| Purpose:1.By observing the effects of Xuemaining in patients who were randomly divided into control group and treatment group according to the order of treatment,obtained the clinical efficacy of Xuemaining in stable angina patients with phlegm and blood stasis intervened;By observing the serum levels of TNF-?,IL-1?,IL-6,IL-23,IL-17 A,explored the mechanism of the treatment of Xuemaining in stable angina patients with phlegm and blood stasis intervened.2.By detecting the serum levels of myocardial injury markers(cTn-T,CK-MB,LDH),HE staining of heart tissue,serum IL-23/IL-17 axis and Inflammatory factors(TNF-?,IL-1?,IL-6,IL-23,IL-17A),the changes of levels of IL-23/IL-17 axis and inflammatory factors(TNF-?,IL-1?,IL-6,IL-23,IL-23 R and IL-17A)in myocardial tissue in MI/RI rats,indicated that Xuemaining exerts a mechanism of myocardial protection by regulating the activation of IL-23/IL-17 axis and inhibiting the expression of inflammatory factors such as TNF-?,IL-1?,IL-6.Material and method Clinical part:A total of 100 elderly patients with stable angina pectoris in Liaoning Provincial Hospital of Traditional Chinese Medicine(Affiliated Hospital of Liaoning University of Traditional Chinese Medicine)were randomly divided into control group and treatment group according to the order of treatment.The control group was given the basic treatment of conventional western medicine;The treatment group received the basic treatment of conventional western medicine and Xuemaining decoction.The treatment course was one month.Observed the effects of Xuemaining on clinical symptoms,nitroglycerin dosage,blood lipids,total effective rate of angina pectoris,the total stopping or reducing rate of the nitroglycerin tablets,total effective rate of TCM syndrome and ECG and serum inflammatory factors before and after treatment.Basic part:Randomized digital method was used to randomly divide 60 male SPF SD rats into two groups:Sham operation group(10);Building modules(50).Then replicated the myocardial ischemia-reperfusion injury model in 50 rats(building modules)by the method of coronary artery ligation.HE staining of heart tissue was performed and the levels of serum cTn-T,CK-MB,LDH in Sham operation group and building modules were detected thenext day after the operation to evaluate the success of the model.Successful animal models were randomly divided into 3 groups: model control group;Chinese medicine group;western medicine control group after evaluating the success of the model.All the rats were divided into four groups: Sham operation group,model control group,Chinese medicine group,western medicine control group.Sham operation group does not process;Model control group orally administered saline;Chinese medicine group orally administered Xuemaining decoction;Western medicine control group orally administered nitroglycerin suspension,once a day for a week.At the end of the experiment,HE staining of heart tissue was performed.The levels of serum cTn-T,CK-MB,LDH,TNF-?,IL-1?,IL-6,IL-23 and IL-17 A in each group were detected by ELISA and the levels of TNF-?,IL-1?,IL-6,IL-23,IL-23 R and IL-17 A in myocardial tissue were detected by WB and IHC.Results:1.After treatment,the number of weekly episodes of angina pectoris,the amount of nitroglycerin per week,and the duration of each angina pectoris were reduced(P<0.01).The number of episodes per week,the amount of nitroglycerin per week,and the duration of each angina pectoris in the treatment group were less than those in the control group.(P<0.05 or0.01).The efficacy of angina pectoris,the efficacy of ECG,the stopping or reducing rate of nitroglycerin tablets,total effective rate of TCM syndrome,the scores of SAQ in the treatment group were significantly better than those in the control group.2.The levels of CHOL,TG,LDLwere significantly decreased and HDL was significantly increased in the serum of the two groups after treatment,with statistical difference(P<0.01);After treatment,the levels of CHOL,TG,LDL in the serum of the treatment group were significantly lower than those in the control group and the level of HDL in the treatment group was significantly higher than that in the treatment group.There was a statistical difference(P<0.01).3.The levels of IL-23,IL-17 A,IL-1?,IL-6 and TNF-? were significantly decreased in the serum of the two groups after treatment,with statistical difference(P<0.01);After treatment,the levels of IL-23,IL-17 A,IL-1?,IL-6,TNF-? in the serum of the treatment group were significantly lower than those in the control group.There was a statistical difference(P<0.01).4.No unusual chang occurred in the sham-operated rats.Model control rats showed large area of necrosis near the ligation point,inflammatory cells infiltrated around the necrotic area,the nuclear of necrotic cardiomyocyte was in the state of pyknosisd,the cytoplasm reductedor disappeared,the membrane of cardiomyocyte shrinkaged.Myocardial pathological changes in the Chinese medicine group and the western medicine control group were significantly reduced compared with the model control group,necrotic foci are more limited,small amount of inflammatory cell infiltration were found at the edge of the necrotic foci.5.Compared with the sham operation group,the contents of cTn-T,LDH in the serum of the other three groups were significantly increased,with statistical difference(P<0.01);Compared with the model control group,the content of cTn-T,LDH in the serum of Chinese medicine group and western medicine control group were significantly decreased,and the difference was statistically significant(P<0.01).the contents of CK-MB in four groups did not show statistical difference(P>0.05);6.Compared with the sham operation group,the contents of TNF-?,IL-6,IL-1?,IL-17 A and IL-23 in the serum of the other three groups were significantly increased,with statistical difference(P<0.01);Compared with the model control group,the content of TNF-?,IL-6,IL-1?,IL-17 A,IL-23 in the serum of Chinese medicine group and western medicine control group were significantly decreased,and the difference was statistically significant(P<0.01).Compared with the Chinese medicine group,the contents of TNF-?,IL-1? in the serum of the western medicine control groups were significantly increased,with statistical difference(P<0.01);7.Compared with the sham operation group,the expression levels of TNF-?,IL-6,IL-1?,IL-17 A,IL-23 and IL-23 R in the myocardial tissues of the other three groups were significantly increased,with statistical differences(P<0.01).Compared with the model control group,the expression levels of TNF-?,IL-6,IL-1?,IL-17 A,IL-23 and IL-23 R in the myocardial tissue of the Chinese medicine group and the western medicine control group were significantly lower,with statistical difference(P< 0.01).Conclusion:1.Xuemaining can significantly improve the clinical symptoms of patients with stable angina pectoris,reduce the dosage of nitroglycerin,regulate blood lipids,improve the total effective rate of angina pectoris,the stopping or reducing rate of the nitroglycerin tablets and the total effective rate of TCM syndrome,inhibit chronic inflammation.2.Xuemaining exerts anti-inflammatory effects by significantly reducing the content of IL-23/IL-17 axis and inflammatory factors(IL-23,IL-17 A,TNF-?,IL-1?,IL-6)in peripheralblood of patients with stable angina pectoris to exert clinical effects.3.Xuemaining can significantly reduce the levels of cTn-T,CK-MB and LDH in the serum of MI/RI rats,effectively alleviate myocardial pathological changes in MI/RI rats,especially resist inflammatory response,reduce the infiltration of inflammatory cell and exert the effect of anti-myocardial ischemia and hypoxia4.Xuemaining acts to inhibit the inflammatory response and play the role of myocardial protection by down-regulating the inflammatory factors overexpressed in the systemic and myocardial tissues of MI/RI rats.5.After myocardial ischemia-reperfusion injury,IL-23/IL-17 axis is activated,TNF-?,IL-1?,IL-6 are overexpressed,and over-expressed inflammatory factors promotes the activation of IL-23/IL-17 axis based on positive feedback mechanism,which mediates the inflammatory response of local myocardial tissue and the whole body.6.The anti-inflammatory mechanism of Xuemaining may be directed to the IL-23/IL-17 axis,multiple targets such as TNF-?,IL-1?,IL-6,by regulating the activation of IL-23/IL-17 axis,inhibiting the expression of inflammatory factors such as TNF-?,IL-1?,IL-6,exerts an anti-inflammatory effect,and play the role of myocardial protection. |
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