| BackgroundThe morbility and mortality of coronary heart disease (CHD) increased year by year. The prevention and treatment of CHD is one of the key problems in the fields of cardiovascular disease. Clinical and evidence-based-medicine have proved that antiplatelet treatment is the emphasis of secondry prevention of CHD. Western medicine treatment such as antiplatelet in combination with traditional Chinese medicine (TCM) treatment such as blood-activating and stasis-dissolving have been applied in preventing and treating CHD in China recently. It was found that western medicine is acted quickly, but the action action target of was single, and the drug resistance easily generated. Blood-activating and stasis-dissolving traditional Chinese medicines have many kinds of action targets and multiple actions of anticoagulation and antiplatelet. Their actions are slow, and gentle in the trearment of CHD. In clinic, the selection of traditional Chinese medicine is not by differentiation of syndrome of TCM in the treating of CHD and the combination with aspirin is not standardized. The effect of traditional Chinese medicine was alway evaluated by symptom, sign and auxiliary examination, and was less evaluated by molecular and biochemical indicators. As a result, the efficacy of traditional Chinese drugs is difficult to quantify, and the clinical trials did not demonstration that the effect of combination is synergia, additive or partially antagonistic. So we study the rationality of blood-activating and stasis-dissolving Chinese patent drugs in combination with antiplatelet western medicine in treating patients with CHD, and study the relationship between syndrome-classification of TCM of CHD and main indexes such as platelet aggregation, P-selection, platelet membrane glycoproteinⅡb/Ⅲa complex and blood rheology, the aim of which can provide the certain reference for the standard treatment of CHD and differentiation of syndrome of TCM.Objective1. To investigate the rationality of blood-activating and stasis-dissolving Chinese patent drugs in combination with aspirin in the treatment patients with chronic stable angina pectoris in order to provide objective evidences for the standardized treatment in these patients.2. To observe the distribution of differentiation of syndrome of TCM of CHD, and to explore the relationship between TCM syndromes differentiation and platelet aggregation (PAG), P-selection (CD62P), platelet membrane glycoproteinⅡb/Ⅲa complex (GPⅡb/Ⅲa), blood rheology in patients with chronic stable angina pectoris in order to provide the objective evidence for diagnosis and syndrome-classification of TCM of CHD, quantize syndromes differentiation by modern method of research and guide clinical treatment.Methods1. Seventy-six patients with chronic stable angina pectoris were randomly divided into 3 groups for 2 weeks after stoping blood-activating and stasis-dissolving Chinese patent drugs : aspirin group, ie aspirin was used alone in this group (25 cases), standard treatment group, ie the group treated with aspirin in combination with Chinese traditioal patent drugs according to TCM syndrome differentiation (17 cases), and customary treatment group, ie Chinese traditioal patent drugs were used by doctor's hobby (34 cases). The changes of platelet aggregation (PAG), P-selection (CD62P), platelet membrane glycoproteinⅡb/Ⅲa complex (GPⅡb/Ⅲa), blood rheology and clinical efficacy were evaluated after 3 months.2. Seventy-six patients with chronic stable angina pectoris were divided into 3 groups according to syndrome differentiation of TCM: cardiac blood stasis group, deficiency of vital energy and blood stasis group and qi-stagnancy and blood stasis group. Platelet aggregation was detected by the instrument of platelet aggregation, and flow cytometry was used to measure CD62P and GPⅡb/Ⅲa, and blood rheology was detected by the instrument of blood viscosity. Above indices were compared by"t"test among 3 groups.3. Data experssed as mean±standard deviation ( x±s). The significance of the results (P <0.05) was determined by"t"test using SPSS 12.0 software.Results1. The level of PAG, CD62P, GPⅡb/Ⅲa, hemorrheology, TCM total symptom scores of standard treatment group significantly decreased after treatment compared with before treatment (P <0.05). In standard treatment group, the decrease of GPⅡb/Ⅲa and TCM total symptom scores were significant greater than aspirin group and customary treatment group (P <0.05), and the decrease of PAG, low-shear whole blood viscosity, erythrocyte rigidity index, erythrocyte aggregation was obviously greater than customary treatment group(P <0.05). Although erythrocyte aggregation index and erythrocyte deformation index in aspirin group and plasma viscosity in customary treatment group were markedly reduced after treatment (P <0.05), but the PAG, CD62P, GPⅡb/Ⅲa, TCM total symptom scores were no significant change in these groups (P <0.05). There was no significant decrease in total angina pectoris symptom scores in 3 groups (P >0.05), but decrease trend was more obvious in standard treatment group than other two groups (P =0.096).2. The level of GPⅡb/Ⅲa was higher in cardiac blood stasis group than deficiency of vital energy and blood stasis group (P <0.05), but no difference than qi-stagnancy and blood stasis group. Compared with qi-stagnancy and blood stasis group, whole blood rheology was significantly higher in deficiency of vital energy and blood stasis group (P <0.05), but erythrocyte aggregation index was significantly lower (P <0.05). There was no difference about PAG or CD62P among 3 groups (P >0.05).Conclusion1. Treating with blood-circulation-activating Chinese Patent Medicines by syndrome differentiation of TCM on the basis of aspirin treatmentcan may improve effectively the TCM symptoms in patients with SAP, and have significant anti-platelet activity and anti-platelet aggregation and improve blood rheology, these effects are superior to aspirin alone and customary treatment group. The results suggested that combination with Chinese traditional patent drugs by TCM syndrome differentiation and aspirin may get better clinical effects in the treatment of chronic stable angina pectoris.2. The level of GPⅡb/Ⅲa was increased significantly in cardiac blood stasis group than deficiency of vital energy and blood stasis group. Whole blood viscosity was significant higher in deficiency of vital energy group than qi-stagnancy and blood stasis group, but erythrocyte aggregation was lower. GPⅡb/Ⅲa and blood rheology may be an index of TCM syndrome differentiation and estimate therapeutic effect, which also may guide the treatment of chronic stable angina pectoris. |
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