| BackgroundDepression is an independent risk factor for the occurrence,development and poor prognosis of coronary heart disease(CHD).With the gradual recognition of the high prevalence of CHD combined with depression,the mental state of patients with CHD has also received further attention.However,the complex relationship between depression and CHD has not been fully elucidated,and there is currently no consensus on the optimal treatment of patients with comorbid depression and CHD.At present,antidepressant drugs are often used in combination with secondary prevention drugs for CHD.However,it has been found that there are still obvious defects in this treatment method in clinical practice,such as some antidepressants have different degrees of cardiovascular adverse reactions.Traditional Chinese medicine(TCM)has a long history in the treatment of CHD combined with depression.It has a deep theoretical basis in syndrome differentiation and treatment,theory,method and prescription,and has a unique curative effect.In view of the shortcomings of the current treatment,this study intends to explore the efficacy of Qilong TongluoJieyu decoction created by Professor Wang Xian under the theory of "internal movement of collateral windcollateral damage and shen injury" in the treatment of CHD combined with depression,in order to provide ideas and plans of TCM for the treatment of CHD combined with depression.AimIn this study,according to the bibliometric analysis,the hotspots and future trends of TCM in the treatment of CHD with depression were analyzed.Secondly,a crosssectional survey was conducted to investigate the incidence of depression in patients with CHD during hospitalization,and a one-year follow-up was conducted to determine the predictive effect of depression on readmission of discharged patients with CHD.Thirdly,systematic review and meta-analysis were conducted on the treatment of CHD combined with depression with Yiqi Huoxue Jieyu method,in order to clarify the clinical efficacy of this treatment.Finally,a randomized controlled trial of Qilong TongluoJieyu decoction,which was developed with the treatment of supplementing qi,activating blood circulation and relieving depression,was conducted to clarify the clinical efficacy and safety of this decoction in the treatment of CHD complicated with depression,and to explore some possible mechanisms.This study aims to provide new ideas and schemes for the effective treatment of CHD combined with depression,and to provide high-quality evidence for the treatment of this complication with Qilong Tongluo Jieyu recipe.Methods1 Hotspots and trend analysis of TCM in the treatment of CHD combined with depression based on bibliometricsLiteratures on TCM in the treatment of CHD combined with depression were retrieved from China National Knowledge Infrastructure(CNKI),Web of science(WoS)and other databases,and the search time was from the establishment of the database to December 2022.Bibliometrics method was used to analyze and describe the basic situation of the research literature(publication time,publishing institutions,publication sources,fund projects,etc.).Citespace software was used to describe the knowledge map and visual analysis of research hotspots,including the co-occurrence analysis,cluster analysis,timeline view analysis and emergence analysis of literature keywords.To explore the dynamic changes and future trends of research hotspots of TCM in the treatment of CHD combined with depression,and to provide ideas and basis for the follow-up clinical and basic research of TCM.2 Effect of depression on the risk of rehospitalization within one year after discharge in patients hospitalized for CHDPatients admitted to Tongzhou Branch of Dongzhilmen Hospital due to CHD were selected.The basic medical history,echocardiography,coronary angiography and other laboratory indicators were collected,and the patients were scored by the depression scale.The discharged patients were followed up for 1 year to collect the date and reason of readmission.Rehospitalization was defined as an emergency department visit or hospitalization other than planned admission for an adverse cardiovascular event.To investigate the incidence of depression in hospitalized patients with CHD.KaplanMeier survival curve was used to calculate the survival time without readmission,and Log Rank test was used to analyze the correlation between depression and rehospitalization.Finally,Cox proportional hazard regression model was used to analyze the effect of depression on the risk of rehospitalization within one year after discharge and its independent predictive effect.3 Systematic review and Meta-analysis of Yiqi Huoxue and Soothing liver therapy in the treatment of CHD complicated with depression Randomized controlled trials of Yiqi Huoxue Shugan therapy in the treatment of CHD complicated with depression were systematically searched in common Chinese and English databases from the establishment of the database to December 2022.Through strict screening,methodological quality evaluation of the included literature,systematic evaluation and Meta-analysis of the outcome indicators with important clinical value,and GRADE evidence quality grading of the key outcome indicators,to explore the efficacy and safety of Yiqi Huoxue Jieyu method in the treatment of CHD complicated with depression.And lay a systematic literature basis and evidence-based basis for follow-up research.4 Qilong Tongluo Jieyu decoction in the treatment of stable angina pectoris in CHD with depression:a randomized controlled trialA block randomized,parallel controlled trial design was used.Patients with stable angina pectoris and mild to moderate depression who met the inclusion and exclusion criteria were enrolled in the Department of Cardiology,Tongzhou Branch of Dongzmen Hospital.They were divided into experimental group(Qilong Tongluo Jieyu decoction combined with the best treatment regimen recommended by the guidelines)and control group(the best treatment regimen recommended by the guidelines).The clinical efficacy and safety of Qilong Tongluo Jieyu decoction in the treatment of stable angina pectoris complicated with depression were determined by observing the clinical angina pectoris,depression,TCM syndrome improvement and safety evaluation indicators of the two groups,combined with the objective indicators such as serum,heart rate variability and non-invasive cardiac output index,and some possible mechanisms were explored.Results1 Hotspots and trends of TCM in the treatment of CHD combined with depression based on bibliometricsThe results of bibliometrics showed that in the past two decades,the literatures on the treatment of CHD combined with depression with TCM were generally on the rise.Current research focuses on the following aspects:①the effect of depression on the quality of life and prognosis of patients with CHD;②Evolution and development of TCM academic thought on CHD combined with depression;③the efficacy of TCM therapy such as Chinese medicine,acupuncture,Baduanjin,etc.on CHD complicated with depression;④The effect of depression on cardiac rehabilitation after myocardial infarction;And 5)the impact of high-fat diet,diabetes,chronic stress,and ethnicity on disease incidence.The future frontier directions are as follows:①the understanding and treatment of patients with depression after PCI;②The effect of depression on the occurrence and development of atherosclerosis;③Disease management of patients with CHD complicated with depression,that is,intervention of disease risk factors and whole process management before,during and after the disease;④The application of emotional nursing in clinical practice.2 Effect of depression on the risk of rehospitalization within one year after discharge in patients hospitalized for CHDA total of 586 hospitalized patients with CHD who met the inclusion and exclusion criteria were investigated by questionnaire,and 549 of them completed the one-year follow-up.The cross-sectional survey showed that 43.4%of inpatients with CHD had at least one psychological disorder(anxiety or depression),31.9%had depression,24.6%had anxiety,and 19.3%had both anxiety and depression.Kaplan-Meier analysis showed that depression was associated with rehospitalization within one year after CHD(P<0.001).Univariate Cox regression analysis showed that depression was associated with a higher risk of rehospitalization within 1 year than nondepression patients(HR=2.43,95%CI:1.80-3.29,P<0.001).After adjusting for confounding factors,results from the multivariate Cox proportional hazards model showed that depression was associated with a higher risk of rehospitalization within 1 year than non-depression patients(HR=2.26,95%CI:1.60-3.18,P<0.001).In order to compare the influence of anxiety and depression on CHD rehospitalization,the patients were further divided into four groups:anxiety and depression group,anxiety group,depression group and normal group.Univariate Cox regression showed that compared with normal patients,patients with depression alone had 2.76-fold(95%CI:1.75-3.13)increased risk of rehospitalization within one year,and patients with anxiety or depression had 1.41-fold(95%CI:1.25-1.59)increased risk of rehospitalization within one year.However,there was no significant difference in the risk of rehospitalization between patients with anxiety alone and normal patients(HR:1.22,95%CI:0.95-1.56,P=0.123)3 Systematic review and Meta-analysis of Yiqi Huoxue and Soothing the liver therapy in the treatment of CHD complicated with depression A total of 17 studies involving 1189 patients were included in this study to evaluate the clinical efficacy and safety of Yiqi Huoxue Shugan therapy in patients with CHD complicated with depression.The results showed that Yiqi Huoxue Shugan TCM combined with conventional western medicine could further improve angina pectoris symptoms(SAQ score),depression symptoms(HAMD score,SDS score),TCM syndrome score and quality of life(PHQ-9 score)on the basis of conventional western medicine,and did not increase the incidence of adverse reactions.GRADEpro GDT was used to grade the evidence of each outcome indicator,and the results showed that the quality of the outcome was between "moderate" and "very low" due to the existence of various biases.4 Qilong TongluoJieyu decoction in the treatment of stable angina pectoris in CHD with depression:a randomized controlled trialAmong 80 patients who met the inclusion and exclusion criteria,73 patients(36 in the Qilong Tongluo group and 37 in the conventional western medicine group)finally completed the trial.The results showed that Qilong TongluoJieyu decoction could further improve angina pectoris(SAQ scale score)and depression(HAMD scale score and PHQ-9 scale score)in patients with CHD combined with mild to moderate depression on the basis of the recommended treatment of CHD guidelines,and could improve TCM syndrome score,with high safety.In addition,Qilong TongluoJieyu Decoction can reduce inflammatory response(NLR,MHR,CRP),reduce blood lipids(TC,HDL-C),regulate heart rate variability(SDNN,rMSSD,LF/HF),improve cardiac function(SV,CO)and peripheral vascular resistance(SVR).Conclusions1.The research of TCM in CHD combined with depression continues to rise.2.Depression is a predictor of rehospitalization in hospitalized patients with CHD.3.The incidence of depression in hospitalized patients with CHD is high.4.The treatment of CHD combined with depression with Yiqi Huoxue Jieyu method has good efficacy and safety.5.Through the verification of this study,Qilong Tongluo Jieyu decoction can improve angina pectoris and depression in patients with stable angina pectoris of CHD combined with mild to moderate depression(qi deficiency and blood stasis,liver depression and qi stagnation),and its clinical application is safe and effective,with great clinical significance and development value. |
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