王  辉1 ，包文亮2

（1.江苏省徐州市中医院，江苏 徐州  221000  2.江苏省邳州市人民医院  江苏  

邳州  221300）

[摘要]  目的：观察中西医结合治疗高血脂症临床疗效。方法：将100例高血脂患者随即分成西药组和中药组各50例。西药组用辛伐他汀治疗，中西医结合组在西药组的基础上加用中药治疗。观察2组患者治疗前后血脂指标血清总胆固醇（CH）、三酰甘油酯（TG）、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇（HDL-C）的变化。结果：治疗后2组的TG、CH明显下降，与治疗前差异均有非常显著意义（P<0.01）；2组的HDL-C也显著的升高，与治疗前比较差异也有非常显著意义（P<0.01）。治疗后中西医结合组总有效率84%，西药组总有效率64%，2组总有效率比较，差异也有非常显著意义（P<0.05）。结论：运用中西医结合治疗高血脂症能增加降脂疗效，减少副作用少，临床值得推广。

[关键词] 高脂血症;  中西医结合疗法; 西医疗法Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

Combination of Chinese traditional and Western medicine in treatment of hyperlipidemia : clinical observation of 50 cases

Wang Hui 1, Bao Wenliang 2

( 1 in Xuzhou Hospital of Traditional Chinese Medicine of Jiangsu Province, Jiangsu Xuzhou Jiangsu 2210002 people's Hospital of Pizhou city Jiangsu Province

Pizhou 221300 )

[ Abstract ] Objective: To observe the combined Chinese and Western medicine in treating hyperlipidemia clinical curative effect. Methods: 100 cases of patients with high blood lipid was divided into western medicine group and the Chinese medicine group, 50 cases in each. The western medicine group with simvastatin in the treatment of integrated traditional Chinese and Western medicine in western medicine group, add on the foundation of the group treated with traditional Chinese medicine. Observation of 2 groups of patients before and after treatment serum lipids serum total cholesterol ( CH ), three of phosphatidyl glycerol ester (TG ), low density lipoprotein cholesterol ( LDL-C ), high density lipoprotein cholesterol ( HDL-C ) changes. Results: the 2 groups after the treatment, TG, CH decreased significantly, and before treatment differences were very remarkable significance ( P < 0.01 ); 2 groups of HDL-C also increased significantly, compared with before treatment difference is very significant ( P < 0.01 ). After treatment with integrated traditional Chinese and Western medicine group, the total efficiency of 84%, western medicine group, the total efficiency of 64%, 2 groups of the total efficiency is compared, difference is very significant ( P < 0.05 ). Conclusion: the combination of traditional Chinese and Western medicine in treating hyperlipemia can increase the lipid-lowering efficacy, reduced side effects, the clinical worth popularizing.

[ Key words] hyperlipidemia; integrated traditional Chinese and Western medicine therapy; western medicine therapy

  高脂血症患者血脂代谢发生紊乱；脂肪代谢或转运异常；血浆中一种或几种脂质浓度，包括血浆TC及TG水平过高或血浆HDL水平过低称高脂血症。既可表现为单纯高TC血症或单纯高TG血症，也可表现为高TC合并高TG混合型高脂血症。高脂血症是中老年人常见的疾病之一，也是倍受关注和严重影响中老年人正常生活的疾病。是冠心病、高血压的主要危险因素之一 。血脂水平维持在正常范围能预防和降低冠心病的患病率和病死率，降低心血管事件的发病率。随着人们饮食结构的不断改变，

【作者简介】： 王辉（1974-），男，主治医师，研究方向：中西医结合内科病的治疗。联系：15380118883

高脂血症的发病率逐年升高，而大量研究表明,高脂血症是心脑血管疾病的主要危险因素之一，降低ＴＣ、ＴＧ、ＬＤＬ-Ｃ,升高ＨＤＬ-Ｃ的水平,有助于阻止动脉粥样硬化的发生和发展，降低冠心病的发生率和死亡率 ，同时也降低脑血管病的发生率和死亡率。近年来，人工合成他丁类降脂药治疗高胆同醇血症或以胆固醇升高为主的混合型高脂血症，临床取得较好的疗效，但是副作用大，易反复。笔者联合西药联合中药治疗高血脂症效果显著，现报道如下：    

1   临床资料

1.1一般资料  选择2008年3月-2009年6月本院门诊及体检中心的患者100例，随即分成2组。治疗组50例，难28例，女22例；年龄35-70岁，平均54.3岁；合并高血压22例，合并冠心病稳定性心绞痛10例。对照组50例， 男26例，女24例；年龄36-68岁，平均53岁；合并高血压20例，合并稳定性冠心病心绞痛12例。2组性别、年龄、病情等方面经统计学处理，差异无显著意义（P>0.05），具有可比性。

1.2诊断标准  参照第七版《内科学》^［1］诊断标准。治疗前1个月停用其他降血脂药物,并经饮食控制至少15ｄ。但胆固醇(ＴＣ)≥5.18ｍｍｏｌ/Ｌ和/或血甘油三酯(ＴＧ)≥1.70ｍｍｏｌ/Ｌ，ＬＤＬ-Ｃ》3.37mmol,ＨＤＬ-Ｃ<1.04mmol. 排除继发于代谢性紊乱疾病的，如：甲状腺功能低下、肝肾疾病、肾上腺皮质功能亢进，或长期服用类固醇激素、避孕药、甲状腺激素等.
2　治疗方法　
   西医组  予辛伐他丁(商品名:降舒之,默沙东中国有限公司生产)20ｍｇ,每晚睡前口服1次,4周为1个疗程，共3个疗程。所有患者于治疗开始前及治疗后4周末、8周末清晨空腹抽血测血脂、血糖、肝肾功能及肌酸磷酸肌酶(ＣＰＫ),在采血前1ｄ晚餐避免高脂饮食及饮酒,伴有高血压、冠心病、糖尿病者继续服用降压药、硝酸脂类药及降糖药.

   中西医结合组  在西医的基础上加用中药降脂饮治疗，处方：丹参15ｇ，山楂12ｇ，黄芪25ｇ，陈皮12，何首乌15ｇ，红花10ｇ，荷叶10ｇ，泽泻12，赤芍12ｇ，决明子15ｇ，每日1剂，分2次饭后服用，4周为一疗程，共治疗3个疗程。

3  观察指标与统计方法 观察2组治疗前后血脂TC、TG、LDL-C、HDL-C的变化。数据采用SPSS13.0统计软件计数资料以均均数（ｘ±ｓ）表示，治疗前后自身及对照采用ｔ检验。
4   疗效标准及治疗结果

4.1  疗效标准  按卫生部《中药新药临床研究指导原则》^［2］心血管药物实验指导原则评定疗效:①显效:ＴＣ下降≥20%，ＴＧ下降≥40%,血清高密度脂蛋白胆固醇(ＨＤＬ-Ｃ)上升≥0.26ｍｍｏｌ/Ｌ；②有效:ＴＣ下降≥10%～20%，ＴＧ下降20～40%，ＨＤＬ-Ｃ上升0.10～0.26ｍｍｏｌ/Ｌ；③无效:

未达到上述标准。

4.2  两组血脂谱指标比较  见表1。治疗后2组的TC、TG均明显下降，予治疗前相比差异均有非常

显著意义（P<0.01）;2组的HDL-C明显升高，予治疗前比较，差异有显著意义（P<0.01）。2组TC、TG、HDL-C比较，中西医结合组下降更明显（P<0.05）。

表1        2组血脂指标变化　           mmol/L

             与治疗前比较，①P<0.01；与西药组治疗后比较P<0.05。

4.3   2组临床疗效比较  见表2.治疗后总有要率中西医结合组86%，西药组64%，2组总有效率比较，差异有显著意义（ P<0.05）.

5.讨论机理

传统中医理论认为高脂血症属中医的“痰证”、“虚损”、“胸痹”、“眩晕”等范畴。高血脂是为病理产物，亦是致病因素，病理上统属中医学“痰”“瘀”的范畴，但痰的含义甚广，高脂血症仅是痰症中的一部分，不能认为，凡痰症皆有高脂血症的存在，二者的区别在于痰在机体内无处不到到，而高脂血症仅存在血脉之中。痰有广义、狭义、有形、无形之分，而高血脂可通过检测来确定，是为狭义有形之痰。且血脂系阴精所化，具有粘稠、沉着之性，若血脂过高，则更加粘腻，沉着，又不同于正常之油脂，故可归纳其为“清从浊化，脂由痰生”之病机。高脂血症的病因有素体脾虚痰盛；或胃火素旺，饮食不节，痰浊内生；或年老体虚，脏气衰减，阴虚痰滞，终致痰积血瘀，化为脂浊，滞留体内而为病。 病理变化为素体脾虚，痰湿内盛，运化不利，致脂浊郁积。或阳盛之体，胃火索旺，恣食肥甘，致痰热壅积，化为脂浊。或痰积日久，入络成瘀，而使痰瘀滞留。或年高体虚，肝肾阴虚，阴不化血，反为痰浊，痰积血瘀，亦可化为脂浊，滞留体内而为病。降脂饮具有健脾化痰，活血化瘀降脂的作用。现代医学研究血脂主要包括胆固醇(或称总胆固醇TC)和甘油三酯,在血循环中以非游离状态存在,和蛋白结合成脂蛋白这样的大分子运输.主要的脂蛋白分类---乳糜微粒,极低密度(前-β)脂蛋白(VLDL),低密度(β-)脂蛋白(LDL),和高密度(a-)脂蛋白(HDL)---这些蛋白是紧密相联的。世界卫生组织按各种血浆脂蛋白升高的程度不同将高脂血症分为6型，我国主要为Ⅱ型和Ⅳ型。根据我国人群血脂异常的情况，近年来学者提出较简易之分类法：①高胆固醇血症：血清TC水平增高。②高甘油三酯血症：血清TG水平增高。③混合型高脂血症：血清TC与TG水平均增高。我国科学工作者根据现代实验研究和临床实践，至今已发掘和整理了六十余种降血脂的中草药。^［3］以降胆固醇为主的有：人参、首乌、黄芪等。以降甘油三酯为主的有：金银花、柴胡、荷叶、赤芍、大黄等。对胆固醇和甘油三酯都有降低作用的有：决明子、丹参、山楂、泽泻、三七等。　综上所述，中药降脂通过多层次、多环节、多靶点的综合调理, 调节人体的各种生理平衡，达到“阴平阳秘，精神乃治”。中药治疗高脂血症停药后不易反弹，明显降低高脂血症的复发率。西药降脂多需要大剂量长期服用才能维持降脂效果，更容易引起不良反应，影响患者的治疗依从性，并且停药后容易反弹。如何在辨证的基础上结合高脂血症的临床分类，合理选择不同疗效降脂中草药结合西药，更好地提高临床疗效将是中医药治疗高脂血症的发展方向。