| ObjectivesAnalysing the incidence of coronary microvascular dysfunction(CMD)and its influencing factors in patients with non-obstructive coronary ischemia disease(INOCA).Evaluating the efficacy and safety of Qishen Yiqi Dropping Pills in the treatment of CMD in patients with INOCA.Methods1.A total of 133 cases of non-obstructive coronary ischemia disease(INOCA)diagnosed by coronary angiography or coronary CTA were selected from our hospital from January 2019 to November 2020 with main complaints of chest tireness or chest pain.The coronary microvascular function was evaluated by myocardial contrast echocardiography(MCE).The coronary microvascular function parameter(CFR)was quantitatively analyzed and CFR<2.0 was divided into coronary microvascular dysfunction group(CMD group,n=60 cases),CFR≥2.0 was considered as normal coronary microcirculation group(non-CMD group,n=73 cases).Sixty patients in the coronary microvascular dysfunction group were enrolled into the experimental group(n=30)and the control group(n=30)according to the random number table method.2.Gender,age,body mass index(BMI),hypertension,type 2 diabetes,smoking historye were collected.Fasting peripheral venous blood was extracted from the patients in the morning to collect fasting uric acid,TG,TC,HDL-C,LDL-C,and other test indicators.The left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),and E/ E ’of left ventricular diastolic function were collected in the echocardiography.The influencing factors of coronary microcirculation disorders in the INOCA patients were analyzed.3.The experimental group was given Qishen Yiqi dropping pills(Produced by Tasly Pharmaceutical Group Co.,Ltd.,National Drug Approval Number: Z20030139,Batch Number: 171202,Specifications: 0.5g per bag)combined with conventional western medicine treatment.The control group was given Qishen Yiqi dropping pills with similar appearance and same smell(Manufactured by Tasly Pharmaceutical Group Co.,Ltd.,Batch Number: 171201).Its main components are polydiethyl alcohol6000 and purified water.Combined with conventional western medicine treatment of coronary heart disease,treatment for 3 months.4.The clinical symptoms,changes in microcirculation function and the incidence of adverse reactions such as rash,dizziness,nausea,vomiting,palpitations,etc were compared between the experimental group and the control group before and after 3months of treatment.5.All data were analyzed by SPSS 20.0 statistical software.The normal distribution of the measurement data was expressed as mean ± standard deviation((?)±s)and the independent sample T test was used for comparison between groups;Counting data were expressed as frequency(%).Chi-square test was used for comparison between groups.Binary Logistic regression was used to analyze the influencing factors of CMD in INOCA patients,and P < 0.05 was considered statistically significant.Results1.The incidence of CMD in the INOCA patients is about 45%.2.The female of the species,the long history of smoking,hypertension and diabetes mellitus and the proportion of left ventricular diastolic dysfunction and the level of low density lipoprotein cholesterol(LDL-C)were higher than those in the non-CMD group(P<0.05),high density lipoprotein cholesterol(HDL-C)levels were lower than those in non-CMD group(P<0.05).3.Binary Logistic regression analysis showed that hypertension(OR=3.269)and left ventricular diastolic dysfunction(OR=3.657)were independent risk factors for CMD in patients with INOCA,and HDL-C(OR==0.024)was a protective factor.4.In the experimental group,8 cases of chest pain symptoms disappeared completely,17 cases were improved,showing reduced frequency of attacks,reduced degree,shortened duration and increased activity tolerance,5 cases of chest pain symptoms were not improved,and the total effective rate was 83.3%.In the control group,2 cases of chest pain symptoms disappeared completely,8 cases were improved,20 cases were ineffective,and the total effective rate was 33.3%.The difference in quality of life between the two groups was statistically significant(P <0.05).5.Due to the influence of Covi D-19 epidemic and other reasons,4 patients in the experimental group and 7 patients in the control group did not complete the review.(1)The CFR quantitative analysis results showed that CFR was improved in both the experimental group and the control group,and the improvement of CFR in the experimental group was higher than that in the control group,the difference was statistically significant(P < 0.05).(2)CFR qualitative analysis results show that in the experimental group,the myocardial segmental images and CFR of 9 patients were completely normal,11 patients improved,and 6 patients showed no significant improvement,with a total effective rate of 79.9%.In the control group,1 patient completely returned to normal,9 patients improved,13 patients were ineffective,and the total effective rate was43.5%.There was statistical significance in the improvement of coronary microcirculation function between the two groups(P < 0.05).6.The incidence of adverse reactions such as rash,dizziness,nausea,vomiting,palpitations,etc was investigated in the two groups of patients,and telephone follow-up was given to those who did not go to the hospital for reexamination.There was no significant difference in ADR between the two groups(P>0.05).Conclusions1.The proportion of CMD in patients with INOCA is high.2.In the INOCA patients with CMD,the proportion of female,smoking,hypertension,diabetes,left ventricular diastolic dysfunction and elevated LDL-C is high.3.Hypertension and left ventricular diastolic dysfunction are independent risk factors for CMD in INOCA patients,and targeted prevention and control should be given early.4.Qishen Yiqi dropping pills can improve the clinical symptoms of patients with INOCA combined with CMD.5.Qishen yiqi dropping pills can improve the coronary microcirculation function and coronary blood flow reserve(CFR)in the patients with IOCA combined with CMD.6.Qishen Yiqi dropping pills have good safety in the treatment of INOCA patients with CMD. |
