Clinical Study Of Blood Stasis Syndrome Of Coronary Heart Disease With Heart Failure

[Objective]To analyse the TCM syndrome, blood stasis scoring, and corelativelaboratory inspection change, observes the CHD with HF patient blood stasisexchange rule, discusses the syndrome characteristic.[Methods]Hospitalized and outpatient patient of CHD with CHF are choosed.The CHD diagnosis standard is the 1979 Naming and Diagnostic standard ofischemic heart disease set by World Health Organization(WHO) and InternationalHeart Association(AHA). The CHF diagnosis standard is the Framingham 1971standard. The HF grade standard is 1982 American New York HeartAssociation(NYHA). The TCM syndrome diagnosis standard refers to "ClinicalDiagnosis and Treatment Term of TCM—Syndrome Part". The blood stasis scoringrefers to standard of Chinese Association of the Integration of Traditionaland Western Medicine, Invigorate Blood and Remove Bloodstasis Committee.All cases classfied TCM syndrome, heart function qualitate, blood stasisscore, draws blood sample to laboratory inspection. Randomly divide cases intothe treatment and compare group. Standard treatment of CHD and HF of both groupis applied. The treatment should as far as possible simple and are relativelyfixed.For treatment group, take Tongguan capsule 3# tid extra.The target observation including the TCM syndrome, blood stasis score.Laboratory examination including Brain Natriuretic Peptide (BNP), plateletfunction, hemoglutination function, hemorheology, blood lipid,ultrsonicardioagraph.If necessary, patients can apply Coronary Angiography(CAG) with Judkinsmethod and Percutanous Coronary Intervention(PCI) with Cruentzig method. After 7 days of treatment, recounter TCM syndrome and blood stasis scoreand statiste again.【Results】Altogether completes observes 110 cases, 66 male and 44 female, age from34 to 76 years old, average 58.02±8.97 years old and 4.71±3.67 years ofdisease course. Cases of heart functionⅡ-Ⅳis 57, 40, and 13 seperately.The qi deficience and blood stasis is the most testimony syndrome of allNYHA grade(43.6% and 62.7%). As heart function failure get worse, qi deficiency,yang deficiency, blood deficiency, and excessive fluid syndeome increase.After treatment, qi deficience and blood stasis is still the most testimonysyndrome (49.4% and 47.3%). Qi deficience syndrome increase and blood stasissyndrome reduce (P＜0.05 and P＜0.01), while other syndrome have no obviouschange.Blood stasis score(BSS) increase withⅡ-ⅣNYHA grade: 45.93±22.09,55.77±25.40,82.57±20.90(P＜0.05-P＜0.001). BSS is higher of cases that malevs female, smoker vs nonsmoker, positive family history that negtive,hospitalized vs outpatient, with abnormal result of chest X-ray, EKG,Ultrucardiogram(UCG).BSS is positive corelation with smoke, family history: with hypertensionand diabetes. The NYHA grade is positive corelation with age and disease course.Sex is is positive with drink and smoke. Male have higher ration of smoke.BSS is negtive corelation with main complain of paltpation and positive withchest Bi-syndrome.After treatmen, BSS is decreased to 31.12±16.08,36.96±18.02,53.50±14.04. And compare outpatient, hospitalized have better improve of BSSFor both treatment group and compared group, BSS is 52.80±24.98,55.05±26.77 before and decrease to 32.63±17.64,39.65±17.60 after treatment,(P＜0.05-P＜0.001), and treatment is better(P＜0.05). 56 cases applied PCI,including 31 of treatment and 25 of compared group.BBS is 63.54±22.16,61.56±22.20 before and decrease to 38.55±15.64,46.28±15.73 after treatment for each group(P＜0.001), and treatment group isbetter(P＜0.05). Compare BSS improve scope PCI(24.99＜8.52vs15.28±7.78)＞qideficience and/or blood stasis syndrome(20.61±9.61vs15.38±10.97)＜all(20.16±9.20vs15.39±10.98). It shows that Tongguan capsule is good for CHD with HF, better for cases with qi deficience and blood stasissyndrome, and perticuly suit for PCI cases.Corelative exam items:Blood lipid: with NHYA grade and BSS increase, TC,TG,LDL-C,Apo-B increase,HDL-C,Apo-Al decrease. These can be improved after treatment, and treatmentgroup is better with TC,TG,LDL-C.Thrombin: with NHYA grade and BSS increase, Fibrinogen (FIB) increase,PT, APTT decrease. FIB decrease after treatment, and treatment group is better.Hemorheology: with NHYA grade and BSS increase, whole blood viscosity,plasma viscosity, blood reductive viscosity, Erythrocyte SedimentationRate(ESR), Erythrocyte Sedimentation Rate Equation K(ESR-K), erythrocytestiff and aggressive index increase, erythrocyte deform index decrease. Allthese items be better after treatment, and treatment group has better effectof ESR-K, erythrocyte deform index, erythrocyte stiff index.B-type natriuretic peptides(BNP): increase with NHYA grade and BSS. BNPcan reduced after treatment.Platelet: with NHYA grade and BSS increase, platelet count(PlT),plateletocrit(PCT), mean platelet vomume(MPV), platelet distributionwidth(PDW) increase and decrease after treatment.The study shows that with NHYA grade and BSS increase, blood lipid,thrombin function, hemorheology are abnormal. BSS decreased after treatmentshows effctive. Blood stasis syndrome is core procession of CHD with HF, andcan be testfied by examine.Tongguan capsule can decrease BSS of cases with CHD and HF. Also can reducewhole blood viscosity high shear rate, plasma viscosity, TC, TG, FIB,erythrocyte stiff index, ESR-K, increase LDL and erythrocyte deform index.【Conclusion】Qi deficience and Blood stasis is the most commonly syndrom of CHD withHF. BSS reflex the serious of disease and have relationship with multi examitems. Blood stasis is core of whole course.Invirgrate qi and promote blood circulation method with Tongguan capsuleis suit for for cases with CHD and HF. It can decrease BSS and some abnormalitems. For cases with insufficience qi and blood stasis symdrome, and caseswith PCI, can have even better effect.The score formula of blood stasis can reflect well the CHF patient blood stasis situation, also have relationship with blood lipid, hemorheology etcitems, is a big progress of the blood stasis diagnosis standard studies.