Systematic Evaluation And Experimental Study On The Effect Of Promoting Blood Circulation To Remove Blood Stasis On Ischemic Myocardial Injury

This study is mainly composed of clinical system evaluation and experimental study in vivo.Clinical system evaluation:System evaluation of PNS in the treatment of ischemic heart disease myocardial injuryObjective:Through the systematic evaluation of different formulations of PNS, to confirm its clinical effectiveness and safety evaluation on ischemic heart disease(AP、AMI), to analysis the clinical efficacy and evaluate the safety. Sum up the best preparation. At the same time to explore the clinical value of Huo Xue Qu Yu method,Methods:thought PNS; XueSaiTong, coronary heart disease, angina pectoris, myocardial infarction as keywords, and thought the data base:PubMed, CNKI, VIP, WANFANG DATA, CBM, to retrieval randomized controlled clinical trial, deadline to December 31,2015. Meta analysis using RevMan 5 software.Results:684 articles were retrieved totally, and 37 papers were included in the final selection. Only 3 papers Jadad score of 2 points, and the remaining 1 points. Literature quality assessment "inverted funnel plot" showed the existence of publication bias. In improving the symptoms of angina, increase the total effective rate of ECG, the therapeutic effect of PNS injection is better than capsule (P<0.05), and injection can improve the coagulation function of patients, inflammatory reaction (P<0.05), and the capsule is not significant (P>0.05); in myocardial infarction, western medicine combined with Xuesaitong injection can significantly improve coronary blood flow after PCI (P<0.05). The reported adverse events and analysis showed that PNS (Xuesaitong) formulation does not increase the incidence of adverse events (P<0.05)Conclusion:In addition to conventional therapy based on the use of PNS preparations for the treatment of ischemic heart disease has increased efficiency, does not increase toxicity, complementary trends, and PNS injection had better curative effect. Indirect inference based on western medicine combined with traditional Chinese medicine treatment of blood stasis therapy is a promising choice.In vivo animal experiments:The experimental study of the protective effect of PNS by inhibiting the VEGF/Notch signaling pathway on myocardial injury in rats.Objective:Study on promoting blood circulation to remove PNS increase MSCs and inhibition VEGF/Notch signaling pathway, promote the repair of myocardial ischemia injury.Methods:Establishment of myocardial injury model in Wistar rats by ligation of left anterior descending artery,60 rats were randomly divided into control group, model group, sham group, PNS group, G-CSF group, PNS+G-CSF group,10 rats in each group. Sham group only line, not ligation, control group without surgery, drug intervention 7 days. Detection of cardiac function by ultrasound in small animals. HE staining was used to observe the pathological changes of myocardial infarction area. Masson staining was used to observe the changes of fibrosis. FCM detection of mesenchymal stem cells (MSCs), hematopoietic stem cell (HSCs) changes. mRNA, of Notch3, DLL4, VEGF, Hesl, Notch1 were detected by real-time fluorescence quantitative PCR (QPCR). Protein expression of related proteins detected by Western blot.Results:Compared with control group, model group, left ventricular diastolic and systolic anterior wall were decreased by 40.71%,68.90%. Diastolic and systolic left ventricular volume were increased by 20.33%,73.22%. Peripheral blood MSCs increased by 74.6%, while HSC had no change (P>0.05). Notchl, Notch3, DLL4, Hesl gene expression was not significant, and DLL4, VEGF, Hesl expression was significantly reduced (P<0.05). Compared with the model group, PNS group left ventricular anterior wall diastolic and systolic were increased 63.86%, accounted for 65.82%(P<0.05) MSCs reduces 94.29%, and the difference of HSCs was not significant (P>0.05). At the genetic level, PNS group was not significant (P>0.05), in the protein level, compared with the model group, PNS group Notch3, Hesl expression were decreased by 32.35%,38.50%(P<0.05). Pathological results showed that the PNS group of myocardial cells arranged in disorder than in the control group, but compared with the model group neat, and the myocardial cell volume is smaller than model, muscle fiber slightly neat, slightly swollen muscle cells, eosinophilic change is obvious. Observation of collagen fiber hyperplasia, PNS group myocardial cell infiltration than control group low, muscle cells row riello neat, the infarct border interstitial collagen fibers change is lower than that of the model.Conclusion:PNS intervention can improve the heart function of rats, reduce pathological change, promote the expression of MSCs and inhibition VEGF/Notch signaling pathway, has the function of protecting myocardium. Indirectly suggest that promoting blood circulation to remove blood stasis method through the intervention of MSCs and VEGF/Notch signaling pathways, to play a myocardial protective effect.