| This article contains two parts:literature survey and clinical investigation. First, literature surveyThis review I mainly discusses the main physiological function of the vascular endothelial cell is the function of the endocrine and the regulation of the blood vessel dilation and contraction, as the first barrier of blood vessels. Multiple cardiovascular disease risk factors through a variety of mechanisms injure endothelial cell. As a new pathogenic factor, the injured endothelial cells become the key link in Atherosclerosis process. There are a lot of methods to detect vascular endothelial dysfunction. Brachial artery flow mediated dilation (FMD) is one of the most commonly used noninvasive methods for evaluating endothelial function. It has been widely used in clinic for many years. Many studies have indicated that vascular endothelial dysfunction is associated with the whole course of coronary heart. And peripheral vascular endothelial function and coronary artery endothelial function has significant correlation. FMD can be used for the diagnosis of coronary heart disease. Forthermore, FMD has a certain predictive value for restenosis after PCI and the occurrence of acute cardiovascular events. A number of studies have indicated that the traditional Chinese medicine can improve the vascular endothelial function by multi targets. It provides a new idea for the prevention and treatment of coronary heart disease.This review II mainly discusses the advantages and disadvantages of coronary interventional treatment and drug treatment. Systematically discusses the understanding of the etiology and pathogenesis of coronary heart disease in modern Chinese medicine. And discusses the changes of pathogenesis after percutaneous coronary intervention.Hoping two kinds of treatment of traditional Chinese medicine and Western medicine can learn from each other and jointly contribute to the prevention and treatment of coronary heart disease. SecondClinical investigation IObjective:By detecting the content of FMD and serum NO, evaluate the correlation between vascular endothelial function and the degree of coronary artery disease and search for the best cutoff value of FMD in predicting coronary heart disease. Hoping the results can provide clinical evidence for early screening of coronary heart disease by using vascular endothelial function. Meanwhile, the correlation is investigated about endothelial function, laboratory related indexes and TCM syndrome differentiation of coronary heart disease. Hoping the results can promote the objectification of TCM syndrome differentiations.Methods:We recruited 130 patients who intend to do coronary angiographying with suspected coronary artery disease, recorded the general situation of patients, related medical history and collected TCM symptoms and syndrome differentiation, and calculation of blood stasis syndrome, Qi deficiency syndrome. Peripheral venous blood was collected in the morning after second days in hospital in order to test laboratory related indexes. FMD was performed in the morning before the angiography. Coronary angiography by catheterization laboratory China-Japan Friendship Hospital specialists is completed. The patients were divided into CHD group and non CHD group according to the result of angiography. Meanwhile, the differences are analyzed about FMD, serum NO and related indexes in different lesion degree of coronary artery. ROC curves were drawn to evaluate the diagnostic boundary value of FMD in coronary heart disease, and to find the optimal cutoff value for diagnosis of coronary heart disease. All the number of input EXCEL table, and were analyzed by SPSS 21.0 statistical package.Results:1. Serum NO and FMD was significantly lower in CHD group than NL group (P<0.01); the CHD group patients with systolic blood pressure, hemoglobin(P<0.01);glycosylated hemoglobin is higher than NL group(P<0.05).The binary logistic regression analysis indicating that FMD and NO for the diagnosis of CHD have predictive value.FMD (0R:0.182 95% of the CI 0.068-0.487, P<0.01), NO (0R:0.892 95%:CI 0.808-0.984 P<0.05). Through drawing ROC curve found that the area under the curve was 0.931, the best cutoff value is 6.05%, the sensitivity is 91.1%, the specificity is 80.4%, positive predictive value is 87.8% and the negative predictive value is 85.4%, diagnostic accordance rate is 86.9%.2. Further analysis subgroups with different number of Coronary artery stenosis show that Glycosylated hemoglobin:multiple lesions group>normal group(P<0.01), multiple lesions group>single lesion group (P<0.05); Fasting blood glucose:multiple lesions group>normal group(P<0.05); Hemoglobin:double lesions group and multiple lesions group is higher respectively than normal group and coronary atherosclerosis group(all p<0.05); SOD: coronary atherosclerosis group and double lesions group is higher respectively than multiple lesions group(both P<0.05), single lesion group>multiple lesions group(p<0.01); HDL-C: normal group and single lesion group is higher respectively than multi lesions group (both p<0.01); FMD:normal group>coronary atherosclerosis group(P<0.05); normal group> single lesion group (P<0.01), normal group and coronary atherosclerosis group is higher respectively than double lesions group and multiple lesions group (all P<0.01), single vessel disease group>multiplelesions group(P<0.05); NO:normal groupand coronary Atherosclerosis group is higher respectively than single lesion group(bothP<0.05),normal group and coronary atherosclerosis group is higher respectively than double lesions group and multiple lesions group (all P<0.01), single vessel disease group>double lesions group>multiple lesions group(all P<0.01). Using Ttest or rank sum test comparison:compared with the normal group, the number of patients with diabetes, smoking, systolic blood pressure were increased, SOD decreased (all P<0.05).In patients with CHD, the FMD and Gensini scores were negatively correlated (r= 0.700, P<0.01), Linear regression model equation:R2=0.29, Gensini scores= 75.501-11.186×FMD. NO and Gensini scores were negatively correlated(r=-0.516, P<0.01), Linear regression model equation:R2=0.204, Gensini scores=93.304-1.159×NO. FMD shows a positive correlation with the serum concentration of NO (R=0.479, P<0.01).3. Blood stasis>Qi deficiency>stagnation of Qi>phlegm dampness is the common syndrome in the CHD group.And in the NL group,the normal group is stagnation of Qi>phlegm dampness>Qi deficiency is a common syndrome.Blood stasis score and FMD, NO show significantly negative correlation(r=-0.594,-0.290, P<0.01、P<0.05);blood stasis syndrome integral and Gensini score, fasting blood glucose, glycosylated hemoglobin was positively related (r= 0.688,0.361,0.358, P<0.01、P<0.01、P<0.05).Qi deficiency syndrome integraland glycosylated hemoglobin,blood glucose were positively correlation (r= 0.353, 0.443, P<0.05,P<0.01).Conclusions:1. There was a significant correlation between the vascular endothelial function and the degree of coronary artery disease. The more severe coronary artery stenosis is, the smaller the value of FMD and NO is; The greater the extent of the lesion is, the more serious injury of endothelial cells are. The best cutoff value of FMD for predicting coronary heart disease is 6.05%.2. High blood pressure, blood glucose and Hcy levels, SOD and HDL-C reduction may be the major risk factors for the incidence and progression of coronary heart disease.3. The more severe blood stasis is, the more serious injury of endothelial cells are. Meanwhile, it indicated the degree of coronary artery stenosis is very serious. High blood glucose may be a risk fator which can lead to blood stasis syndrome. Clinical investigation II Objective:Through the analysis of post PCI patients with coronary angiography results and clinlcal symptom, the correlation is studied between endothelial function, inflammatory factors and coronary artery disease progress, unstable angina pectoris of correlation. Hoping the results can provide clinical evidence for assessment of the patient’s condition after PCI by using vascular endothelial function. And help clinicians find the condition changes early, give the treatment, nip in the bud.Methods:We selected 51 patients who reviewing coronary angiography after PCI in the China-Japanese Friendship Hospital and record the general situation of patients, related medical history. Peripheral venous blood was collected in the morning after second days in hospital in order to test laboratory related indexes. FMD was performed in the morning before the angiography. According to the results of coronary angiography,27 patients with non target vascular plaque progression and stent restenosis were classified as (the worsen group); 24 patients with no change in the angiographic findings were were classified as (progression free group). According to clinical symptoms,22 patients were divided into unstable angina pectoris (UAP group) and 29 patients with stable angina pectoris (SAP group). The correlation is studied between endothelial function, inflammatory factors and coronary artery disease progress, unstable angina pectoris of correlation.All numbers are recorded in EXCEL table, and statistical analysis is carried out with SPSS 21.Results:1. The number of 3 branch lesions、Systolic blood pressure, fasting blood glucose, glycosylated hemoglobin in worsen group>progression free group (all,P<0.05). The number of unstable angina pectoris, hs-CRP, TNF-a, IL-6 in worsen group> progression free group (all, P<0.01). FMD in worsen group<progression free group (P<0.05). By controlling the influence of unstable angina pectoris, We use partial correlation analysis found, TNF-a, fasting blood glucose,3 branch lesions and chronic coronary artery disease progression have positive correlation (r= 0.439,0.298,0.248, P<0.01, P<0.05, P<0.05). FMD was negatively correlated with the progression of chronic coronary artery (r=-0.579 P<0.01). Multivariate logistic regression analysis showed that TNF-was positively correlated with the progression of coronary artery (OR:1.052 95%:1.007-1.100 P<0.05 CI). TNF-a may have independent predictive value for coronary artery development.2. Systolic blood pressure in UAP group>SAP (P<0.05), the number of coronary lesions development, Hs-CRP, TNF-a, IL-6>SAP group (all P<0.01), UAP group FMD<SAP group (P<0.05). By controlling the influence of chronic coronary artery disease, we use partial correlation analysis found that IL-6 and unstable angina pectoris correlated (r= 0.80, p<0.01). Multivariate logistic regression analysis showed that IL-6 and unstable angina pectoris were positively correlated (95% of the OR:1.139:CI 1.006-1.297 P<0.05) and IL-6 may have independent predictive value for unstable angina pectoris3. SAP & progression free FMD>SAP & progression, SAP & progression free FMD>UAP & progression (P<0.01), which indicates that FMD has a certain value in predicting the prognosis of coronary heart disease.Conclusions:1. Impaired vascular endothelial function, high blood pressure and elevated blood glucose Levels, inflammation may be play important roles in coronary atherosclerosis progression and in stent restenosis.TNF-a maybe has positive significance in chronic inflammation of coronary atherosclerosis progression. The vulnerable plaque in acute cardiovascular events is closely related to the inflammatory response, and the value of IL-6 in the prediction of unstable angina pectoris may be even greater.2. FMD is superior to serum NO for evaluating endothelial function in patients with coronary heart disease. There is a correlation between vascular endothelial function and after PCI prognosis. FMD can reflect the state of vascular endothelial function. It has a certain value for the prediction of PCI after plaque progression, in stent restenosis, acute cardiovascular events. It can be used for long term follow-up of patients after PCI. |
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