| This thesis consists of two parts.The first part is a relevant clinic study of mental stress-induced myocardial ischemia(MSIMI)in patients with stable coronary heart disease.The second part is the clinical study of virtual reality rehabilitation training combined with Bupleurum plus dragon bone and oyster shell Decoction intervention on the MSIMI with stable coronary heart disease.Study 1: Objective: To study the relationship among risk factors for coronary heart disease,abnormal mental state and MSIMI.The relationship between MSIMI and inflammation,platelet activation,and sympathetic hyperactivity.Methods: 246 patients with coronary heart disease who were admitted to the Huguosi TCM Hospital affiliated to Beijing University of Chinese Medicine from October 2016 to December 2018 were enrolled,and 246 patients with primary screening for coronary heart disease and mental disorders were evaluated through consultation and scale assessment.The mental stress test was performed.The venous blood of the patient was collected before the test,and the indicators such as inflammation and platelet activation were measured,and blood pressure was measured.Results: The incidence of MSIMI in patients with coronary heart disease was 46.4%.There was a significant correlation between the incidence of MSIMI and BMI,SAS and SDS(P<0.05).The relationship between MSIMI incidence and gender,age,mean duration,smoking,drinking,hypertension,diabetes,hyperlipidemia and other variables was not significant(P>0.05).An increase in anxiety and test stress levels increased the odds of MSIMI(P<0.05),whereas depression did not have a significant effect on MSIMI(P>0.05).There was a significant correlation between MSIMI and Hs-CRP,IL-6,TXB2,SDNN,r MSSD,PNN50,AD,NAD,DA(P<0.05),There was a significant positive correlation between Hs-CRP,IL-6,TXB2,AD,NAD,and DA levels,and a significant negative correlation with SDNN,r MSSD,and PNN50 levels.The overall level of SCL-90 score in MSIMI patients was higher than that in the national norm.The scores of somatization,interpersonal relationship,anxiety,depression and hostile factors were high,which was positive for screening.Conclusions: Risk factors such as age,gender,diabetes,hypertension,hyperlipidemia,smoking,drinking,etc.may not be the key factors for MSIMI in patients with coronary heart disease,and the psychological state may be closely related to MSIMI.The incidence of coronary heart disease MSIMI may be related to inflammation,platelet activation and sympathetic hyperactivity.Study 2: Objective: To evaluate the effectiveness and safety of virtual reality rehabilitation training combined with Bupleurum plus dragon bone and oyster shell Decoction on treatment of MSIMI and explore its possible treatment mechanism.Methods: This study used a stratified randomized,double-blind,placebo-controlled clinical study design.Patients with coronary heart disease MSIMI diagnosed in Study 1 were randomly divided into control group(control Chinese medicine granule),Chinese medicine group and rehabilitation + Chinese medicine treatment group,and the distribution sequence was hidden.The Chinese medicine group was given Bupleurum plus dragon bone and oyster shell particles,one bag each time,orally twice a day.The control group was given a placebo with no clinical effect on the appearance and packaging of Bupleurum plus dragon bone and oyster shell particles,1 bag each time,orally twice a day.Rehabilitation+Chinese medicine group applied Bupleurum plus dragon bone and oyster shell particles(prescription and treatment same with the Chinese medicine group),and at the same time applied the virtual rehabilitation training system for cognitive psychotherapy.All three groups received conventional medication for coronary heart disease.During the treatment period of 6 weeks,four visit points for the 0th week,the 2nd week,the 4th week,and the 6th week were arranged to arrange visits and collect data.In this study,SPSS 20.0 software was used to calculate the outcome indicators,and the random assignment sequence was blinded to the outcome evaluators and data-statisticians.The main evaluation indicators included anginapectoris frequency and duration,wall motion score index(WMSI),ejection fraction,total number of psychological stress tasks,SAS score,SDS score,SCL-90 score,coping style score,SAQ score,and SF-36 score,TCM syndrome score,single symptom scores and safety indicators.Secondary observations were peripheral blood hs-CRP,IL-6 values,serum TXB2 values, heart rate variability indicators SDNN,r MSSD,PNN50,and blood catecholamine levels.Results: 1.Angina related indicates: After 6 weeks of treatment,the frequency of angina pectoris was reduced in the Chinese medicine group,control group and the rehabilitation + Chinese medicine group,and the duration of angina pectoris was shortened.The difference was statistically significant(P<0.05).However,virtual reality rehabilitation combined with Bupleurum plus dragon bone and oyster shell Decoction was better than Chinese medicine group in reducing the frequency and duration of angina pectoris(P<0.05).2.MSIMI related indicators: After 6 weeks of treatment,the three tests of the wall motion index(WMSI)and the total number of psychological stress tasks in the rehabilitation + Chinese medicine group were lower than before treatment,and the ejection fraction was higher than before treatment.The difference was statistically significant(P<0.05).The total number of psychological stress tasks in the Chinese medicine group decreased compared with that before treatment(P<0.05).Only in the test II and the test III,the WMSI decreased and the ejection fraction increased(P<0.05).There was no significant change in the above indicators in the control group(P>0.05).After treatment,the improvement of the above indicators in the rehabilitation + Chinese medicine group was better than that in the Chinese medicine group,and the difference was statistically significant(P<0.05).3.Mental disorder related indicators: After 6 weeks of treatment,the SAS scores and coping style scores of the rehabilitation + Chinese medicine group were lower than those before treatment,and the difference was statistically significant(P<0.05).The SAS score and coping style score of the Chinese medicine group decreased compared with before treatment,but only in SAS statistical differences were found in the scores(P < 0.05).There was no significant change in the above indicators in the control group(P>0.05).The scores of most of the SCL-90 factors(excluding paranoia)after treatment in the Chinese medicine group and rehabilitation + Chinese medicine group were lower than those before treatment(P<0.05).In the two treatment groups,the scores of SCL-90 interpersonal relationship,anxiety,hostility,and fear factor were lower in the rehabilitation + Chinese medicine group than in the Chinese medicine group,and the difference was statistically significant(P<0.05).There were no significant differences between the two groups in other dimensions(P>0.05).4.Quality of life related indicators: The scores of SF-36 in the Chinese medicine group and the rehabilitation + Chinese medicine group were higher than those before treatment(P<0.05).The scores of mental health in the rehabilitation + Chinese medicine group were higher than those in the Chinese medicine group.The difference was statistically significant(P <0.05).The SF-36 score of the control group only increased in the four scores of physical health(P<0.05).There was no significant difference between the scores in rehabilitation + Chinese medicine group and Chinese medicine group(P>0.05).After 6 weeks of treatment,the rehabilitation + Chinese medicine group and Chinese medicine group increased the scores of SAQ physical activity limitation,angina pectoris stability,angina pectoris frequency,treatment satisfaction degree,and disease cognition in five dimensions.The difference was statistically significant.(P<0.05).The scores of treatment satisfaction and disease awareness in the rehabilitation + Chinese medicine group were higher than those in the Chinese medicine group,and the difference was statistically significant(P<0.05).The control group had better improvement in SAQ physical activity,angina pectoris and stable status than before treatment(P<0.05),but there was no significant difference between the rehabilitation + Chinese medicine group and Chinese medicine group(P>0.05).5.TCM syndrome related indicators: After 6 weeks of treatment,the TCM syndrome scores of control group,the Chinese medicine group and the rehabilitation + Chinese medicine group decreased,and the difference was statistically significant(P<0.05).In terms of single symptom scores of traditional Chinese medicine,the Chinese medicine group,rehabilitation + Chinese medicine group had chest pain,chest tightness,irritability and impatience,fullness in chest and hypochondrium,oropharyngeal dryness,insomnia,constipation all decreased,the difference was statistically significant(P<0.05).Single symptom scores of chest tightness,irritability and impatience,fullness in chest and hypochondrium,insomnia were lower than those in the Chinese medicine group,and the difference was statistically significant(P<0.05).6.Inflammation related indicators: After 6 weeks of treatment,the levels of Hs-CRP and IL-6 in the Chinese medicine group and the rehabilitation + Chinese medicine group decreased,the difference was statistically significant(P<0.05).The Hs-CRP level in the rehabilitation + Chinese medicine group after treatment was lower than that in the Chinese medicine group,the difference was statistically significant(P<0.05).There was no decrease in the above indicators in the control group,and the difference was statistically significant(P>0.05).7.Platelet activation indexes: After 6 weeks of treatment,the serum TXB2 values of the Chinese medicine group and the rehabilitation + Chinese medicine group decreased,the difference was statistically significant(P<0.05).After treatment,the serum TXB2 value of the rehabilitation + Chinese medicine group was lower than that of the traditional Chinese medicine group.The difference was statistically significant(P<0.05).There was no significant decrease in TXB2 value in the control group,and the difference was statistically significant(P>0.05).8.Heart rate variability indexes: After 6 weeks of treatment,the SDNN,r MSSD,and PNN50 in the rehabilitation + Chinese medicine group,the control group and the Chinese medicine group were higher than those before treatment,but only rehabilitation + Chinese medicine group was statistically significant(P < 0.05).9.Blood catecholamine indexes: After 6 weeks of treatment,the plasma levels of AD,NAD and DA in the rehabilitation + Chinese medicine group and the Chinese medicine group decreased,the difference was statistically significant(P < 0.05).After treatment,the concentration of plasma AD,NAD and DA in the rehabilitation + Chinese medicine group was lower than that in the Chinese medicine group,the difference was statistically significant(P<0.05).There was no decrease in the above indicators in the control group,and the difference was statistically significant(P>0.05).10.Safety indicators: No serious adverse events occurred in the three groups during the 6-week treatment period.Conclusions: Bupleurum plus dragon bone and oyster shell Decoction can reduce the frequency of angina pectoris,duration of angina pectoris,abnormal psychological state,TCM symptom scores and improve the quality of life in patients with MSIMI.However,virtual reality rehabilitation combined with Bupleurum plus dragon bone and oyster shell Decoction is better than Chinese medicine treatment in reducing the frequency of angina pectoris,duration of angina pectoris,WMSI,total number of psychological stress tasks,abnormal psychological state,TCM symptom scores,and improving quality of life.The three groups of effects on the safety indicators are equivalent,suggesting that the treatment group is relatively safe.Compared with Chinese medicine group,inflammatory factors,platelet activating factor,Blood catecholamine indexes decreased while heart rate variability indexes increased in rehabilitation + Chinese medicine group,suggesting that virtual reality rehabilitation combined with Bupleurum plus dragon bone and oyster shell Decoction may play a therapeutic role by affecting the inflammatory mechanism,platelet activation mechanism,heart rate variability,and blood catecholamine concentration. |
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