| Background:Premature coronary artery disease (PCAD) is a kind of disease which is poorlyprognosed, with short life period, causing disability and high medical cost. At present,there are still not many researches of PCAD, and study on the syndromes oftraditional Chinese medicine and Chinese medicine treatment is almost blank.Premature coronary artery disease unstable angina (PCADUA) is one type of PCAD,belonging to the acute coronary syndrome (ACS). Atherosclerosis(As) vulnerableplaque (VP) rupture, thrombosis is one of the most important pathological basis ofACS. How to stabilize VP, and prevent ACS has become the focus of the study. Wehold that the occurrence of ACS has something to do with six stagnations including qi,blood, phlegm, dampness, food, fire stagnation. As the pathological basis of ACS isVP, we believe that the formation of the VP is also associated with six stagnations, the"six stagnations removement " treatment, which including invigorating the circulationof Qi and blood, dissipating phlegm dampness and eliminating catharsis as well asfire, can stabilize the VP and prevent ACS. To prove this hypothesis, we have doneboth clinical and experimental researches.1. Clinical study: Study on Syndromes of Premature Coronary Artery DiseaseUnstable AnginaObjective: This study is to investigate the syndrome patterns of premature coronaryartery disease unstable angina.Methods: We collected demographic data, the clinical data of patients in general(smoking history, drinking history, body mass index, history of hypertension,diabetes, hyperlipidemia history) and TCM diagnostic data of a total of60cases ofpremature coronary artery disease unstable angina patients, in which men and womenof the30cases. We made diagnosis standard according to the people’s Republic ofChina Ministry of Health issued in2002"traditional Chinese medicine new drug for the treatment of coronary heart disease and angina pectoris clinical research guidingprinciple","the TCM clinical syndrome part of terminology" and Shanghai scienceand Technology Publishing House of the five edition of "diagnostics of Chinesemedicine","internal medicine", and established "TCM symptoms of patients withpremature coronary artery disease clinical features", according to traditional Chinesemedicine data for syndrome element differentiation. Observation items:1prematurecoronary artery disease unstable distribution characteristics of syndrome in patientswith angina pectoris type; correlation between2different syndromes and clinicaldata.Results:(1) Men with an average age of48±3.9years, women with an average ageof56±5.6years old, the difference was statistically significant (P <0.01);(2)Thenumber of male patients was significantly higher than that in female in smoking anddrinking history (P <0.01), while the number of female patients was significantlyhigher than men in hypertension history (P <0.01);(3)The distribution of type:60cases, single syndrome element has1people, two cards known as15people, threecards known as15people, four cards known as22people, five cards known as7people, among them, the symptoms of qi deficiency blood stasis stagnation phlegm inmost patients; a single syndrome elements of heart-qi deficiency syndrome, qistagnation and qi deficiency syndrome has two majority, three certificates for both qistagnation, qi, blood stasis and the majority, four syndromes with qi deficiency, bloodstasis, qi deficiency, phlegm are;(5) Distribution of documents: of the60patients,80%patients with stagnation of qi and heart vessel syndrome,63.3%patients withsyndrome of deficiency of heart qi,61.67%of the patients with blood stasis syndrome,56.67%of the patients had sputum blocking heart vessel syndrome,35%patientswith heart Yin deficiency syndrome,30%patients had fire hyperactivity syndrome,patients and the heart yang deficiency syndrome, cold coagulation heart pulse syndrome, syndrome of deficiency of heart blood not foot5%;(6) Gender differences:document distribution difference of more than610people in different gender,different sex differentiation is found in patients with the syndrome of deficiency ofheart qi, phlegm blocking heart-vessels syndrome, hyperactivity of heart-fire wasstatistically significant difference (P<0.01), female diagnosis of heart The proportionof patients with qi deficiency are significantly larger than the male, male diagnosis ofsyndrome, phlegm blocking heart-vessels heart-fire hyperactivity syndrome wassignificantly larger than the female;(7) Each syndrome factor and history datacorrelation: more than30syndromes associated with history data between using nontwo-dimension Logistic regression model test, the diagnosis results as the dependentvariable, age, weight, smoking, drinking, exceed the standard history of hypertension,diabetes, hyperlipidemia history as a dependent variable, results showed no obviouscorrelation between qi and heart vessel syndrome and the history, significantcorrelation of Heart-qi Deficiency and age (P <0.01), was significantly related toblood stagnation syndrome and hypertension (P <0.01), phlegm blockingheart-vessels syndrome and drinking significantly correlated (P <0.01); there was nocorrelation between male patients with the history of heart blood stasis, phlegmblocking heart-vessels syndrome and age, drinking, history of hypertension, diabetes,hyperlipidemia history (P <0.05); there was no correlation between female patientswith stagnation of qi heart vessel syndrome, syndrome of deficiency of heart qi andthe medical history, blood stasis syndrome associated with a history of diabetesmellitus (P<0.05), phlegm blocking heart-vessels syndrome associated with age(P<0.05).Conclusion:(1)The age gap between male patients with PCADUA and femalepatients may be related to the PCAD definition and the protective effect of estrogen.(2)We should focus on different intervention measures according to different genders in PCADUA patients,.(3) The syndrome distribution is dispersive in patients withPCADUA, and sthenia syndrome is the main type. Syndrome characteristics ofpatients with PCADUA is irregularly and should not be limited with fixed types. Theapplication of syndrome element combination in the form of syndrome differentiationis better.(4) PCADUA is a complex, multiple syndrome, the syndrome elements ofdisease ill machine, virtual, real two class, virtual class to qi deficiency, yindeficiency, qi stagnation, blood stasis in solid type, phlegm, heat. The solid+solidsyndrome factor combination is the combination of the most common PCAD, qistagnation and blood stasis, qi stagnation and phlegm is the most commoncombination, virtual and real combination, mainly with qi deficiency and blood stasis,deficiency and virtual combination at least, mainly to yin deficiency.(5) In malepatients with phlegm, heat is more than the female, female patients with qi deficiencythan women. Probably because of age male patients than in female patients with small,and much like smoking, drinking, easy to heat phlegm; older women with larger, so itis easy to get qi deficiency.(6) Age is a risk factor of qi deficiency, hypertension is arisk factor of stasis, alcohol is a risk factor of phlegm. In male patients, age, drinking,history of diabetes, hyperlipidemia history are risk factors of phlegm. In femalepatients, diabetes is a risk factor for blood stasis; age is a risk factor of phlegm.2. Experimental research: Study on the Stabilizing Effect on Vulnerable Plaqueof Traditional Chinese MedicineObjective: To study six stagnations removement treatment of ApoE gene knockoutfrom As plaque lipid core size, collagen, matrix metalloproteinases expression ofaortic plaque stability in mouse models, aiming to provide a theoretical basis for theclinical treatment of As.Methods:44ApoE-/-mice aged6weeks old, male,weight18-20g, given high fat diet (diet containing21%fat,0.15%cholesterol).Four of them were executed at the age of30weeks. Their aortic root HE staining, confirming the basic AS lesion formation.The other40mice were randomly divided into4groups,10rats in each group.Simvastatin group were intragastrically administered with simvastatin5mg/kg,low-dose group was treated with Yueju pill combined with Gualou Xiebai BanxiaDecoction2.5g/kg, high dose group was treated with Yueju pill combined withGualou Xiebai Banxia Decoction5g/kg, control group were given2.5g/kg tap water.At the same time,10only6weeks old C57BL/6J mice were normal, male, weighted18-20g, perfusion of normal saline, normal diet, as the blank control group. Drugtreatment lasted for12weeks. After12weeks all the mice were killed, their bloodcollected. Under steriled conditions, the heart and aorta were removed, fixed in10%neutral formalin, dehydrated, embedded in paraffin sections. Serial sections of mouseheart cross section, slice thickness of5μ M. Adjacent sections were observed by HEStaining, Sirius red staining, matrix metalloproteinase-9(MMP-9)immunohistochemical staining. Observe the following contents:1plaque morphologyunder the microscope, including plaque lipid core percentage plaque area, plaque,ratio of collagen type Ⅰ collagen area and the collagen type I/III collagen;2plaquesof matrix metalloproteinase-9(MMP-9) positive expression percentage accounted forplaque area.Results:(1) compared with the model group, simvastatin group, high dose group, lowdose group of mice significantly reduced plaque lipid composition, a statisticallysignificant difference (P<0.01); simvastatin group＞low dose group＞high dosegroup, differences between the three groups was significant (P<0.01);(2) comparedwith the model group, simvastatin group, high dose group, low dose group of miceplaque collagen area were increased, the difference was statistically significant (P<0.01), type Ⅲ collagen area decreased, the difference was statistically significant (P< 0.01); low dose traditional Chinese medicine group, simvastatin group, high dosegroup, there was statistical significance for Chinese medicine low dose group andhigh dose group compared differences (P<0.01), and simvastatin group the differencewas not statistically significant;(3) compared with the model group, simvastatingroup, high dose group, low dose of plaque in type III collagen/collagen ratio is tosimulate group were decreased, the difference was statistically significant (P<0.01),low-dose group of type III collagen/collagen type Simvastatin group were<low-dosegroup<high dose group, differences were significant between the three groups(P<0.01);(4) compared with the model group, simvastatin group, the positiveexpression of high dose group, low dose group of plaque area percentage of MMP-9were decreased, the difference was statistically significant (P<0.01), the positiveexpression percentage than low-dose group MMP-9area of simvastatin group <highdose group, the three groups, the difference was statistically significant (P<0.01).Conclusion: six stagnations removement treatment can stabilize atheroscleroticplaque by reducing plaque lipid plaque, increasing type I collagen area, reducingcollagen area and inhibiting the expression of plaque MMP-9, and the effect is notproportional to dose. |
PDF Full Text Request