The Clinical Effects Of Acupoints On Chronic Stable Angina Pectoris And The Mechanism Of Stable Plaque

Objective:This project has selected Stable Angina Pectoris (SAP) as research object and has been guided with the theory of where the meridian moves, where the meridian can play an therapeutic role in the body. We aim to discuss the clinical efficacy and mechanism of stabling plaques in how selecting acupoints according to meridians treat SAP through observing selecting acupoints along meridians, selecting acupoints without following meridians theory and Non-points in non-meridian. Meanwhile, we also want to elucidate the basic laws of acupoints effect specificity further and supply relative symptomatology, imageology and biology evidences for the existence of acupoints effect specificity.Methods:40 SAP patients who matched the inclusion criteria were divided into 4 groups with the Central Randomization System,10 patients as a group. There groups were administered puncturing at different acupoints:Group A:acupoints in Heart meridian and Pericardium meridian (PC6 and HT5), Group B:acupoints in Lung meridian(LU6 and LU9), Group C:Non-acupoints in Non-meridian (two predefined non-acupoints were punctured), and Group D was waiting-list group (there was no puncturing in this group). And all of the groups were punctured under the primary drug treatment. Both acupoints and non-acupoints were punctured bilaterally, we have punctured one more needle where was 2mm away from the points (proximal part) after puncturing all the points in order to connect electric acupuncture apparatus (LH200). During the process, according to patients’tolerance, Monophase fixe was selected,2Hz as the frequency, current intensity was around 0-2mA. Acupuncture treatments were given for every other day,4 weeks as a course,3 times in one week, each acupuncture treatment lasted 30 minutes and all for 12 times in a course. The following outcome measurements were assessed at 0,4,8,12 and 16 weeks after randomization. Frequency of angina differences from baseline, VAS score differences from baseline, dose of Nitroglycerin Tablets differences from baseline. And the ST-T changes, contents changes of MMP-9 and TIMP-1 in the serum were assessed before and after acupuncture; while measured the coronary arteries and AS plaque in the coronary arteries with DSCT before and after acupuncture.Results:General baseline condition have been compared before treatment in these four groups, including age, gender, process, frequency of angina, VAS scores, dose of Nitroglycerin Tablets, ST-T changes, contents of MMP-9 and TIMP-1, these factors have no statistical significance (P>0.05), which are comparable.1. frequency of angina①Intra-group comparison:(1)Group A:comparisons among the prior treatment and post-treatment, the first, second, third follow-up, all have extreme statistic significance (P<0.001). Comparisons among post-treatment and the first, second, third follow-up have outstanding statistic significance (P<0.01) and extreme statistic significance (P<0.001), while comparison between first follow-up and third follow-up has outstanding statistic significance (P<0.01)(2) Group B:comparisons among the prior treatment and post-treatment, the third follow-up, all have extreme statistic significance (P<0.001). Comparisons among the prior treatment and the first, second follow-up have outstanding statistic significance (P<0.01).(3)Group C:comparisons among the prior treatment and post-treatment, the first, third follow-up, all have outstanding statistic significance (P<0.01), while comparison between prior treatment and second follow-up has statistic significance (P<0.05).(2)Inter-group comparison(1) Post-treatment:comparisons among the Group A and Group C, Group D have outstanding statistic significance and extreme statistic significance (P<0.01, P<0.001), while comparisons among Group B and Group C, Group D have statistic significance and extreme statistic significance (P<0.05, P<0.001).(2) The first follow-up:comparison between Group A and Group B has outstanding statistic significance (P<0.01), comparisons among Group A and Group B, Group C have extreme statistic significance (P<0.001), while comparison between Group B and Group D has outstanding statistic significance (P<0.01)(3) The second and third follow-up:comparisons among Group A and Group B, Group C, Group D have extreme statistic significance (P<0.001).(4) The third follow-up:comparisons among Group B and Group C, Group D have statistic significance and outstanding statistic significance (P<0.05, P<0.01)2. VAS scores①Intra-group comparison:(1) Group A, Group C:comparisons among the prior treatment and post-treatment, the first, second, third follow-up, all have extreme statistic significance and outstanding statistic significance (P<0.001, P<0.01).(2) Group A:comparisons among the post-treatment and the second, third follow-up, all have statistic significance and extreme statistic significance (P<0.05, P<0.001), while comparisons between the first follow-up and the third follow-up have outstanding statistic significance (P<0.01).②Inter-group comparison(1) The first follow-up:comparisons among Group A and Group B, Group C, Group D have statistic significance, outstanding statistic significance and extreme statistic significance (P<0.05, P<0.01, P<0.001), while comparison between Group B and Group D has statistic significance (P<0.05)(2) The second and third follow-up:comparisons among Group A and Group B, Group C, Group D have extreme statistic significance (P<0.001).3. Dose of Nitroglycerin Tablets①Intra-group comparison:Group A:comparison between prior treatment and post-treatment has outstanding statistic significance (P<0.01), while comparisons among the prior treatment and the first, second, third follow-up, all have extreme statistic significance (P<0.001).②Inter-group comparison:all have no statistic significance.4. Minutes and range of ST-segment depression in 24h Dynamic Electrocardiogram before and after treatment in the four groupsMinutes of ST-segment depression in 24h Dynamic Electrocardiogram:①Intra-group comparison:Group A, Group B:comparison between prior treatment and post-treatment has outstanding statistic significance and has statistic significance (P<0.01, P<0.05)②Inter-group comparison:There is a trend of:Group A>Group B> Group C> Group D, but they all have no statistic significance(P>0.05).Range of ST-segment depression in 24h Dynamic ElectrocardiogramIntra-group compari son:①Group A:comparison between prior treatment and post-treatment has outstanding statistic significance (P<0.01).②Group B, Group C:comparisons between prior treatment and post-treatment has statistic significance (P<0.05).Inter-group comparison:There is a trend of:Group A> Group B>Group C> Group D, but they all have no statistic significance(P>0.05).5. Contents of MMP-9 and TIMP-1 in four groups before and after treatmentIntra-group comparison of MMP-9:Group A:comparison between prior treatment and post-treatment has outstanding statistic significance (P<0.01)Inter-group comparison of MMP-9:they all have no statistic significance (P>0.05)Intra-group comparison and Inter-group comparison of TIMP-1:they all have no statistic significance (P>0.05)6. According to the DSCT examination, the acupuncture treatment has no effect on the stenosis of coronary artery; while Group A (acupoints along heart and pericardium meridians) can improve the tendency of patients’plaque value; the volume of CACP, equivalent mass of CACP and CACS in the patients are all in downtrend, especially the Group A.Conclusion:1. Group A (Acupoints along the heart and pericardium meridians) have significant effect on the SAP, such as:(1) Group A can reduce the frequency of angina and decrease VAS scores obviously to relieve the pain degree of angina, in addition, it has better effect than Group B, Group C and Group D. (2) Group A can reduce the dose of Nitroglycerin Tablets for mitigating side effects. (3) Group A can lessen the minutes and range of ST-segment depression in 24h Dynamic Electrocardiogram to improve the myocardial ischemia situation.2. Group A can inhibit the compound and secretion of MMP-9 effectively, and it has the tendency of enhancing the contents of TIMP-1.3. According to the DSCT examination, the acupuncture treatment has no effect on the stenosis of coronary artery; while Group A (acupoints along heart and pericardium meridians) can improve the tendency of patients’plaque value; the volume of CACP, equivalent mass of CACP and CACS in the patients are all in downtrend, especially the Group A.