Clinical Study On Coronary Slow Flow Phenomenon And The Therapeutic Effect Of Pushen Capsule

Objective: To analyze the risk factors of coronary slow flow(CSF). To analyze thevascular endothelial function indicators and the high-sensitivity C-reactive protein (Hs-CRP)levels of CSF and the possible pathogenesis of CSF. To observe the therapeutic effect ofPushen Capsule in treating CSF patients.Methods:60CSF patients confirmed by coronary angiography (CAG) and determinedby Corrected TIMI Frame Count (CTFC) method were enrolled in the coronary slow flowgroup(CSF group). In the same time20patients with normal coronary angiography wereenrolled in the control group(CNF group). All the cases were all hospitalized in theCardiology Department of Jining First People’s Hospital from October2011to October2012.The cases with coronary artery stenosis, thrombosis and coronary artery abnormalities wereall ruled out. Recorded all the cases’s clinical data and the laboratory date, such as bloodroutine, liver function, renal function, blood glucose, blood lipid, uric acid, creatine kinase,creatine kinase isoenzyme etc. T-test and χ2-test were used to screen out the risk factors ofCSF from the above indicators, and the multinomial logistic regression analysis was used toscreen out the independent risk factors of CSF from the risk factors. All the cases’ brachialartery diameter, brachial artery endothelium-dependent blood flow-mediated dilation response(FMD) and nitroglycerin-mediated noendothelium-dependent relaxation response (NID) weremeasured by high-resolution Doppler ultrasound. The high sensitivity C-reactive protein (Hs-CRP) level was measured by ELISA. Compared the differences of endothelial functionindicators and Hs-CRP levels between the CSF group and the CNF group, and analyzed thecorrelation of the average frame count and the FMD, Hs-CRP. Then to observe the role thatvascular endothelial dysfunction and the vascular inflammation played in the development ofCSF.60CSF patients were randomly divided into the Pushen capsule group(30cases)and thesimvastatin group(30cases). The Pushen capsule group patients were given Pushen capsules3times a day, once0.5g. The simvastatin group patients were given simvastatin20mg daily.The two groups were all given the conventional treatment. After8weeks of treatment wemeasured the D0, FMD, NID and Hs-CRP levels, recorded the laboratory date and the clinicalsymptom of the two group patients. SPSS17.0software was used for the statistical analysis,with P <0.05as the significant difference statistically.Results:1. The CSF group and the control group had no significant differences in age, BMI,fasting blood sugar, TC, TG,LDL-C, HDL-C, diastolic blood pressure, heart rate, white bloodcell number, red blood cell number and platelet cell number(P＞0.05). The CSF group hadhigher proportion of smoking(63.33%vs.25%), higher systolic blood pressure(126.40±11.93mmHg vs.119.30±12.60mmHg), and higher hemoglobin level(137.67±11.74g/L vs.129.90±12.12g/L) than the control group (P<0.05). The CSF group had significantly higher proportionof males(78.33%vs.30%)and higher blood uric acid level(294.57±65.01umol/L vs.244.15±54.57umol/L)than the control group(P<0.01). Multinomial logistic regression analysisshowed that male (OR=2.84，95%CI:1.05～6.91， P=0.04) and blood uric acid level(OR=1.21，95%CI:1.02～2.57，P=0.04) were the independent risk factors of CSF.2. The CSF group and the control group had no significant differences in D0and NID(P>0.05). The FMD of CSF group was significantly lower than the control group(6.28%±1.30%vs.10.18%±1.90%， P＜0.01). The Hs-CRP level of CSF group wassignificantly higher than the control group (3.42±1.13mg/L vs.2.10±0.80mg/L,P＜0.01).3. The average frame count of CSF group was significantly higher than the control group(30.23±2.09frames vs.22.00±2.23frames, P＜0.01). The frame count of CSF group was significantly negative correlated with FMD (Pearson correlation coefficient r=﹣0.697, P＜0.01), and significantly positive correlated with Hs-CRP level (Pearson correlation coefficientr=0.685, P＜0.01).4. Comparision of the therapeutic effect between Pushen capsule group and simvastatingroup4.1Clinical effect: The frequency（Pushen capsule group:1.15±0.18times a week vs.3.52±0.32times a week, simvastatin group:1.73±0.21times a week vs.3.57±0.38times aweek） and duration of symptoms (Pushen capsule group:1.58±0.47min once time vs.5.68±0.75min once time, simvastatin group:2.37±0.54min once time vs.5.47±0.69min oncetime)were all reduced after8weeks in the two groups (P＜0.05); The Pushen capsule grouphad a good control of frequency and duration of symptoms than simvastatin group (P <0.05).4.2Vascular endothelial function: After treated for8weeks, the D0and NID had nosignificant change in the two groups (P>0.05). The FMD were higher than that of beforetreatment in the two groups (Pushen capsule group:8.98%±1.13%vs.6.27%±1.28%,simvastatin group:9.02%±1.22%vs.6.29%±1.31%, P<0.05). Between the two groups therewere no significant differences in D0、FMD、NID before and after the treatment (P>0.05).4.3Hs-CRP levels: After treated for8weeks, the Hs-CRP levels of the two groups werelower than that of before treatment (Pushen capsule group:2.51±1.06mg/L vs.3.44±1.13mg/L, simvastatin group:2.48±1.07mg/L vs.3.40±1.05mg/L, P<0.05). Between the two groupsthere were no significant differences in Hs-CRP levels before and after the treatment (P>0.05).4.4Uric acid levels: Between the two groups there were no significant difference in uricacid level before treatment (P>0.05). After treated for8weeks, the uric acid level was lowerthan that of before treatment in Pushen capsule group (246.37±55.27vs.293.05±65.16umol/L, P<0.05). The uric acid level had no significant change after treatment in simvastatin group(286.48±59.37umol/L vs.295.97±63.95umol/L, P>0.05). The level of uric acid of Pushencapsule group was lower than that of simvastatin group after treated for8weeks (246.37±55.27vs.286.48±59.37umol/L, P<0.05).4.5Adverse drug reactions: There were two cases that the ALT and AST increased in the Simvastatin group. Stopping taking the simvastatin for two weeks the ALT and AST returnedto normal levels. There were no adverse drug reactions in Pushen capsule group.Conclusion:1. Male, blood uric acid level may be the independent risk factors of CSF.2. The CSF group has lower FMD and higher Hs-CRP level than the control group. Theframe count of CSF group was significantly negative correlated with FMD and significantlypositive correlated with Hs-CRP level. It prompts that endothelial dysfunction and vascularinflammation may participate in the development of CSF.3. Pushen capsule and simvastatin all can improve endothelial function and reduce thevascular inflammatory reaction. But the Pushen capsule can reduce the level of uric acid, andon symptom control it is better than simvastatin.