| Psychocardiacology,that is,psychological cardiology,mainly studies cardiovascular diseases with mental disorders.With the change of modern life style,the incidence and mortality of the psychocardiacology disease are gradually increasing,so it is urgent to find an effective clinical treatment plan.The diagnosis and treatment of the psychocardiacology is the combination of routine heart disease treatment and psychological intervention,relaxation therapy,exercise therapy and other treatment methods,in order to maintain the psychocardiacology health of patients.However,at present,its clinical effect in the psychocardiacology disease is still uncertain.In addition,studies have shown that one of the reasons for the high mortality rate of the psychocardiacology disease is that the psychological and heart diseases can influence each other and accelerate the poor prognosis of patients.Therefore,it is particularly important to clarify the pathogenesis of the psychocardiacology disease and fundamentally block this vicious circle.It is found that mi R-34a/Notch1 is closely related to the psychological and heart disease,which may be one of the pathological mechanisms of the psychocardiacology disease.The previous study of our team shows that chaihujialonggumuli soup has the effect of double heart treatment,but its mechanism is not completely clear.Based on the above research background,this paper intends to study the psychocardiacology disease from two aspects of clinical literature and basic experiments:(1)To systematically evaluate the effect of diagnosis and treatment of psychocardiacology on patients with the psychocardiacology disease-coronary heart disease with anxiety and depression;(2)To explore possible pathogenesis of the psychocardiacology disease-coronary heart disease complicated with anxiety from the view of mi R-34a/Notch1 and the target of chaihujialonggumuli soup.Study 1: The Review and Meta Analysis of the Diagnosis and Treatment of Psychocardiacology in the Treatment of Coronary Heart Disease with Anxiety and Depression.Objective: To systematically evaluate the effect of the diagnosis and treatment of psychocardiacology on patients with coronary heart disease(CHD)with anxiety and depression,and to provide evidence-based medicine for clinical practice.Methods:The Chinese and English studies related to this Meta analysis were collected and published in Pub Med,the Cochrane Library,China knowledge Network,Wanfang Medical Network,VIP Database and China Biomedical Literature Database.The search time is the database construction day-December 2018.The data were analyzed by the Rev Man software,and the methodological quality of the included literatures were evaluated with reference to the Risk of bias(ROB)evaluation criteria,and the heterogeneity of outcomes were determined by subgroup analysis,and using sensitivity analysis to test the robustness of the results.The funnel chart was used to evaluate the publication bias,and the GRADE system tool was used to evaluate the evidence grade of the results of this study.Results: A total of 11 randomized controlled trials were included in this study,including 9 in Chinese and 2 in English,involving 1035 patients.The research literatures were published from 2010 to 2018.The main intervention measures were psychological intervention(10 articles),cognitive behavior intervention(6 articles),exercise therapy(6 articles),relaxation therapy(7 articles),social support(3 articles)and discharge follow-up(2 articles).Except for the relatively high quality of one document,the quality of the rest of the literatures are generally on the low side.The results of Meta analysis showed that compared with the control group,the scores of SAS and SDS in the intervention group decreased significantly,the left ventricular ejection fraction increased,the effective rate of treatment increased significantly,and the incidence of adverse cardiac events decreased.The results of subgroup analysis showed that the heterogeneous sources of SAS and SDS may be related to the types of intervention measures for the diagnosis and treatment of psychocardiacology,and the heterogeneous sources of LVEF may be related to the follow-up time.The results of sensitivity analysis showed that the stability of SAS,SDS,LVEF,effective rate and incidence of major cardiac adverse events may be good,while the HAMD,SAQ and BNP may be poor.Funnel plot analysis shows that there may be publication bias in the results of SAS and SDS indicators.Grade evidence grade evaluation indicates that the evidence level of the results of this study are low or very low.Conclusion: Low evidence shows that combined with the intervention of diagnosis and treatment of the psychocardiacology can more effectively treat patients with CHD with anxiety and depression and reduce the incidence of major cardiac adverse events,which should be treated with caution in clinical practice.Study 2:Partial Mechanism of the Efficacy of Chaihujialonggumuli Soup From the Mi R-34a/Notch1Objective: To explore the pathogenesis of Chaihulonggumuli soup in the treatment of myocardial infarction with anxiety mice.Methods:In this study,the model of acute myocardial infarction in mice was established by the left coronary artery ligation.The anxiety model was established by the uncertainty of empty bottle stimulation method.The two models were superimposed to prepare a composite model of myocardial infarction and anxiety.The myocardial infarction complicated with anxiety group were intervented with the Chaihujialonggumuli soup Echocardiography and HE staining were used to evaluate the changes of cardiac structure and function of the mice.The cardiac Masson staining and immunohistochemistry were used to qualitatively and quantitatively evaluate the deposition degree of myocardial collagen fibers.The open field test and the elevated plus maze test were used to evaluate the anxiety-like state of the mice.The level of 5-HT in the serum of mice was detected by Elisa method;the content of mi R-34 a in the marginal zone of hippocampus and hippocampus were detected by PCR;the protein expression of Notch1 and Jagged1 in the marginal zone of myocardial infarction and hippocampus were detected by WB.Results: Experiment 1: Effects of Chaihujialonggumuli Soup on Myocardial Fibrosis and Anxiety in Mice with Myocardial Infarction Complicated with AnxietyIn terms of cardiac structure and function,compared with the sham operation group,the left ventricular ejection fraction and the short axis shortening rate decreased significantly,and the left ventricular end-systolic / end-diastolic diameter and end-diastolic / end-systolic volume increased significantly in the myocardial infarction group.The contents of Col I and Col III in the marginal zone of myocardial infarction increased significantly;the body weight of mice in the anxiety group decreased.Compared with the anxiety group and myocardial infarction group,the myocardial infarction combined with anxiety group had lower ejection fraction and short axis shortening rate,larger heart weight / body weight ratio,more Col I and Col III deposits,and higher collagen volume ratio.Chaihujialonggumuli soup could increase the cardiac ejection fraction and short the axis shortening rate,reduce the Col I,Col III content,collagen volume ratio in the marginal zone of myocardial infarction and the heart weight ratio.In terms of anxiety,compared with the sham operation group,the horizontal and vertical movement scores,the percentage of open arm residence time and the content of serum 5-HT in the myocardial infarction group and the anxiety group were significantly lower.The percentage of mice entering the open arm in the anxiety group also decreased.Compared with the anxiety group,the score of horizontal movement was lower,the vertical motion scores had a lower trend,the percentage of entering open arm was higher,the residence time in open arm had a longer trend,and the content of 5-HT was higher in myocardial infarction group.The scores of horizontal and vertical movement,the percentage of times and time to enter the open arm and the content of 5-HT in the myocardial infarction with anxiety group were lower than those in the anxiety group and myocardial infarction group.The scores of horizontal and vertical movement and the percentage of times and time of entering the open arm in the traditional Chinese medicine group were higher than those in the compound model group.Experiment 2: Study on the Partial Mechanism of Chaihujialonggumuli Soup in the Treatment of Myocardial Infarction Complicated with Anxiety Based on the mi R-34a/Notch1In the marginal zone of myocardial infarction,compared with the sham operation group,the content of mi R-34 a increased and the expression of Notch1 and Jagged1 decreased in the myocardial infarction group,and the content of mi R-34 a increased and the expression of Notch1 decreased in the anxiety group.Compared with the myocardial infarction combined with anxiety group,the content of mi R-34 a in the marginal zone of myocardial infarction in the anxiety group,myocardial infarction group and traditional Chinese medicine group were significantly lower,and the expression of Notch1 were higher,while the expression of Jagged1 were only higher in the anxiety group and traditional Chinese medicine group.In the hippocampus,compared with the sham operation group,the content of mi R-34 a was higher and the content of Notch1 protein was lower in the myocardial infarction group;the content of mi R-34 a was also increased,and the expression of Notch1 and Jagged1 were significantly decreased in the anxiety group.Compared with the myocardial infarction group,the content of mi R-34 a was higher,but the expression of Notch1 and Jagged1 were significantly lower in the anxiety group.Compared with the myocardial infarction with anxiety group,the mi R-34 a content were lower,and Notch1 and Jagged1 content were higher in the anxiety group,myocardial infarction group and traditional Chinese medicine group.Conclusion: The main results were as follows:(1)Myocardial infarction may show anxietylike behavior by causing mi R-34a/Notch1 changes in the hippocampus,and the degree is lower than that of empty bottle stimulation.(2)Anxiety may be caused by myocardial mi R-34a/Notch1 changes,mild myocardial fibrosis,and its degree is lower than that of myocardial infarction stimulation.(3)Anxiety and myocardial infarction may further increase the content of mi R-34 a and inhibit the expression of Notch1 in marginal area of myocardial infarction and hippocampus area,thus aggravating myocardial fibrosis and anxiety.(4)The effect of chaihujialonggumuli soup on anxiety and cardiac function may be related to the regulation of mi R-34a/Notch1. |
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