糖尿病心脏病中医诊断与治疗:从基础到临床

**章　基 础 篇..............................................................................................................................1
**节　心脏生理.........................................................................................................................1
一、心脏的泵血功能.......................................................................................................1
二、心脏的生物电活动和生理特性...............................................................................9
三、心血管活动的调节.................................................................................................21
四、冠脉循环.................................................................................................................30
第二节　糖尿病发病机制...........................................................................................................33
一、胰岛细胞功能与糖尿病.........................................................................................33
二、代谢紊乱与糖尿病发病.........................................................................................38
三、胰岛素抵抗与糖尿病并发症.................................................................................53
第三节　糖尿病心血管病发病机制..........................................................................................60
一、动脉粥样硬化的组织学分型.................................................................................61
二、糖尿病冠状动脉粥样硬化病变特征.....................................................................61
三、糖尿病对动脉粥样硬化发病机制的影响.............................................................62
四、内皮-白细胞黏附.................................................................................................63
五、糖尿病的内皮功能障碍.........................................................................................66
六、糖尿病对血管顺应性和动脉僵硬度的影响.........................................................69
七、糖尿病对凝血和血栓形成的影响.........................................................................69
八、糖尿病心血管危险因素.........................................................................................69
九、引起血管并发症的生化机制.................................................................................74
第四节　糖尿病心脏病的病因与发病机制..............................................................................79
一、糖尿病与冠心病.....................................................................................................79
二、糖尿病性心肌病变.................................................................................................86
三、糖尿病心血管自主神经病变.................................................................................95
第五节　糖尿病心脏病的病理..................................................................................................96
一、DCM中各级血管形态结构病变严重并发生纤维化..........................................97
二、DCM血管胶原纤维堆积......................................................................................98
三、DCM炎性细胞明显增加，血管周围以巨噬细胞浸润为主..............................98
四、DCM血管弹力纤维紊乱变形，炎性细胞对血管的浸润以巨噬细胞为主......98
第二章　临床篇...........................................................................................................................100
**节　糖尿病心脏病的流行病学........................................................................................100
一、糖尿病冠心病......................................................................................................100
二、糖尿病心肌病......................................................................................................101
第二节　糖尿病心脏病的诊断与鉴别诊断............................................................................101
一、糖尿病冠心病......................................................................................................101
二、糖尿病心肌病......................................................................................................106
第三节　糖尿病心脏病的中医治疗........................................................................................109
一、心脏疾病的中医认识..........................................................................................109
二、疾病源流..............................................................................................................113
三、病因病机..............................................................................................................117
四、辨证论治..............................................................................................................126
五、单验方..................................................................................................................149
六、中成药治疗..........................................................................................................154
七、单味中药..............................................................................................................162
八、中医外治法..........................................................................................................203
第四节　糖尿病心脏病的营养治疗、生活调摄与心脏康复...............................................228
一、糖尿病心脏病的营养治疗..................................................................................228
二、糖尿病心脏病的生活调护..................................................................................247
三、糖尿病心脏病的康复治疗..................................................................................273
第五节　糖尿病心脏病名医经验............................................................................................289
一、陈可冀临证经验..................................................................................................289
二、程益春临证经验..................................................................................................292
三、丁学屏临证经验..................................................................................................294
四、李果烈临证经验..................................................................................................297
五、李赛美临证经验..................................................................................................299
六、林兰临证经验......................................................................................................301
七、吕靖中临证经验..................................................................................................305
八、吕仁和临证经验..................................................................................................306
九、南征临证经验......................................................................................................312
十、任继学临证经验..................................................................................................314
十一、仝小林临证经验..............................................................................................315
十二、魏执真临证经验..............................................................................................319
十三、魏子孝临证经验..............................................................................................327
十四、熊曼琪临证经验..............................................................................................330
十五、祝谌予临证经验..............................................................................................331
第六节　验案精选.....................................................................................................................335
一、祝谌予医案..........................................................................................................335
二、林兰医案..............................................................................................................338
三、仝小林医案..........................................................................................................338
四、魏子孝医案..........................................................................................................340
五、丁学屏医案..........................................................................................................340
六、栗锦迁医案..........................................................................................................342
七、张素清医案..........................................................................................................342
第三章　展望篇...........................................................................................................................344
**节　糖尿病合并冠心病病证结合诊疗方案...................................................................344
一、研究对象..............................................................................................................344
二、研究方法..............................................................................................................345
三、结果......................................................................................................................347
四、讨论......................................................................................................................380
五、结论......................................................................................................................386
第二节　益气活血方治疗糖尿病心肌病的疗效和有效组分处方优化..............................386
一、丹参饮抗糖尿病心肌病大鼠心肌纤维化疗效及分子机制..............................387
二、生脉散抑制高糖环境心肌细胞凋亡疗效及分子机制......................................406
三、基于均匀设计抗糖尿病心肌纤维化中药有效组分处方优化..........................418
四、益气活血方有效组分配伍验证研究..................................................................447
第三节　 2型糖尿病合并冠心病证候规律及益气活血方抗心肌间质纤维化的
分子机制.....................................................................................................................458
一、基于结构化住院病历数据库的2型糖尿病合并冠心病中医证治规律..........458
二、益气活血方抗心肌纤维化分子机制..................................................................473
第四节　糖尿病心脏病相关研究进展....................................................................................506
一、研究方法..............................................................................................................506
二、糖尿病心脏病动物模型研究进展......................................................................525
三、流行病学..............................................................................................................535
四、相关诊疗进展......................................................................................................536

参考文献.......................................................................................................................................547
附录一　缩略语表.......................................................................................................................567
附录二　方剂索引.......................................................................................................................573
附录三　糖尿病、糖尿病前期与心血管疾病指南...................................................................578
一、绪论......................................................................................................................578
二、引言......................................................................................................................578
三、血糖代谢异常和心血管疾病..............................................................................579
四、糖尿病发生心血管疾病的分子基础..................................................................584
五、血糖紊乱患者心血管风险评估..........................................................................586
六、在糖尿病患者中预防心脑血管疾病..................................................................588
七、糖尿病患者稳定型和不稳定型冠状动脉疾病的管理......................................604
八、心力衰竭与糖尿病..............................................................................................613
九、心律失常：心房纤颤与心源性猝死..................................................................619
十、外周血管和脑血管疾病......................................................................................624
十一、眼睛和肾脏等部位的微血管病变 ..................................................................628
十二、以患者为中心的医疗护理..............................................................................631
附录四　糖尿病合并心脏病中医诊疗标准...............................................................................633
一、范围......................................................................................................................633
二、引用标准..............................................................................................................633
三、术语、定义和缩略语..........................................................................................633
四、 诊断 [参照 ZYYXH/T 3.8—2007《糖尿病中医防治指南》“糖尿病合并
心脏病”].............................................................................................................634
五、鉴别诊断..............................................................................................................635
六、处理原则（见附录B）.......................................................................................635