床发病特点、发病机制及准确治疗需要又有不同的概念和描述.深入探讨心绞痛与中医学"胸痹心痛"、劳力型心绞痛与中医学"肺心痛"、初发劳力型心绞痛与中医学"卒心痛"、血运重建后心绞痛或顽固型心绞痛与中医学"久心痛"的相似性,对于深入挖掘、继承古代相关理论、治法、方药及技术,提高中医临床诊治水平具有积极意义.

目的 探讨曲美他嗪联合大剂量阿托伐他汀钙治疗不稳定性心绞痛的效果.方法 选取2016年8月～2018年1月我院收治的100例不稳定性心绞痛患者作为研究对象,随机分为观察组(50例)与对照组(50例),对照组采用曲美他嗪联合小剂量阿托伐他汀钙治疗,观察组采用曲美他嗪联合大剂量阿托伐他汀钙治疗,比较两组的治疗效果、临床各指标水平以及不良反应发生情况.结果 观察组患者的治疗总有效率为96.00％,明显高于对照组的80.00％,差异有统计学意义(P＜0.05);治疗后,观察组患者的超敏C反应蛋白(hs-CPR)水平、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)显著低于对照组,高密度脂质蛋白胆固醇(HDL-C)高于对照组,差异均有统计学意义(P＜0.05);两组患者不良反应总发生率比较,差异无统计学意义(P＞0.05).结论 曲美他嗪联合大剂量阿托伐他汀钙治疗不稳定性心绞痛的效果较为理想,能提高治疗效果,改善相关指标水平,保证患者的健康,具有非常重要的临床意义.

目的 探讨无创正压通气( BiPAP)呼吸机治疗急性左心衰竭患者的临床效果.方法 选取2016年12月至2017年12月医院收治的90例急性左心衰竭患者,在向患者说明治疗方案后,根据患者及其家属选择意愿,将选择常规内科综合治疗的45例患者纳入对照组,而选择BiPAP呼吸机治疗的45例患者则纳入试验组.比较两组治疗前后的呼吸频率( RR)、动脉血气指标、心功能指标及气管插管率、住院时间.结果 两组治疗后RR、pH、动脉血氧分压( PaO2 )、动脉血二氧化碳分压( PaCO2 )均有不同程度改善,且试验组RR、PaO2 、PaCO2 改善情况优于对照组,差异有统计学意义( P＜0. 05).试验组治疗后左心室射血分数( LVEF)、左心室舒张末内径( LVEDd)、左心室收缩末内径( LVEDs)、心搏出量( CO)、心脏指数( CI)均有不同程度改善,对照组治疗后LVEF、CI均有不同程度改善,且试验组LVEF、CI改善情况明显优于对照组,差异有统计学意义( P＜0. 05).试验组插管率低于对照组,住院时间短于对照组,差异有统计学意义( P＜0. 05).结论 BiPAP呼吸机是治疗急性左心衰竭患者的有效手段,可显著改善患者的呼吸和血气指标,促进心功能恢复,降低气管插管率.

Objective:To observe the influence of alcohol extraction of Rosa multiflora Thunb on atherosclerosis rats.Methods:Fifty uniform weight SD rats were randomly divided into 5 groups,including blank control group,model group,Rosa multiflora Thunb extract low and high group,atorvastatin calcium tablet group;Intragastric administration for 90 days and gastric volume was adjusted with food ration and weight every two weeks;Rats in blank control group were fed with standard diet,rats in other groups were fed with high-fat diet,intraperitoneally injected vitamin D3 and dealed with immune injury.One hour after the last delivery,take the rat aorta to observe the pathological tissue.The level of superoxide dismutase and malondialdehyde was detected by colorimetric method.The level of C-reactive was detected by chemiluminescence.The level of soluble CD40L,Adiponectin,Interleukin-18,Interleukin-16 was detected by enzymelinked immunosorbent assay.The level of Interleukin-6 and Tumor necrosis factor-α was detected by radioimmunoassay.Results:The incrassate aortic wall and lipidosis could be improved obviously by alcohol extraction of Rosa multiflora Thunb of low and high dose group,also foam cell formation in artery endothelium and lymphocytes infiltration could be decreased.The rats in YT low dose group showed remarkablely decreased weight gain and malondialdehyde,meanwhile increased food ration.The rats in YT high dose group showed remarkablely decreased interleukin-18.Conclusions:Rosa multiflora Thun extract could improve AS through regulating lipid peroxidation and inflammatory reaction.

Objective To observe the changes of ischemia modified albumin (IMA),high -sensitivity C -reactive protein (hs -CRP)after percutaneous coronary intervention (PCI).The factors related to intervention procedures to patients with IMA and hs -CRP elevation after PCI and impact of the risk of IMA and hs -CRP on the clinical outcomes were investigated.Methods IMA,hs -CRP from vein blood of 90 cases received PCI were detec-ted before operation and after operation at time of 30 min,2h,6h and 24h.The clinical characteristics of patients and factors related to intervention procedures were recorded.The number of lesion vessels and the relative factors in PCI were compared.The clinical outcomes of the patients were followed up.Results After operation,IMA was significantly different compared with that before operation (t =2.293,P <0.05).The concentration of IMA peaked at 2h after operation,which was significantly different from that before surgery (t =1.116,P <0.01).The increase of IMA and hs -CRP were closely related with the inflation pressure,total times of inflation,dilated times,length and diameter of stent and the number of stents (t =3.678,P <0.01 ).The angina onset was more common and length of stay was longer in the patients with the rise of IMA and hs -CRP.Conclusion PCI may cause myocardial injury,which is associated to inflation pressure,total time of inflation,dilated times,length and diameter of stent and the number of stents.To a certain extent the level of troponin can predict the outcomes.

Objective To investigate the effect and safety of tirofiban in PCI patients with non -ST elevation acute coronary syndrome(NSTE -ACS).Methods 80 high -risk patients were randomly divided into treatment group (tirofiban +PCI )and control group (PCI ).Collected all the clinical and coronary angiography.The coronary reperfusion flow(TIMI grade)of the culprit vessel after PCI,ultrasound cardiogram 1 week after PCI,bleed events, major adverse cardiac events with 30 days and one year,and heart function status were compared between the two groups.Results TIMI after PCI,major adverse cardiac events within 30 days,heart function status after one year, revascularization within 1 year in the treatment group were superior to the control group(χ2 =42,3,2,28,all P <0.05).Conclusion Tirofiban is safe and effective for elderly patients with NSTE -ACS received PCI.

目的:观察益气活血、化痰祛瘀方联合西药治疗PCI术后心绞痛的临床疗效.方法:选择PCI术后心绞痛患者65例,采用随机数字表法随机分为治疗组和对照组.对照组给予西药标准治疗,治疗组在对照组用药基础上加用益气活血、化痰祛瘀方(黄芪、丹参、川芎、郁金、半夏、茯苓、白术、瓜蒌),1d1剂,水煎服.两组均以2周为1个疗程,连续治疗4个疗程.结果:治疗组显效15例,有效14例,无效3例,有效率为90.63％;对照组显效6例,有效17例,无效10例,有效率为69.70％.两组对比,差别有统计学意义(P＜0.01).结论:益气活血、化痰祛瘀方联合西药可显著改善PCI术后心绞痛患者的临床症状,提高其生活质量.

尽管PCI术成为治疗急性心梗的常用手段,但并不能解决患者的所有问题,如PCI术后仍有胸闷、胸痛、心悸,而积极应用中药可在某种程度上改善患者的症状.本研究通过对40例急诊PCI术后患者在常规西药用药基础上予以中药治疗2个月,评价患者中医证候、中医临床症状和心脏彩超的变化,观察中西医结合治疗PCI术后的疗效.研究结果显示,中西医结合治疗可改善患者的临床症状,抑制病情的发展.急性心肌梗死后应尽早应用中药干预,从整体论治,多途径,多靶点的防治疾病.

医学研究生临床诊疗能力和科学研究能力强弱至关重要. 中医临床学位研究生能力培养"四环节"一曰学习,二曰实践,三曰总结,四曰思考. 学习为实践的基础,实践是学习的目的,总结乃提高实践水平的手段,思考是学习和实践的灵魂. 通过学习,为实践打下基础;通过实践,实现救死扶伤,防病治病之目的;通过总结,明晰得失优劣及所要解决的问题;通过思考,以问题为导向,找出解决问题办法,从而解决问题. 在解决问题过程中再学习,如此往复,则可不断提高中医临床学位研究生临床诊疗能力和科研能力.

目的：观察体外反搏联合养阴活血方治疗老年高血压肾虚血瘀证的临床疗效。方法：将80例老年高血压患者采用随机数字表法随机分为治疗组和对照组各40例，对照组给予苯磺酸左旋氨氯地平片2．5 mg／次，1次／d，口服，必要时加用吲达帕胺片，2．5 mg／次，1次／d；治疗组在对照组用药基础上加服活血养阴方（熟地黄、山茱萸、枸杞子、山药、茯苓、当归、川芎、益母草、甘草），1 d 1剂，水煎400 mL，分早晚2次温服。体外反搏采用江西杰派gp－2000型体外反搏治疗仪治疗，隔日1次。两组均以4周为1个疗程，共治疗1个疗程。结果：治疗组显效15例，有效20例，无效5例，有效率为87．5％；对照组显效11例，有效18例，无效11例，有效率为72．5％。两组相比，差别有统计学意义（ P＜0．01）。结论：体外反搏联合养阴活血方治疗老年高血压肾虚血瘀证疗效确切。

CHEN Yang-chun, a researcher, chief physician, a famous specialist of TCM, the second batch of the old TCM experts academic experience inheritance guidance teacher, who work at Henan Province TCM medicine research institute. She thought that Qixu Xueyu was main pathogenesis of coronary heart disease. Buqi Huoxue combined Shugan therapy can achieve good results.

目的 探讨不同抗栓药物二级预防高龄非瓣膜性心房颤动患者发生脑梗死的临床效果.方法 高龄非瓣膜性房颤并血栓栓塞患者165例,依据治疗方法分为华法林组57例,氯吡格雷组54例和阿司匹林组54例,分别给予华法林、氯吡格雷、阿司匹林口服,随访比较观察3组脑梗死复发、短暂性脑缺血、出血事件发生率及病死率.结果 3组均随访1 a,华法林组脑梗死复发率(3.5％)、短暂性脑缺血发生率(12.3％)、总危险事件发生率(42.1％)低于氯吡格雷组(22.2％、24.1％、74.1％)和阿司匹林组(38.9％、35.2％、92.6％)(P＜0.05),氯吡格雷组低于阿司匹林组(P＜0.05);阿司匹林组总出血事件发生率(13.0％)低于华法林组(19.3％)和氯吡格雷组(22.2％)(P＜0.05);3组病死率比较差异无统计学意义(P＞0.05).结论 高龄非瓣膜性心房颤动患者应用华法林可降低脑血管危险事件发生率.

陈阳春教授认为气虚、血虚、阴虚、阳虚,痰湿、瘀血、气滞、热毒等常常相兼为病,发为心律失常,自创益气活血(气虚血瘀)-益气活血定心饮,化痰祛湿(痰湿内盛)-栝蒌薤白半夏汤、二陈汤,益气养阴(气阴两虚)-生脉定心饮,温阳益气(阳气亏虚)-益心复脉饮,益气养血(气血两虚)-归脾汤,滋阴降火(阴虚火旺)-归黄一贯煎,疏肝理气(肝气郁结)-柴胡疏肝散,平肝定悸(阴虚阳亢)-天麻钩藤饮八法,临证加减,疗效显著.

陈阳春研究员是河南省中医药研究院主任医师,第二批全国老中医药专家学术经验继承工作指导老师,享受国务院政府特殊津贴,从事中医内科临床及科研工作50余载,擅长治疗心血管疾病.就其辨病与辨证相结合、中西医结合、重视气血、形神并调、师古以创新等基本学术思想做一简介.

目的:观察化痰活血平肝方联合西药治疗顽固性高血压的临床疗效.方法:将72例顽固性高血压患者采用随机数字表法随机分为治疗组和对照组,对照组接受常规3种降压药物(盐酸贝那普利、左旋氨氯地平、吲哒帕胺)治疗;治疗组在对照组用药基础上加服化痰活血平肝方(陈皮、法半夏、茯苓、丹参、赤芍、天麻、钩藤、泽泻、益母草)治疗,水煎,1d1剂,分早、晚2次口服.两组均以4周为1个疗程,1个疗程后判定疗效.结果:治疗组治疗后降压疗效和症状疗效均优于对照组(P＜0.05);治疗组治疗后收缩压和舒张压较治疗前对比,差别有统计学意义(P＜0.05).结论:化痰活血平肝方联合西药治疗顽固性高血压患者疗效显著,值得临床推广运用.

慢性心力衰竭是由神经内分泌激素激活所引起的一组临床综合征，具有较高的发病率和死亡率。将心衰患者72例按照随机数字表随机分为治疗组和对照组，两组均给与基础治疗，治疗组另予以通阳活血方治疗，治疗2个月后，分别测定心功能疗效、心脏彩超和血浆BNP水平。研究结果发现与对照组相比，治疗组受试者心功能疗效和血浆BNP水平显著降低，差异有统计学意义（P＜0.05）。与对照组相比，治疗组受试者左室射血分数显著提高，差异有统计学意义（P＜0.05）。本研究结果提示益气温阳活血利水方可提高心衰患者的左室射血分数，提高心功能。

CHEN Yang-chun is a researcher and chief physician who work at Henan Province Chinese medicine research institute, a famous specialist of TCM medicine. In more than fifty years of work, CHEN believes that the treatment of subacute thyroiditis should first detoxify, then cleaning away heat and eliminating stagnation. We have received good effects through the application of Liushen Wan.

目的：将成人心理弹性量表（Resilience Scale for Adults ，RSA）运用于原发性高血压患者，了解原发性高血压患者心理弹性状况及影响因素。方法采用成人RSA、症状自评量表（Symptom Checklist 90，SCL-90）和艾森克人格问卷（Ey-senck Personality Questionnaire ，EPQ ），由心理学专业人员分别对50例原发性高血压1～2级患者与50例健康人进行问卷调查。结果原发性高血压患者与健康人SCL-90中躯体化因子比较差异有统计学意义，原发性高血压患者的心理弹性与健康人比较差异无统计学意义（ P＞0.05）；原发性高血压患者的心理弹性与焦虑、抑郁、躯体化、神经质呈显著负相关，与内外向呈显著正相关。结论原发性高血压患者的心理健康水平较低，神经质、内外向因子对原发性高血压患者心理弹性具有预测作用。

陈阳春研究员是河南省中医药研究院研究员、主任医师，第二批全国老中医药专家学术经验继承工作指导老师，享受国务院政府特殊津贴，从事中医内科临床及科研工作50余载，擅长治疗心血管疾病。通过跟师坐诊、理论教学等多种形式，对陈阳春研究员治疗汗证的临床经验加以总结，并在陈阳春研究员的指导下分析了其治疗的思想，提炼出了从肝肾论治汗证的中医理论基础及其可能的病机，并以临床验案加以佐证，以期起到抛砖引玉的作用。