The Differences Of Clinical Characteristics And Inflammatory Factors In Acute Coronary Syndrome Patients With Qi-deficiency Blood-stasis Syndrome And Qi-stagnation Blood-stasis Syndrome

Acute Coronary Syndrome(ACS)is a critical type of coronary atherosclerotic disease.The data shows that the prevalence of myocardial infarction in people over 45 years old in our country has been increasing year by year.Coronary interventional therapy has saved the lives of numerous patients with severe myocardial infarction,but its morbidity and mortality have not decreased.It suggests that the risk factors of coronary atherosclerotic disease have not been fully and completely controlled.And the inflammatory response plays an important role in the instability of coronary atherosclerotic plaque.For example,inflammatory factors stimulate monocytes to differentiate into macrophages;macrophages are transformed into foam cells by ingesting oxidized low-density lipoprotein,and the necrotic core is further enlarged;matrix metalloproteinases can degrade the collagen of the extracellular matrix,and the fibrous caps at the plaques become thin and rupture.ACS belongs to the category of"chest stuffiness and pains" "sudden precordial pain" in traditional Chinese medicine.Studies indicate that Qi-deficiency blood-stasis syndrome(QDBSs)and Qi-stagnation blood-stasis syndrome(QSBSs)are the two common syndromes in patients,and blood stasis is the common pathological feature of these two types of syndromes.Compared with patients with chronic coronary syndrome(CCS),ACS has the characteristics of sudden onset,severe inflammation and rapid changes in the condition.Studying the changes of inflammatory factors in the acute phase of ACS will help to understand the pathological characteristics of Traditional Chinese Medicine syndromes in patients with QDBSs and QSBSs,and provide a new perspective for the diagnosis and treatment of coronary atherosclerotic disease by combining disease and syndrome.This study compared the clinical characteristics and expression levels of inflammatory factors of different types of ACS blood stasis syndrome,and observed the relevant inflammatory factors that affect patients’ heart function and the complexity of coronary artery lesions.And to provide evidence-based clinical trails for standardized syndrome differentiation of ACS Qi disease and blood stasis syndrome.Objective:To observe the differences in clinical characteristics and expression levels of inflammatory factors in ACS patients with QDBSs and QSBSs,and to explore the correlation between the heart function,coronary artery lesions and inflammatory factors in the two groups of ACS patients.Methods:244 patients reaches were eligible for enrollment from August 2016 to March 2018,if they were diagnosed as acute coronary syndrome(ACS)and were hospitalized at the cardiovascular center of Xiyuan Hospital of China Academy of Chinese Medical Sciences,Department of Cardiology in Beijing Anzhen Hospital of Capital Medical University.All patients who provided written informed consent were underwent percutaneous coronary intervention(PCI)treatment after admission.Among them,112 cases of ACS patients met to QDBSs criteria and 132 cases of ACS patients met to QSBSs criteria.The general clinical information,laboratory testing measurements,echocardiography,blood-stasis syndrome scores and different symptoms scores,expression levels of Hs-CRP,IL-6,TNF-α,Lp-PLA2,YKL-40,ICAM-1,FGF-21,and the coronary artery lesion scores(Gensini scores)based on the results of coronary angiography were collected,respectively.The obtained results were statistically analyzed with the use of SPSS,21.0 version software.Continuous variables normally distributed are presented as mean±standard deviation(SD),while for non-parametric variables median and interquartile range(IQR:range from the 25th to the 75th percentile).Comparisons for continuous variables,normally distributed,were performed with the independent samples impaired t-test.The Mann-Whitney U test was used in order to analyze non-parametric variables.Correlation coefficients were obtained by applying Spearman’s rank method.Differences were considered statistically significant for P<0.05.Results:1.The comparison of two groups displayed that there were no significant differences between sex,age,height,weight,smoking history,drinking history,hypertension,diabetes,dyslipidemia,history of stroke,liver and kidney functions,LVEF,LUEDd(P>0.05).The serum levels of pro-BNP and cTnT in ACS patients with QDBSs were significantly higher than those with QSBSs,and the differences were statistically significant(P<0.05).2.Compared with QSBSs ACS patients,the QDBSs patients have higher symptome scores of angina pectoris,lower symptome scores of dark lips and gums,lower sublingual varicose veins,the differences were statistically significant(P<0.05).However,there were no significant differences in scores of blood-stasis syndrome,number of coronary artery lesions and Gensini scores between QSBSs and the QDBSs ACS patients(P>0.05).3.The Hs-CRP level of ACS patients with QDBSs was significantly higher than that of patients with QSBSs,and the difference was statistically significant(P=0.014).There were no significant differences between two groups with the levels of six inflammatory factors,including IL-6、TNF-α、Lp-PLA2、YKL-40、ICAM-1、FGF-21(P>0.05).4.According to the analysis with Spearman correlation,the results showed that the serum level of Hs-CRP was negatively correlated with the LVEF(r=-0.206,P=0.033),and ICAM-1 was positively correlated with the LVEDd in QSBSs ACS patients.And we found that there were no correlations between the seven inflammatory factors and the heart function of ACS patients with QDBSs(P>0.05).5.We analyzed the correlations between Gensini scores and the levels of inflammatory factors(Hs-CRP、IL-6、TNF-α、Lp-PLA2、YKL-40、ICAM-1、FGF-21),the results were as follows:in the QSBSs group,Gensini scores were positively correlated with the serum level of IL-6 and no correlations were found between Gensini scores and other inflammatory factors.Moreover,there was no correlation between the coronary Gensini scores and inflammatory factors in ACS patients with QDBSs(P>0.05).Conclusions:1.Compared with ACS patients with QSBSs,the patients with QDBSs have less degree of dark lips and gums and sublingual varicose veins.These symptoms may be helpful in the diagnosis and differentiation of QSBSs and QDBSs.2.Among to the ACS patients met to QDBSs and QSBSs criterias,the degrees of myocardial damage and inflammatory reaction in QSBSs group are significantly more severe;3.In ACS patients with QSBSs,the levels of inflammatory factors are negatively correlated with cardiac function,and are positively correlated with the coronary Gensini score.That is,as the level of inflammatory factors increases,the degree of heart function and coronary artery lesions gradually become worsen.