糖尿病心臟病中醫(yī)診斷與治療：從基礎(chǔ)到臨床

章　基 礎(chǔ) 篇..............................................................................................................................1
節(jié)　心臟生理.........................................................................................................................1
一、心臟的泵血功能.......................................................................................................1
二、心臟的生物電活動和生理特性...............................................................................9
三、心血管活動的調(diào)節(jié).................................................................................................21
四、冠脈循環(huán).................................................................................................................30
第二節(jié)　糖尿病發(fā)病機(jī)制...........................................................................................................33
一、胰島細(xì)胞功能與糖尿病.........................................................................................33
二、代謝紊亂與糖尿病發(fā)病.........................................................................................38
三、胰島素抵抗與糖尿病并發(fā)癥.................................................................................53
第三節(jié)　糖尿病心血管病發(fā)病機(jī)制..........................................................................................60
一、動脈粥樣硬化的組織學(xué)分型.................................................................................61
二、糖尿病冠狀動脈粥樣硬化病變特征.....................................................................61
三、糖尿病對動脈粥樣硬化發(fā)病機(jī)制的影響.............................................................62
四、內(nèi)皮-白細(xì)胞黏附.................................................................................................63
五、糖尿病的內(nèi)皮功能障礙.........................................................................................66
六、糖尿病對血管順應(yīng)性和動脈僵硬度的影響.........................................................69
七、糖尿病對凝血和血栓形成的影響.........................................................................69
八、糖尿病心血管危險(xiǎn)因素.........................................................................................69
九、引起血管并發(fā)癥的生化機(jī)制.................................................................................74
第四節(jié)　糖尿病心臟病的病因與發(fā)病機(jī)制..............................................................................79
一、糖尿病與冠心病.....................................................................................................79
二、糖尿病性心肌病變.................................................................................................86
三、糖尿病心血管自主神經(jīng)病變.................................................................................95
第五節(jié)　糖尿病心臟病的病理..................................................................................................96
一、DCM中各級血管形態(tài)結(jié)構(gòu)病變嚴(yán)重并發(fā)生纖維化..........................................97
二、DCM血管膠原纖維堆積......................................................................................98
三、DCM炎性細(xì)胞明顯增加，血管周圍以巨噬細(xì)胞浸潤為主..............................98
四、DCM血管彈力纖維紊亂變形，炎性細(xì)胞對血管的浸潤以巨噬細(xì)胞為主......98
第二章　臨床篇...........................................................................................................................100
節(jié)　糖尿病心臟病的流行病學(xué)........................................................................................100
一、糖尿病冠心病......................................................................................................100
二、糖尿病心肌病......................................................................................................101
第二節(jié)　糖尿病心臟病的診斷與鑒別診斷............................................................................101
一、糖尿病冠心病......................................................................................................101
二、糖尿病心肌病......................................................................................................106
第三節(jié)　糖尿病心臟病的中醫(yī)治療........................................................................................109
一、心臟疾病的中醫(yī)認(rèn)識..........................................................................................109
二、疾病源流..............................................................................................................113
三、病因病機(jī)..............................................................................................................117
四、辨證論治..............................................................................................................126
五、單驗(yàn)方..................................................................................................................149
六、中成藥治療..........................................................................................................154
七、單味中藥..............................................................................................................162
八、中醫(yī)外治法..........................................................................................................203
第四節(jié)　糖尿病心臟病的營養(yǎng)治療、生活調(diào)攝與心臟康復(fù)...............................................228
一、糖尿病心臟病的營養(yǎng)治療..................................................................................228
二、糖尿病心臟病的生活調(diào)護(hù)..................................................................................247
三、糖尿病心臟病的康復(fù)治療..................................................................................273
第五節(jié)　糖尿病心臟病名醫(yī)經(jīng)驗(yàn)............................................................................................289
一、陳可冀臨證經(jīng)驗(yàn)..................................................................................................289
二、程益春臨證經(jīng)驗(yàn)..................................................................................................292
三、丁學(xué)屏臨證經(jīng)驗(yàn)..................................................................................................294
四、李果烈臨證經(jīng)驗(yàn)..................................................................................................297
五、李賽美臨證經(jīng)驗(yàn)..................................................................................................299
六、林蘭臨證經(jīng)驗(yàn)......................................................................................................301
七、呂靖中臨證經(jīng)驗(yàn)..................................................................................................305
八、呂仁和臨證經(jīng)驗(yàn)..................................................................................................306
九、南征臨證經(jīng)驗(yàn)......................................................................................................312
十、任繼學(xué)臨證經(jīng)驗(yàn)..................................................................................................314
十一、仝小林臨證經(jīng)驗(yàn)..............................................................................................315
十二、魏執(zhí)真臨證經(jīng)驗(yàn)..............................................................................................319
十三、魏子孝臨證經(jīng)驗(yàn)..............................................................................................327
十四、熊曼琪臨證經(jīng)驗(yàn)..............................................................................................330
十五、祝諶予臨證經(jīng)驗(yàn)..............................................................................................331
第六節(jié)　驗(yàn)案精選.....................................................................................................................335
一、祝諶予醫(yī)案..........................................................................................................335
二、林蘭醫(yī)案..............................................................................................................338
三、仝小林醫(yī)案..........................................................................................................338
四、魏子孝醫(yī)案..........................................................................................................340
五、丁學(xué)屏醫(yī)案..........................................................................................................340
六、栗錦遷醫(yī)案..........................................................................................................342
七、張素清醫(yī)案..........................................................................................................342
第三章　展望篇...........................................................................................................................344
節(jié)　糖尿病合并冠心病病證結(jié)合診療方案...................................................................344
一、研究對象..............................................................................................................344
二、研究方法..............................................................................................................345
三、結(jié)果......................................................................................................................347
四、討論......................................................................................................................380
五、結(jié)論......................................................................................................................386
第二節(jié)　益氣活血方治療糖尿病心肌病的療效和有效組分處方優(yōu)化..............................386
一、丹參飲抗糖尿病心肌病大鼠心肌纖維化療效及分子機(jī)制..............................387
二、生脈散抑制高糖環(huán)境心肌細(xì)胞凋亡療效及分子機(jī)制......................................406
三、基于均勻設(shè)計(jì)抗糖尿病心肌纖維化中藥有效組分處方優(yōu)化..........................418
四、益氣活血方有效組分配伍驗(yàn)證研究..................................................................447
第三節(jié)　 2型糖尿病合并冠心病證候規(guī)律及益氣活血方抗心肌間質(zhì)纖維化的
分子機(jī)制.....................................................................................................................458
一、基于結(jié)構(gòu)化住院病歷數(shù)據(jù)庫的2型糖尿病合并冠心病中醫(yī)證治規(guī)律..........458
二、益氣活血方抗心肌纖維化分子機(jī)制..................................................................473
第四節(jié)　糖尿病心臟病相關(guān)研究進(jìn)展....................................................................................506
一、研究方法..............................................................................................................506
二、糖尿病心臟病動物模型研究進(jìn)展......................................................................525
三、流行病學(xué)..............................................................................................................535
四、相關(guān)診療進(jìn)展......................................................................................................536
 
參考文獻(xiàn).......................................................................................................................................547
附錄一　縮略語表.......................................................................................................................567
附錄二　方劑索引.......................................................................................................................573
附錄三　糖尿病、糖尿病前期與心血管疾病指南...................................................................578
一、緒論......................................................................................................................578
二、引言......................................................................................................................578
三、血糖代謝異常和心血管疾病..............................................................................579
四、糖尿病發(fā)生心血管疾病的分子基礎(chǔ)..................................................................584
五、血糖紊亂患者心血管風(fēng)險(xiǎn)評估..........................................................................586
六、在糖尿病患者中預(yù)防心腦血管疾病..................................................................588
七、糖尿病患者穩(wěn)定型和不穩(wěn)定型冠狀動脈疾病的管理......................................604
八、心力衰竭與糖尿病..............................................................................................613
九、心律失常：心房纖顫與心源性猝死..................................................................619
十、外周血管和腦血管疾病......................................................................................624
十一、眼睛和腎臟等部位的微血管病變 ..................................................................628
十二、以患者為中心的醫(yī)療護(hù)理..............................................................................631
附錄四　糖尿病合并心臟病中醫(yī)診療標(biāo)準(zhǔn)...............................................................................633
一、范圍......................................................................................................................633
二、引用標(biāo)準(zhǔn)..............................................................................................................633
三、術(shù)語、定義和縮略語..........................................................................................633
四、 診斷 [參照 ZYYXH/T 3.8—2007《糖尿病中醫(yī)防治指南》“糖尿病合并
心臟病”].............................................................................................................634
五、鑒別診斷..............................................................................................................635
六、處理原則（見附錄B）.......................................................................................635