Clinical Observation Of Jiedu Huoxue Decoction In Treating Non-ST-segment Elevation Acute Coronary Syndromes

ObjectiveThrough the prospective cohort study,we observed the clinical efficacy of Jiedu Huoxue Decoction in patients with non-ST-segment elevation acute coronary syndrome syndrome and the relative expression of microRNA-146 a,hs-CRP),CD40,soluble CD40 ligand(sCD40L),and nuclear factor-?B(NF-?B)in order to provide a reference for the treatment of non-ST-segment elevation acute coronary syndrome in traditional Chinese medicine.MethodsA prospective cohort study was included in the Department of Cardiology of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from October 1,2017 to January 15,2018.The admission was in line with non-ST-elevation acute coronary syndrome patients were divided into Jiedu Huoxue Decoction group and conventional treatment group according to the use of Jiedu Huoxue Decoction.The treatment last 4 weeks,and the TCM symptom score,angina score,relative expression of microRNA-146 a,hs-CRP,CD40,sCD40 L,NF-?B expression changes were observed.ResultsIn this study,a total of 56 cases were observed,including 29 cases of Jiedu Huoxue Decoction group,27 cases of conventional treatment group,were observed for 4 weeks.The results showed that after 4 weeks of treatment,angina pectoris score improved significantly in both groups,with significant difference(p <0.05).The conventional treatment group after 4 weeks of treatment,TCM symptom score evaluation invalid in 3 cases,effective in 22 cases,markedly effective in 2 cases,the total effective rate was 88.89%;1 in Jiedu Huoxue Decoction group was invalid,effective in 16 cases,markedly effective in 12 cases,tthe total effective rate was 96.55%.In the improvement of TCM symptom score,the TCM symptom score of Jiedushi Huoxue Decoction group dropped significantly after 4 weeks of treatment compared with the conventional treatment group,indicating that for the NSTE-ACS patients with TCM syndrome differentiation syndrome of stagnation of stasis,the application of Jiedu Huoxue Decoction in alleviating TCM symptoms?Its efficacy is superior to conventional treatment.From the perspective of the improvement of TCM symptoms,the main symptoms(chest pain,chest tightness)of both groups were significantly improved before and after treatment,and there was no significant difference between the two groups in the remission of major symptoms.From the point of view of the disease,in addition to the normal treatment group before and after treatment,there was no significant difference in the change of the tongue,Jiedu Huoxue Fang group,the conventional treatment group after treatment for 4 weeks,have a curative effect in improving symptom score of traditional Chinese medicine,among them,items of palpitation,shortness of breath,flushing fever,yellow urine,pulse,the difference between the groups was not statistically significant.but there were statistically significant differences between groups in terms of upset,insomnia,dry mouth,constipation,tongue,and tongue coating.It was shown that Jiedu Huoxue Fang was superior to the conventional treatment group in improving symptoms such as upset,insomnia,dry mouth,constipation,tongue and tongue.This study examined the relative expression of miR-146 a and the changes of serum levels of hs-CRP,CD40,sCD40 L,and NF-kappaB before and after treatment.After examination,before and after treatment,there were significant differences in the changes of hs-CRP,CD40,sCD40 L,and NF-?B between Jieduhuoxue decoction group and conventional treatment group.After treatment,hs-CRP,CD40,sCD40 L,NF-?B and other indicators were lower than before treatment.There was no significant difference in the relative expression of miR-146 a between the two groups before and after treatment.By multivariate logistic regression analysis,Jieduhuoxue Decoction can further reduce serum hs-CRP(OR=-7.03),CD40 expression(OR=-59.9)and sCD40 L expression(OR=-0.10)compared with conventional treatment group.),NF-?B expression(OR =-50.09),of which,CD40,NF-?B changes significantly(p <0.05),hs-CRP,sCD40 L did not change significantly(p> 0.05).In the relative expression of miR-146 a,the adjusted OR was lower than the adjusted absolute value,and the P value was changed from 0.0256 to 0.2105,indicating that after adjusting the confounding factors,the Jieduhuoxue Decoction group compared to conventional In the treatment group,the relative expression of miR-146 a still showed a decreasing trend,but the difference was not significant.Safety Analysis: no significant adverse reactions in both groups,before and after treatment of blood analysis,liver and kidney function,no significant abnormalities,did not record the occurrence of adverse reactions.Conclusion1.Jiedu Huoxue Decoction can effectively improve the Chinese medicine syndrome of patients with NSTE-ACS stasis syndrome and its efficacy is better than that of the conventional treatment group;its safety is good and no obvious adverse reactions are observed during the medication period;2.Jiedu Huoxue Decoction could down-regulate the expression of inflammatory factors including hs-CRP,sCD40 L,CD40 and NF-?B in patients with NSTE-ACS.However,the changes of hs-CRP and sCD40 L were not significant in the treatment group.3.The research did not find the regulation effect of Jiedu Huoxue Decoction on miR-146 a,suggesting that it may be related to the multi-target and multi-pathway regulatory mechanism of miR-146 a,which is still need further experimental study confirmed.