| ObjectivesTo explore the basic pathogenesis of phlegm stasis evolution, analyze the role of abnormal lipid metabolism in the occurrence and development of phlegm stasis evolution of coronary heart diease, and explain the rules and the essences of phlegm stasis evolution from the perspective of lipid metabolism.Methods1Literature ResearchThrough systematic analysis of ancient literature, the basic pathogenesis of phlegm stasis evolution could be summarised; Searching records about changes of phlegm stasis syndrome differentiation and changes of blood lipid from the datatbases collected by Chinese Net of Knowledge and Information (CNKI), VIP (CQVIP), Wan Fang (WANFANG DATA), China biomedical literature database (CBM), and putting forward the information from literature reviewing, using method of Meta analysis to conclude and evaluate the relationship between abnormal changes of lipid metabolism and pathological changes of phlegm stasis.2Clinical StudyBy using cluster random sampling method, conducting multi-centered and large-sampled investigative survey of TCM clinical epidemiology of coronary heart disease; simultaneously detecting blood lipid, blood sugar, blood rheology and cardiac color ultrasound index on both patients suffered from coronary heart disease patients and healthy people, and exploring distribution of the syndrome differentiation of phlegm and micro-indictions of evolution of phlegm stasis in coronary heart diease.3Experimental StudyCopying rat model of myocardial ischemia of phlegm stasis evolution, carrying out electrocardiogram, blood lipid, blood sugar, blood rheology, blood insulin and histopathological examination, and adopting real-time fluorescence quantitative RT-PCR expression to detect the pathway related by genes lipid metabolism; Resorting to benefiting Qi for removing phlegm in treatment of rats suffered from myocardial ischemia, and evaluating the above indications so as to explore the relation between evolution of phlegm stasis of coronary heart diease and lipid metabolism and interpret the intrinsic mechanism of phlegm stasis evolution of coronary heart disease from the angle of the lipid metabolism.Results1Literature Research(1) The fundamental reason for evolution of phlegm stasis of coronary heart diease is caused by improper diet externally and the weakness of the spleen and stomach internally. Malfunctional transfusion, the deficiency of vital qi, and phlegm turbid inside ultimately leads to the accumulation of phlegm and blood stasis gluing to heart pulse and forming patch itself. Heart, spleen (stomach) and blood are the main organs with pathological changes, with "deficiency in origin and excess in superficiality" as the main feature and phlegm and blood stasis being the key pathology.(2) Through access to the database of syndrome differentiation of phlegm stasis of coronary heart diease and blood lipid changes in a total of10documents (last search date November30,2012) and quantitative analysis by the random effect model of Meta analysis, the result showed that there was a close correlation between the pathological changes of coronary heart disease of phlegm stasis and blood fat of coronary heart disease, and showed some correlation between the evolution of phlegm stasis and TC, TG, LDL-C.2Clinical Study(1) Through investigation of the clinical epidemiology of TCM in298cases of patients with coronary heart disease, it has been found that the phlegm stasis correlated syndrome group (including the phlegm, phlegm and blood stasis syndrome of heart pulse) accounted for64.1%, heart kidney yang deficiency syndrome accounted for7.4%, heart and kidney yin deficiency accounted for9.7%, cold coagulation heart vessel syndrome accounted for8.1%, and Qi deficiency accounted for10.7%. There were significant differences between phlegm stasis syndrome group and non Phlegm stasis group.(2) Through detection of the indexes related to coronary heart disease cases, it was found that microscopic indexes of phlegm coagulation heart vessel syndrome with abnormal lipid metabolism is obvious; and phlegm obstruction in the abnormal blood rheology and left ventricular ejection fraction, left ventricular shortening index, left ventricular related functions changed obviously. Coronary heart disease by changes in health and non Sputum Stasis Syndrome, phlegm heart vessel syndrome, phlegm and blood stasis syndrome in a blood glucose change generally showed an increasing trend; and "abnormal lipid metabolism "was common in the whole process of phlegm stasis pathologic changes in CHD.3Experimental Study(1) The pathological change of rat suffered from myocardial ischemia is a process from normal to non Sputum or Stasis, phlegm coagulation and heart pulse, and phlegm stasis blocking, which existed in the electrocardiogram, blood lipids, the abnormal changes of Hemorheology and insulin resistance, and lipid metabolism related genes PPAR y mRNA, INSIG2mRNA, SCAP mRNA indications increased abnormaly, while the indications of SREBP2mRNA decreased, meanwhile, morphology during phlegm stasis blocking phase changed obviously.(2) Through drug treatment for myocardial ischemia rats, it was found that method of benefiting Qi and removing phlegm plus promoting blood circulation (Pills of nourishing heart and circulating pulses) has achieved good effect. On the one hand, it could adjust lipid metabolism, and simultaneously improving the phenomena of blood rheology and insulin resistance. On the other hand it can protect organizational structure of the coronary artery, improve vascular injury, simultaneously improving the abnormal indications of lipid metabolism pathway genes PPAR y mRNA, INSIG2mRNA, SCAPmRNA, SREBP2mRNA, and enable them to be normal so as to protect the functions of cardiovascular system.Conclusion1.The correlated phlegm stasis syndrome (including the phlegm coagulation heart pulse, phlegm and blood stasis syndrome) is the main type of syndrome of coronary heart disease, including "phlegm coagulation heart pulse" being the key to the pathogenesis of coronary heart diease."Phlegm stasis blocking" is the inevitable trend of the development of coronary heart disease, and " abnormal lipid metabolism" went the whole process throughout the phlegm stasis evolution of coronary heart diease.2.Abnormal blood rheology of, blood sugar, decreasing insulin sensitivity index, and the changes of histomorphology existed in phlegm stasis evolution of CHD, which may be related to relevant abnormal pathway genes caused by lipid metabolism or lipid metabolism induced abnormal indications.3.Benefiting Qi and removing phlegm of TCM therapy and Western medical lipid-lowering therapy can improve myocardial ischemia and "phlegm" pathology, which showed that there existed a kind of correlation between abnormal lipid metabolism and phlegm stasis evolution of coronary heart disease.In conclusion, from the researching results of this thesis, it has been found that there was a close relation between phlegm stasis evolution and lipid metabolism, and genes expressions related with lipid metabolism increased or decreased, which may be the mechanism underlying development of evolution of CHD "phlegm stasis". |
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