| Background and purpose:Acute coronary syndrome is a group of clinical syndromes caused by acute myocardial ischemia,mainly including patients with UA,NSTEMI and STEMI.Ventricular remodeling after ACS is a compensatory dynamic response of the heart caused by hypoxic ischemia,which includes thinning of the ventricular wall in the ischemic area,myocardial reactivity thickening in the non-ischemic area,and global expansion and deformation of the ventricle.The pathological changes of ventricular remodeling include two aspects,one is cardiomyocyte hypertrophy,necrosis and apoptosis,the other is fibroblast hyperplasia and myocardial interstitial fibrosis.Ventricular remodeling can lead to heart failure,malignant arrhythmia,and even sudden death.It is an important predictor of cardiovascular events.Many studies have confirmed that different types of coronary heart disease affected left ventricular remodeling and cardiac function.Myocardial infarction significantly affects the left ventricular remodeling and cardiac function.Despite the use of PCI and optimal standard pharmacotherapy,such as ACEI?ARB??-receptor and so on,left ventricular remodeling ultimately occurs in 30 % of anterior AMI.Non-anterior infarcts involve a smaller myocardial mass,thus left ventricular remodeling occurs in only approximately 17 % of cases.Traditional Chinese medicine has been widely used in the treatment of cardiovascular diseases.Among them,Qishen yiqi dripping pills is used for treating coronary heart disease and angina.Previous studies have showed that: Qishen yiqi dripping pills exert anti-inflammatory,anti-fibrosis,anti-apoptosis effects,and inhibited the activation of RAAS system,lipid metabolism disorder and protecting heart function.Qishen yiqi dripping pills can delay the development of left ventricular remodeling and improve cardiac function after PCI in STEMI patients.After PCI,qishen yiqi dripping pills can relieve angina symptoms and significantly improve the quality of life of patients with coronary heart disease.Currently,there are few studies on left ventricular remodeling and cardiac function in patients with ACS.Therefore,the aim of this study is to invastigate the effect of qishen yiqi dripping on left ventricular remodeling and cardiac function in patients with ACS,and explored its mechanism through the rat model of acute myocardial infarction.Experimental method:1.In clinical observation,from December 2017 to August 2018,we enrolled 83 patients with UA,NSTEMI,and STEMI who underwent PCI in the Department of Cardiology,Second Hospital of Jilin University.All subjects were randomly divided into the control group(43 cases of clinical routine drug treatment)and the treatment group(On the basis of conventional drug therapy,40 cases were treated with 0.5g qishen yiqi dripping pills,which were taken orally half an hour after three meals for half a year).There were 11 cases of UA,11 cases of NSTEMI and 21 cases of STEMI in the control group.There were 11 UA cases,13 NSTEMI cases and 16 STEMI cases in the experimental group.General information of the patients in the two groups was recorded in detail,including age,gender,height,weight,smoking history,history of hypertension,history of diabetes,family history of cardiovascular disease and so on.Blood routine,urine routine,stool routine,blood biochemistry and electrocardiogram,heart color ultrasound,chest X-ray and other routine examinations were collected.Coronary angiography was recorded,including lesion count,TIMI blood flow and so on.Patients in the two groups were followed up for 1 month,3 months and 6 months with cardiac ultrasound,and left ventricular remodeling and cardiac function related indicators were observed,which including LV,LVESV,LVEDV,IVS,EF,FS.2.In experimental study,45 healthy 8-week-old SPF Wistar rats were selected and fed for 7 days at a standard temperature of 25 ± 2 ° C,humidity of 50 ± 10%,and 12 h light/dark alternation.The rats were weighed after fasting for 12 hours,and injected by intraperitoneal of chloral hydrate(0.4 ml/100g).The anesthetized rats were fixed on a rat plate(supine position),limb insert electrodes.The electrocardiogram was examined and the standard II lead electrocardiogram was observed,and the ST segment values were recorded.The rats were randomly divided into four groups.Control group(15);Experimental group: ISO group(15),treatment group(15).In the experimental group,ISO(100mg /kg)was injected subcutaneously into the back once a day for two consecutive days.In the control group,the same amount of 0.9%NaCl was injected subcutaneously into the back.After the last subcutaneous injection,the ECG of the rats was examined again,and the procedure was the same as above.The treatment groups were given 125mg/(kg.d)qishen yiqi dripping pills for two consecutive weeks.Control group and ISO group were given the same amount of 0.9%NaCl.Three rats in each group were randomly selected at the following time points: before treatment,on the third day of treatment,on the seventh day of treatment,and on the fourteen day of treatment.The following examinations were performed: color doppler ultrasound,HE staining and Masson staining.Color doppler ultrasound included LVIDd?LVIDs?LVPWd?LVPWs?IVSs?EF?FS?The experimental data were statistically analyzed using R 3.5.2 software.Count data present at usage rate.The chi-square test was used to compare the counting data.When the theoretical frequency is less than 5,Fisher's exact probability method is adopted.Measurement data are represented by mean plus or minus standard deviation.Wilcox rank sum test was used.The test level was 0.05,and P < 0.05 was statistically significant.Graphpad prism 5 is used to draw graphics.Results:1 Clinical results 1.1 The values of LV,LVESV and LVEDV in the control group were higher than those in the admission group at 3 months after treatment(P<0.05).In the experimental group,the level of LVESV increased at 3 months compared with that at admission with statistical significance(P<0.05).LVEDV was statistically significant between the control group and the experimental group after 3 months of treatment(P<0.05).There was no significant difference in EF and FS between the two groups(P>0.05).1.2 When UA group was treated for 3 months,there were no statistical significance between the experimental group and the control group(P>0.05).At 3 months of treatment in the NSTEMI group,LVESV in the control group was statistically significant compared with that at admission(P<0.05),LVESV in the experimental group was statistically significant compared with that at admission(P<0.05).At 3 months of treatment in the STEMI group,LV,LVESV and LVEDV of the control group were statistically significant(P<0.05).Comparison of FS at admission between the two groups was statistically significant(P<0.05) 2 Effects of subcutaneous injection of ISO on ECG in rats 2.1 The ST values of the experimental group before and after subcutaneous injection of isoproterenol were statistically significant(P<0.05);ECG changes in rats with acute myocardial infarction occurred in the experimental group with observing dynamically.2.2 Color doppler ultrasound of rat heart 2.2.1 Intra-group comparison: EF and FS values of ISO group on the fourteenth day of treatment were statistically different from those of the third day of treatment(P<0.05).2.2.2 Comparison between groups: LVIDd in the two treatment groups was statistically different from that in the control group after treatment(P<0.05);the EF and FS values of the ISO group and the treatment group were significantly different from those of the control group(P<0.05).After administration,EF and FS values in the treatment group were statistically different from those in the ISO group(P<0.05).2.3 Histopathological analysis of rat myocardium2.3.1 HE staining: Compared with the control group,the ISO group showed nuclear shift,myocardial fiber arrangement disorder,fracture,necrosis,edema and inflammatory cell infiltration,and gradually appeared myocardial fibrosis and scar repair.Treatment group showed significant improvement in inflammatory cell infiltration and myocardial fibrosis on the seventh day of treatmentand on the fourteen day of treatment compared with the ISO group.2.3.2 Masson staining: Compared with the control group,the ISO group gradually developed abnormally proliferating collagen fibers,and only a small amount of cardiomyocytes were present.In the treatment group,the collagen fibers increased gradually,which was lighter than the ISO group.Conclusions:Qishen yiqi dripping pills can significantly improve left ventricular remodeling in STEMI patients.Qishen yiqi dripping pills can alleviate the infiltration of inflammatory cells and myocardial fibrosis after acute myocardial injury.Qishen yiqi dripping pills can protect heart function. |
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