| Cardiovascular diseases (CVD) and cerebrovascular diseases (CBD) that primarily caused by atherosclerosis (AS) are the highest morbidity rate and mortality rate in most diseases that seriously threaten the health and lives of human. Studying the etiopathogenisis and mechanisms of AS can provide a new direction to postpone and retroconvere the progress of AS, consequently decrease the rate of morbidity and mortality of CVD and CBD. So the study is the one of the most important reseach in the cardiovascular and cerebrovascular study fields.Upper Chapter Literature Review1 The Modern Study of the Mechanisms of AtherogenesisIt was knowed that the most common risk factors for AS were dyslipidemia, high blood pressure and diabetes, and recent studies showed that endotoxin (infectious agents) is susceptible to AS. Subsequently, how dyslipidemia and endotoxin (infectious agents) cause AS remains uncertain, and draw medical reseachers' extensive attention. 1. 1 Dyslipidemia and ASLipids metabolic disturbance, especially high low-density lipoprotein (LDL) cholesterol level and low high-density lipoprotein (HDL) cholesterol level, has a close relation with the occurrence and the development of AS. Once LDL is oxidized, forming oxidized low-density lipoprotein (oxLDL), the macrophages in vessel walls may take immoderately up LDL through scavengerreceptor (SR), and then the macrophages form the characteristic foam cell of early atherosclerosis. At the same time, the lipids in peripheral tissues (including endarterium) also may be transported to liver, adrenal gland, and so on, and be degraded. As HDL directly participates in the process, the process is mediated together by SR-A and SR-B. So the up-regulation of the expression of SR in hepatic tissues may delay and even reverse the progress of AS. 1.2 Infection, Endotoxin and ASInfection is related with AS, but as yet there is no experiment that can separate pathogen from atherosclerotic plaque (AP) in hominal arteries and the antibiotic therapies did not gain expectant curative effect. Therefore most doctors regarded that AS is not directly induced by the infection of local arterial walls, but induced by the indirect aftereffect of the inflammation induced by endotoxin including immune response, lipids metabolic disturbance and so on. So studying the relation between endotoxin and AS may be one of breakthrough of the atherosclerotic study. 2 Damp-heat Syndrome and AS 2. 1 Moderm Study of Damp-heat Syndrome in Chinese traditional medicineRecent studies showed that the formation of Damp-heat Syndrome (DHS) is related to high fat diet and the exogenous infection by the evil of damp-heat. The exogenous infection is not only related to damp-heat condition but also related to infecting easily pathogenic microorganism, e.g. bacterium, especially in damp-heat condition. Thereby animal models of DHS were established stably by compounded with hyperlipemia diet and infection by Gram-negative bacteria. Because lipopolysaccharide endotoxin in the bacterial membrane is the main pathopoiesis factor of Gram-negative bacteria, typical animal models of DHS were also copied by combined factors e.g. hyperlipemia diet and endotoxin injection. 2.2 Investigation of Damp-heat Pathogenesis of ASSome studies showed that the damp-heat and pyrophlegm are the main contradictions of AS regardless of hyperlipemia, hyperpiesia and diabetes on the view of the thoery of traditional Chinese medicine. Hereby the reseaches suggested that endoretention of damp-heat is the important pathogenesis of AS and the constitution of damp-heat is the important foundation of atherogenesis. They also considered that chronic DHS is the susceptible factors of AS and the formation of the damp-heat becoming the blood stasisis the important pathological component element of AS. Clinical researches also showed that the therapy of clearing away heat, dissipating dampness and dissipating blood stasis (CHDDDBS) has a better effect on the diseases resulted form AS. For example some investigators reported that Wendan decoction, Huanglian Wendan decoction, Longdan Xiegan decoction or Xinglou Chengqi decoction plus the herbals of promoting blood flow and dissipating blood stasis gained satifactory effects on preventing and curing coronary artery disease and cerbral infarction. Therefore the reseaches approved that the therapy of CHDDDBS on the diseases resulted form AS is viable in clinic. 3 Argumentation Standpoints-Recognition of the Pathogenesis of AS in Chinese Traditional MedicineRecent reseaches showed that there may be a certain association between DHS and AS owing to hyperlipemia diet and endotoxin are not only two independent susceptibility factors of AS, but also two major fators leading to DHS. But it is partial that former studies traditionally laid particular stress on syndrome of blood stasis to diagnose and treat AS. In fact, syndrome of blood stasis is not remarkable in the morning of AS, on the contrary syndrome of damp-heat, sputum or pyrophlegm (heat) is more remarkable and the situation that damp-heat, pyrophlegm and blood stasis intermixed each other most apppears along with the evolution of AS, whereas single syndrome of blood stasis do not appear much. So we supposed that chronic DHS is the important susceptible factors of AS and damp-heat forming into blood stasis is the important pathological component element of AS. So the therapy of CHDDDBS is the main therapeutical principle of AS and the therapy of AS do not comply with syndrome of blood stasis. In our reseach we studied the moderm pathomechanism of the association between chronic DHS, damp-heat forming into blood stasis and AS and observed the curative effect of the therapy of CHDDDBS on AS. Accordingly it may suggest a new way to prevent and treat AS with Chinese traditional medicine.Middle Chapter Clinic StudyRetrospective Cohortstudy of 242 Cases of Constitution of DSH with Coronary Artery Disease and Cerbral InfarctionThe study found that 37.19 percents of the investigated patients with AShad the constitution of DSH and 30. 99 percents had the constitution of DSH accompanied with blood stasis. To sum up, there were 68. 18 percents of the investigated patients, in other words about tow-thirds cases, existed the constitutional character of DSH with different degrees. In addition, 61. 16 percents had different degrees of dyslipidemia and 46.96 percents had different degrees of high fibrinogenemia. Moreover, atherosclerotic index (AI) in group of the constitution of DSH and group of the constitution of DSH accompanied with blood stasis was markedly higher than others not with the constitution of DSH (FKQ. 01), and fibrinogen in group of the constitution DSH accompanied with blood stasis was higher than the other two groups (K0. 01). The results suggested that the patients in group of the constitution of DSH and group of the constitution of DSH accompanied with blood stasis existed obvious lipids disturbance and the character of microcosmic blood stasis. It can be seen that chronic DHS is the important susceptible factors of AS and damp-heat forming into blood stasis is the important pathological component element of AS.Lower Chapter Empirical Study1 Establishment of Animal Models of Chronic DSHDHS rabbit models in our experiment copied by combined factors e. g. damp-heat condition, cherichia coli endotoxin, and hyperlipemia diets were satisfactory. After establishment models, animals appeared intermittent febris with difference levels, less food intake, lassitude, lie-addiction, lofty hair, and loose stool. The symptoms were very similar to the patients with chronic DSH and remarkedbly ameliorated after treatment with the herbals of CHDDDBS.2 Effects of CHDDDBS on Ultrastructure of Rabbit Arteriae Aorta of DSHOur research found that rabbit arteriae aorta in group of DSH models present conspicuous characteristic atherosclerotic changes including atheromatous plaque, endothelial injury, foam cells, smooth muscle proliferation, and so on. The changes in group of DSH were significant difference compared with control group and obviously ameliorated after treatment with the herbals of CHDDDBS. Thereby, the pathogenesis that chronic DSH can lead to AS is sufficiently supported by morphological evidences andCHDDDBS has a significant intervention effect on AS.3 Effects of CHDDDBS on Rabbit Models Blood Lipids Level of DSHOur reseach showed that the group of DSH had obviously blood lipids disturbance, and CHDDDBS can markedly clear or depress LDL and oxLDL pivotally leading to the blood lipids disturbance of AS. So one of antiatherosclerotic pharmacomechanism of CHDDDBS is to ameliorate the blood lipids disturbance.4 Effects of CHDDDBS on Rabbit Models Hemorheology and Fibrinogen of DSHOur reseach showed that model animals of atherogenesis are in the condition of microcosmic blood stasis that appeared high thickness, high viscosity, high coagulability, and high aggregation. It is said that damp-heat forming into blood stasis is the important pathological component element of AS. CHDDDBS can ameliorate obviously the indexes of microcosmic blood stasis such as hemorheology and fibrinogen. Jt suggested that another antiatherosclerotic pharmacomechanism of CHDDDBS is to dispart and dispel dampness, heat and blood stasis that uniting one another in chronic DSH.5 Effects of CHDDDBS on the expression of SR-A1 and SR-BlmRNA in hepatic tissue of DSH Rabbit ModelsOur reseach showed that CHDDDBS could up-regulate the expression of SR-A1 mRNA in hepatic tissue, strengthen the capability that liver clean blood lipids, and degrade the levels of plasmic LDL and oxLDL, thus it achieve antiatherosclerotic effect. CHDDDBS also can up-regulate the expression of SR-B1 mRNA in hepatic tissue and adjust cholesterol counter transport process to postpone even reverse atherosclerotic occurrence.ConclusionChronic DHS is the important susceptible factors of AS and damp-heat forming into blood stasis is the important pathological component element of AS. CHDDDBS can lessen the atherosclerotic ultrastructural injuries and protect endarterium. The mechanisms of CHDDDBS on AS are related to rectificating blood lipids disturbance, ameliorating microcosmic blood stasis, and regulating the expression of SR in hepatic tissue.Creativity of Our Reseach... |
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