Meta Analysis On The Efficacy Of Compound Xueshuantong Capsule In The Treatment Of Coronary Heart Disease And Study On Its Protective Effect On Cardiac Function After AMI

ObjectiveSystematic evaluation of the clinical efficacy of Compound Xueshuantong Capsule in intervention of coronary heart disease.And then through clinical research to observe the effect of Compound Xue-shuantong Capsule on cardiac function after PCI after acute myocardial infarction,in order to evaluate its clinical efficacy and safety in preventing and treating heart failure after myocardial infarction,which provide new ideas for prevention and treatment.In addition,based on the preliminary experimental research of Compound Xueshuantong Capsule,we attempts to explore its effects on ventricular remodeling,myocardial fibrosis,and inflammation after myocardial infarction,and uses RNA sequencing(RNA-seq)to find its related mechanisms.Methods1.Part ?:Meta analysis on the efficacy of Compound Xueshuantong Capsule in the Treatment of Coronary Heart DiseaseThrough CBM,CNKI,Wangfang Data,VIP,and other databases,to retrieve all randomized controlled trials of Compound Xueshuantong Capsule combined with conventional Western medicine in the treatment of coronary heart disease.Then,the Rev Man 5.3 software provided by the Cochrane Collaboration was used to meta-analyze the references included in the study.The combined values of all data effects are derived and converted using95% confidence intervals.2.Part ?:Clinical research on the intervention of compound Xueshuantong Capsule on the incidence of heart failure in patients with acute myocardial infarction after PCIThis study is a prospective,randomized,double-blind,placebo-controlled trial,including patients with acute myocardial infarction after emergency PCI and Killip I in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.These patients were randomly divided into an experimental group and a control group.The test group was Compound Xueshuantong Capsule combined with conventional Western medicine treatment,and the control group was a placebo combined with conventional Western medicine treatment.The course of treatment was 3 months.Before and after treatment,the two groups were recorded with cardiac function grading,echocardiography,hs-CRP,BNP,TCM syndrome score,Minnesota heart failure quality of life score,and other efficacy indicators,as well as myocardial enzymes,liver and kidney function,and other safety indicators to comprehensively evaluate the clinical efficacy and safety of Compound Xueshuantong Capsules combined with conventional basic therapies to intervene acute myocardial infarction after PCI.3.Part ?:Study on the Protective Mechanism of Compound Xueshuantong Capsules on Cardiac Function in Rats with Myocardial Infarction(1)The SD rat model of myocardial infarction was constructed.The effect of Compound Xueshuantong Capsule on the heart function and structure of rats was observed by echocardiography.(2)The effect of Compound Xueshuantong Capsule on rat myocardium was observed by HE.The effect of Compound Xueshuantong Capsule on myocardial tissue fibrosis was observed by Masson and Sirius red.Image J software was used to measure Masson's stained CVF to calculate the percentage of rat myocardial collagen.(3)The effects of Compound Xueshuantong Capsule on serum BNP and serum IL-6and TNF-? in rats with myocardial infarction were observed by ELISA.(4)RNA-seq technology was used to find the significantly different genes expressed in the myocardial infarction model group and the Compound Xueshuantong Capsule group,in order to explore the mechanism of protective effects of Compound Xueshuantong Capsule on myocardial infarction,improve ventricular remodeling,reduce myocardial fibrosis and reduce inflammation.(5)Western blot was used to detect the expression levels of selected pathway proteins PI3 K,Akt,p53 and autophagy-related proteins LC3,Beclin1,and p62.Results1.Part ?:Meta analysis on the efficacy of Compound Xueshuantong Capsule in the Treatment of Coronary Heart DiseaseEleven literature studies that meet the criteria were included,with a total of 1282 patients,including 644 in the experimental group and 638 in the control group.Statistical analysis results show that Compound Xueshuantong Capsule combined with Western medicine conventional treatment can significantly improve patients with angina [RR=1.21,95% CL(1.14,1.29),P<0.01],ECG curative effect [RR=1.26,95% CL(1.09,1.45),P<0.01],improve heart function [MD=7.38,95% CL(6.44,8.33),P<0.01],reduce hs-CRP level [MD=-3.83,95% CL(-5.23,-2.43),P<0.01] and decrease incidence rate of MACEs[RR=0.50,95% CL(0.26,0.94),P<0.01],compared with conventional Western medicine treatment alone.2.Part ?:Clinical research on the intervention of compound Xueshuantong Capsule on the incidence of heart failure in patients with acute myocardial infarction after PCIA total of 60 patients with acute myocardial infarction after PCI were included in this study.The two groups of patients had baselines in terms of age,gender,BMI,smoking history,family history of cardiovascular disease,combined underlying diseases,type of myocardial infarction,location of myocardial infarction,blood vessels of crime,and echocardiogram,hs-CRP,BNP before treatment,etc.Consistent,there is no statistical difference after testing,can be compared.In terms of cardiac function grading,the experimental group was better than the control group in improving the efficacy of cardiac function grading on the 3rd and 7th day after treatment.After 3 months of treatment,there was no statistical difference in the efficacy of cardiac function grading between the two groups after treatment.In terms of BNP,the experimental group was better than the control group in improving BNP levels on the 3rd and 7th day after treatment.After 3 months of treatment,the difference was not statistically significant in BNP levels between the two groups.In addition,after 3 months of treatment,compared with the control group,the level of hs-CRP in the experimental group decreased significantly,and the TCM syndrome score and the Minnesota heart failure quality of life score were significantly decreased;there was no statistical difference in the efficacy of the two groups in the echocardiographic measurement items.However,compared with the control group,LVEF in the test group has an increasing trend,and LVEDD has a decreasing trend.During the research and observation process,the test group had no adverse drug reactions,and the safety was good.There was no liver and kidney damage in the two groups.In terms of MACEs events,one patient in the control group had acute heart failure.After symptomatic treatment with drugs The condition was stable,and there were no cardiovascular events in the experimental group;there was no shedding or discontinuation in the two groups.3.Part ?:Study on the Protective Mechanism of Compound Xueshuantong Capsules on Cardiac Function in Rats with Myocardial Infarction(1)Comparing the Compound Xueshuantong Capsule intervention group with the model group,the values of LVEF and LVFS increased(P<0.01),while LVEDD and LVESD decreased(P<0.05).(2)Compared with the model group,the Compound Xueshuantong Capsule intervention group showed less cardiomyocyte damage under HE staining,roughly normal cell nucleus,mild local cardiomyocyte arrangement,and no obvious inflammatory cell infiltration;Masson and Sirius red staining decreased myocardial collagen fibrous tissue proliferation;CVF decreased(P<0.01).(3)Compared with the model group,the levels of BNP,IL-6 and TNF-? in the Compound Xueshuantong Capsule intervention group were significantly decreased(P<0.01).(4)Through RNA-seq,it was found that the differential proteins between the model group and the Compound Xueshuantong Capsule group are related to inflammation,such as PI3K-Akt signaling pathway,TNF signaling pathway,p53 signaling pathway,etc,which is the most significant.(5)Compared with the model group,the Compound Xueshuantong Capsule intervention group had lower expression levels of PI3 K,Akt,p62,and LC3,and increased Beclin1 expression.Compared with the model group,the middle and high-dose groups had lower p53 expression.Conclusion1.The Compound Xueshuantong Capsule combined with the conventional western medicine treatment of coronary heart disease can effectively relieve the symptoms of angina pectoris and has the effect of improving the electrocardiogram,and reduce hs-CRP levels,improve heart function,and reduce the incidence of MACEs.It has a certain reference value for the clinical treatment of coronary heart disease.However,the number and quality of RCTs included in this study are limited where there is a lack of large sample size,multi-center,randomized,double-blind,high-quality clinical trial support.In the future,further statistical data needs to be updated to compare the combination of Compound Xueshuantong Capsules with Western medicine routines to verify the clinical efficacy of the treatment of coronary heart disease and angina pectoris.2.Compound Xueshuantong Capsules combined with conventional Western medicine basic treatment compared with simple Western medicine basic treatment can effectively prevent heart failure in the acute phase after myocardial infarction PCI,improve cardiac function classification and BNP level.Moreover,it can significantly reduce the hs-CRP level of patients with acute myocardial infarction after PCI,improve the clinical symptoms of patients,improve the quality of life.Last,it is safe for clinical use.3.Compound Xueshuantong Capsule can improve the ejection function,maintain the basic structure of heart,reduce myocardial fibrosis,reduce the levels of BNP,IL-6,and TNF-?,thereby improving ventricular remodeling in rats with myocardial infarction.Through RNA-seq,further studies have found that the myocardial protection and improvement of cardiac function of Compound Xueshuantong Capsule on myocardial infarction may be achieved by regulating autophagy through PI3K/Akt signaling pathway.