| backgroundThe basic pathogenesis of Acute Coronary Syndrome (ACS) was pyretic toxicity and blood stasis.according to the Professor chenjinghe's theory of acute coronary syndrome, who is famous in the first hospital affiliated to Guangzhou university of Chinese Medicine, as well as a number of clinical studies has shown in recent years. The detoxicating and promoting blood circulation therapy plays an important role in the the treatment of ACS by alleviating the body's inflammatory response in a certain degree, regulating lipid metabolism, enhancing the body resistance to hypoxia and anti apoptosis,r educing cardiomyocyte apoptosis, so as to improve the quality of life in the patients with ACS.ObjectiveTo objectively assess the clinical efficacy and safety of the detoxicating and promoting blood circulation therapy after 1 month treatmen and it's mechanism, thereby make an objective evaluation for the efficacy of Chinese medicine;as far as the experiment was concerned, the ecectrocardiograph(ECG) was observed in myocardial ischemia rats induced by pituitrin(Pit) through lingual vein, the contents of CK, LDH, IL-1β,TNF-αin serum was assayed respectively,in myocardial ischemia mice which pituitrin was peritoneal injected. the control group was established, for the purpose of definiting this method's effect (the detoxicating and promoting blood circulation therapy) in the treatment of ACS, so as to provide powerful experimental evidence for the clinical treatment. Method:80 cases with Acute coronary syndrome were collected and randomly divided into treatment and control groups, the control group was treated with Standard treatment method of Western medicine, while the treatment group was treated with standard Western medicine methos and the detoxicating and promoting blood circulation decoction. Therapeutic effect was evaluated according to the standard by Assessment on electrocardiograph(ECG), nitroglycerin consumption, symptom effect of Chinese Medicine, laboratory indicators of inflammation, Liver and kidney function before and after 4 weeks treatment between the two groups, analyze the correlative laboratory parameters such as the IL-1,TNF-a,SCD40L, MMP-9 in serum through statistical analysis so as to explore the mechanism, The side effect, The incidence rate of main cardiovascular lesion in the patients during treatment were recorded as well.the animal experiment research:the ecectrocardiograph(ECG) was observed inmyocardial ischemia rats induced by pituitrin(Pit) through lingual vein and intervened by the detoxicating and promoting blood circulation in high, medium and low dose (32g,16g,8g/kg) the contents of CK, LDH, IL-1β,TNF-αin serum was assayed respectively, in myocardial ischemia mice which pituitrin was peritoneal injected. subjects. sCD40L and TNF-a levels were measured by Enzyme-linked immunosorbent assay.Result(1)clinical therapeutic efect analysis of angina pectoris after treatment in the two groups:24 cases markedly effective, improved in 13 cases,3 cases invalid after four weeks intervention in the treatment group, the total effective percentage was 92%. while the cases was 17,15,8 rspectively in the control group, and the total effective percentage was 80%, there was distinct significance between the two group (P<0.05)(2)Angina onset conparison before and after treatment between the two groups:the frequency and duration of angina attacks in the treated group before intervention was (12.60±2.17) times/week, (9.50±1.72) minutes /time,while it was (13.90±2.60) times/week, (9.10±2.13) minutes/time respectively in the control group, there was no significant difference between the two group (P>0.05). the frequency and duration of angina attacks in the treatment group after intervention was (4.00±1.41) times/week, (3.90±1.29) minutes/time, while in the control group it was (5.70±1.42) times/week, (5.20 ±1.32) minutes/time, There was obvious improvement in the two group, but the decrease margin in the treated group was more significant than that of the controlled group(p<0.05).(3)The incidence rate of main cardiovascular events:compared with the control group, the times of cardiac incidents of the treated group was much less, but the difference comes from the times of common cardiac incidents, in terms of the times of serious cardiac incidents, there was no significant difference between the two group.(4)The syndromes score of TCM:after being treated,the scores of clinical symptoms of the patients in two groups were reduced much and the clinical symptoms of two groups were improved effectively, when compared with the controlled group, the reduction of the scores of clinical symptoms in the treated group was more significant(P<0.01).(5)the acute physiological and chronic healthy evaluationⅡ(APACHEⅡ) scores between the two group:the APACHEⅡscore was (15.10±3.47) in the treatment group, and it was (14..50±3.95) in the control group, there was no significant difference between the two group before intervention and after 2 weeks treatment, but the significance was obvious when compared with admission.- There was apparent improvement in the two group after 4 weeks treatment, but the improvement in the treated group was more significant than that of the controlled group(p<0.05).(6)Nitroglgcerin withdrawal in the two group:there was no statistical significance between them after treatment (P>0.05)2. laboratory test analysis(1)The electrocardiograph(ECG) changes after treatment:13 cases markedly effective, improved in 16 cases,11 cases invalid after four weeks intervention in the treatment group, while The cases was 14,18,8 rspectively in the control group. there wase no obvious significance between the two group (P>0.05).(2)The lipid level before and after the treatment:after the treatment, the lipid level of each group was both improved than that of the before, Such as the total cholesterol, total triglyceride, low density lipoprotein declined and high density lipoprotein rised. however, the improvement extent of the lipid level in the treated group was more significant than that of the controlled group(p<0.05).(3)The level of hypersensitive C-reactive protein(hs-CRP):after the treaatment, the level of hs-CRP of each group was both lower than that of the before(p<0.01), but the decrease margin of the hs-CRP level in the treated group was more significant than that of the controlled group, (p<0.05).(4)The level of leukocytes after treatment:there were no significance between the two group before treatment(P>0.05), while the difference were obvious after treatment between the two group(P<0.05) although the WBC count obviously declined in the control group. The difference value before and after treatment showed no statistically significant difference.(5)The level of fibrinogen(FIB):there were obvious decline after treatment in the two group(P<0.05), while difference between two group showed no significant difference (P>0.05)(6)Changes and relations betwvee IL-1, TNF-a,SCD40L and MMP-9 in patients of ACS after 4 weeks treatment:there was no statistical significance(P>0.05) between the two group before treatment, while the Serum IL-1, TNF-a,SCD40L and MMP-9 level was obviously lower in the treatment group than in control group after treatment((P<0.05). there was no significant difference in the level of MMP-9 before and after treatment in the control group, however the level of MMP-9 was obviously declined in the treatment group after treatment, and the difference was also visible between the two group. so the treatment group was superior to the control group in respect of inflammatory indicators improvement.3. Observation of adverse reactions:1 patient had slightly elevated ALT and one case with slight low hemoglobin were observed in the control group after 4 weeks treatment,and the former's liver function got right 1 month later after took hepatinica orally,no special treatment measures was adopted for the latter.5 cases with nausea, poor appetite in the treatment group, other patients had no adverse reactions after treatment.4. experimental study:the ecectrocardiograph(ECG) changes in myocardial ischemia rats induced by pituitrin(Pit) through lingual vein and intervened by the detoxicating and promoting blood circulation in high, medium and low dose shows high-dose group could improve pituitrin-induced myocardial ischemia much better than the model group (P<0.05), Low dose group showed improvement, but without significant difference.in terms of the changes in laboratory parameters, the cardiac enzyme, IL-1β,TNF-αwas much higher in the model group than the blank control group, and the low, middle and high dose group could improve cardiac enzyme and IL-1β,TNF-αin serum significantly, this change was particularly evident in the high dose group (P<0.01).Conclusion(1) The detoxicating and promoting blood circulation therapy had much better curative effect than the simple western medicine group for the ACS paients, particularly for the improvement in clinical symptoms. This therapy was safe and reliable, with no obvious toxicity;(2) For the treated group,there was an obvious improvement in their laboratory parameters than the control group;(3) the myocardial ischemia rats model induced by pituitrin(Pit) through lingual vein shows the detoxicating and promoting blood circulation therapy had a marked improvement in myocardial ischemia, reduction of serum IL-1, TNF-αpro-inflammatory cytokines, The clinical efficacy of Chinese medicine in curing ACS had to be further support by high-quality experimental trials. The suppression on the inflaumatory reaction of ACS may be one mechanism of TCM in treating patients with ACS.
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