Effect of Chinese Herbs for Activating Blood Circulation,Removing Stasis and Supplementing Qi on the Circulating Endothelial Cells in Patients with Unstable Angina Pectoris

Objective: To observe the effect and clinical significance of circulating endothelial cells (CEC) in the pathogenesis of coronary heart disease with unstable angina pectoris (CHD-UAP), and to explore the protective effect of Chinese herbs for activating blood circulation, removing stasis and supplementing Qi (CH) on CHD-UAP patient's CEC. Methods: Sixty patients with diagnosis of CHD-UAP confirmed and differentiated to be Qi-deficiency and blood stasis by TCM were randomly divided into two groups and treated, on the basis of Western drug-therapy, with Tongxinluo capsule (通心络胶囊, TXL) and Huoxue Tongmai capsule (活血通脉胶囊, HXTM) respectively by way of oral taking three times a day, 3 capsules every time, with 1 month as one therapeutic course. The number of CEC in patients' blood circulation was counted before and after treatment. Besides, the number of CEC in 30 healthy persons was also counted for control. Results: The number of CEC in CHD-UAP patients was significantly higher than that in the healthy persons (P<0.01). After the patients were treated with CH, either TXL or HXTM, it significantly decreased (P<0.01)with insignificant difference between the two treated groups. Conclusion: CEC in CHD-UAP patients is severely damaged and endothelial function in disorder, Chinese herbs have protective effect on patients' CEC.

Effect of Traditional Chinese Medicine combined with Western Medicine on blood lipid levels and inflammatory factors in patients with angina pectoris in coronary heart disease identified as intermingled phlegm and blood stasis syndrome:a network Meta-anal

OBJECTIVE:To evaluate the clinical efficacy of Traditional Chinese Medicine prescriptions for resolving phlegm in the treatment of angina pectoris of phlegmstasis coronary heart disease by a network Meta-analysis.METHODS:Randomized controlled trials(RCTs)on clinical efficacy of CHD angina pectoris with interaction of phlegm and blood stasis were searched in PubMed,Springer,the Cochrane Library and Chinese-language databases China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data from their inception to December 2021.Literature was screened and literature bias risk was assessed by RevMan5.4 software.The overall response rate,the duration of angina attack,the levels of serum lipids such as total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),and high density lipoprotein cholesterol(HDL-C),and expression of hypersensitive C-reactive protein(hs-CRP)were selected as outcome indicators for network Meta-analysis and mapped using Stata15.1 software.RESULTS:Totally,26 RCTs were included,involving 2098 participants.There were 6 TCM formulas with the effects of dispelling phlegm and removing blood stasis.Taking conventional Western Medicine as the common intervention measures,the results showed that the overall response improvement rate from high to low was displayed as modified Xiaoxianxiong decoction(小陷胸汤,MXD),Danlou tablet(丹蒌片,DT),modified Gualou Xiebai Banxia decoction(瓜蒌薤白半夏汤,MGXBD),modified Wendan decoction(温胆汤,MWD),modified Zhishi Xiebai Guizhi decoction(枳实薤白桂枝汤,MZXGD),and modified Erchen decoction(二陈汤,MED).The sequence of angina attack duration improvement from high to low was MZXGD,MGXBD,DT,MWD,MXD.The sequence of TC improvement from high to low was MZXGD,MED,DT,and MGXBD.Sequence of improving TG from high to low was MED,MZXGD,MGXBD,and DT.For LDL-C improvement,the effect from good to poor was MZXGD,MGXBD,DT,and MED.With regard to HDL-C improvement,the effect was ranked as MED,MZXGD,MGXBD,and DT from good to poor.hs-CRP expression from high to low was MZXGD,MXD,MED,MWD,and MGXBD.CONCLUSION:TCM formula with the effects of dispelling phlegm and removing blood stasis combined with conventional Western Medicine has obvious advantages in treating CHD angina pectoris with interaction of phlegm and blood stasis.MZXGD has great potential in increasing the overall response rate,reducing Duration of angina attack improving blood lipids,and reducing inflammatory factors.However,due to the limitations of extant studies,the conclusions of this study need to be confirmed by numerous reasonably-designed RCTs.

A Clinical Study of Safflower Yellow Injection in Treating Coronary Heart Disease Angina Pectoris with Xin-Blood Stagnation Syndrome

Objective： To evaluate the clinical effect and safety of Safflower Yellow injection （SYI） in treating coronary heart disease angina pectoris （OHD-AP） with Xin-blood stagnation syndrome （XBSS）. Methods： Adopted was the multi-centered, randomized, positive parallel controlled method, 448 patients with CHD-AP-XBSS were enrolled and divided into two groups, 336 in the tested group treated with SYI and 112 in the control group treated with Salvia injection by intravenous dripping once a day for 14 days, so as to observe the conditions of angina, electrocardiogram, and therapeutic effect on traditinal Chinese medicine （TCM） symptoms as well as the safety of the treatment. Results： The significantly effective rate and total effective rate in the tested group were 60.06% （194/323） and 91.02 % （294/323） respectively; those in improvement of TOM symptoms were 40. 18% （129/321） and 75.23% （243/323） respectively, which were better than those in the control group （P〈0.01）. Conclusion： SYI Injection is effective and safe in treating OHD-AP-XBSS.

Effect of Gualou Xiebai Banxia decoction combined with Danshen Decoction on clinical efficacy of unstable angina with phlegm and blood stasis syndrome

Objective:To observe the clinical efficacy and safety of Gualou Xiebai Banxia decoction combined with Danshen decoction on unstable angina(UA)with phlegm and blood stasis syndrome.Method:Eighty patients with UA were randomly divided into treatment group(40 cases)and control group(40 cases)by random number table.The control group was given conventional western medicine treatment,and the experimental group was given Gualou Xiebai Banxia decoction and Danshen decoction on the basis of the control group.Both groups were treated for 4 weeks.Before and after treatment,the angina attacks,dosage of nitroglycerin,traditional Chinese medicine syndrome score,quality of life score,blood lipid,coagulation index and clinical total efficacy were observed and recorded.Results:After 4 weeks of treatment,the attack times and duration of angina in the two groups were both decreased compared with those before treatment.And the treatment group was more significantly reduced than the control group,the difference was statistically significant(p<0.05);the consumption of nitroglycerin of the treatment group was 90.0%,which was better than 67.5%of the control group,the difference was statistically significant(p<0.05);the total effective rate of the treatment group was 90%,which was better than 65%of the control group,the difference was statistically significant(p<0.05);the traditional Chinese medicine(TCM)syndrome score of the experimental group was lower than that of the control group,the differences was significant(p<0.05).The improvement of low density lipoprotein(LDL-C),total cholesterol(TC)and prothrombin time(PT)in the experimental group was better than that in the control group(p<0.05).During the study,there were no obvious adverse reactions in both groups.Conclusion:Gualou Xiebai Banxia decoction combined with Danshen decoction can effectively relieve the attack of angina and the consumption of nitroglycerin,improve clinical symptoms,regulate blood lipid and blood flow state,and improve the quality of life of patients with UA,with good clinical efficacy and safety.

Traditional Chinese medicine for activating blood circulation and detoxifying in unstable angina pectoris:A systematic review and meta-analysis

Objective:The purpose of this review was to evaluate the effectiveness of traditional Chinese medicine for activating blood circulation and detoxifying(ABCD)in patients with unstable angina pectoris.Methods:We performed an electronic literature search of six medical databases for relevant articles published up to December 2014.Randomized controlled trials that compared ABCD Chinese medicine(alone or alongside conventional drugs)with conventional drugs or other Chinese medicines alone were included.A meta-analysis was performed for the following outcome measures:reduction of angina symptoms,electrocardiogram improvement,blood lipid levels,inflammatory factor levels,and plasma fibrinogen levels.Results:In total,11 moderate-to low-quality studies involving 686 patients were included.The evidence indicated that ABCD Chinese medicine exhibited superior effectiveness in relieving angina symptoms compared with conventional drugs[relative risk,1.23;95%confidence interval,1.05e1.44];however,electrocardiogram improvement was not very significant(relative risk,1.21;95%confidence interval,0.91e1.62).Moreover,ABCD Chinese medicine exhibited superior anti-inflammatory,anticoagulant,and lipid-lowering effects compared with other medicines.Conclusions:Within the methodological limitations of the included studies,our results suggest that ABCD Chinese medicine is beneficial for the treatment of unstable angina pectoris.

Effect of Yixinkangtai Capsule combined with diltiazem on endothelial function, blood viscosity and lipid metabolism in patients with unstable angina pectoris

Objective: To discuss the effect of Yixinkangtai Capsule combined with diltiazem on endothelial function, blood viscosity and lipid metabolism in patients with unstable angina pectoris. Methods: A total of 150 patients with unstable angina pectoris who were treated in the hospital between February 2014 and February 2017 were divided into the control group (n=75) and the research group (n=75) according to the random number table method. Control group received clinical conventional therapy, research group received Yixinkangtai Capsule combined with diltiazem therapy on the basis of conventional therapy, and both groups received 3 months of treatment. Differences in endothelial function, blood viscosity and lipid metabolism were compared between the two groups of patients before and after treatment. Results: Before treatment, the differences in serum levels of endothelial function indexes, blood viscosity indexes and lipid metabolism indexes were not statistically significant between the two groups. After 3 months of treatment, serum NO level of research group was higher than that of control group while ET-1 level was lower than that of control group;serum blood viscosity index TXB2 content of research group was lower than that of control group while PGI2 content was higher than that of control group;serum lipid metabolism indexes TG, TC and LDL-C contents of research group were lower than those of control group while HDL-C content was higher than that of control group. Conclusion: Yixinkangtai Capsule combined with diltiazem therapy can effectively optimize the endothelial function, reduce the blood viscosity and balance the lipid metabolism in patients with unstable angina pectoris.

A Multicenter,Randomized,Double-blind Clinical Study on Wufuxinnaoqing Soft Capsule(五福心脑清胶囊) in Treatment of Chronic Stable Angina Patients with Blood Stasis Syndrome

Objective： To confirm the efficacy and safety of Wufuxinnaoqing Soft Capsule （五福心脑清胶囊, WSC） in the treatment of chronic stable angina （blood stasis syndrome）. Methods： A multicenter, randomized, double-blind, placebo-controlled trial with superiority test was designed. A total of 240 patients with chronic stable angina （blood stasis syndrome） from multiple centers were randomly and equally assigned to the treatment group and the control group. Based on standard treatment of Western medicine, the treatment group was given WSC, while the control group was given WSC mimetic, both for 12 weeks. Observed indicators included the efficacy in angina, the efficacy in Chinese medicine syndrome, the withdrawal or reduce rate of nitroglycerin and routine safety indices. Results： After 12-week treatment, the significant effective rate and total effective rate of the treatment group were significantly better than those of the control group （23.5% vs. 9.2%, 64.7% vs. 30.8%）, respectively, with statistically significant difference （P〈0.01）. After 12-week treatment, the decreased points and the decreased rate of angina symptom score in the treatment group were better than in the control group （5.1±4.2 points vs. 2.8± 3.5 points, 44.9% ±37.2% vs. 25.4%±30.7%） respectively, with significant difference （P〈0.01）. After 12-week treatment, the significant effective rate and total effective rate of the treatment group were better than the control group （respectively, 30.3% vs. 15.0%, 67.2% vs. 45.0%, P〈0.01）. After 8- or 12-week treatment, the decreased points and the decreased rate of Chinese medicine syndrome score in the treatment group were better than the control group （P〈0.05 or P〈0.01）. After 12-week treatment, nitroglycerin withdrawal rate and the withdrawal or reduce rate in treatment group were better than the control group （P〈0.01）. On safety evaluation, the incidence of adverse events （7.563% vs. 7.500%） and the incidence of cardiovascular events （0.840% vs. 0.000%） in the treatment group were similar with the control group, and the difference was not statistically significant （P〉0.05）. Couch=SlOB： In treatment of chronic stable angina （blood stasis syndrome）, WSC can reduce angina attacks and consumption of nitroglycerin, decrease angina severity degree, effectively relieve the blood stasis syndromes, such as chest pain, chest tightness, palpitations, dark purple tongue and other symptoms. Besides, adverse events and cardiovascular adverse events in the treatment group and the control group showed no difference. All shows that the drug is safe and effective. [This study was registered in Chinese Clinical Trial Registry （ChiCTR）, with registration number： ChiCTR-TRC-14005158.]

Effects of Garlicin on Unstable Angina Pectoris and Its Relationship with Blood Lipid and Granule Membrane Protein-140

Objective: To observe the clinical effects of Garlicin on unstable angina pectoris (UAP) and explore how the Garlicin's effects vary among syndromes as defined by traditional Chinese medicine (TCM).Methods: Fifty-five patients with UAP were randomly divided into the Garlicin group (34 patients) and the control group (21 patients). Each patient was classified according to TCM Syndrome Differentiation as having Cold Syndrome type, Heat Syndrome type, severe blood stasis (SBS) type, and mild blood stasis (MBS) type of UAP. Garlicin 60 mg or nitroglycerin 5 mg was given to the two groups respectively by intravenous drip for 10days as one therapeutic course. The curative effect was evaluated by symptomatic changes and electrocardiogram. The effective rates as well as indexes such as blood lipid, lipoprotein, apolipoprotein, and granule membrane protein-140 (GMP-140) were compared between groups and types. Results: Garlicin and nitroglycerin group did not differ significantly in effective rate, while that of Garlicin group was higher for the Cold Syndrome type than that of Heat Syndrome type (P < 0. 01 ). The high density lipoprotein/low density lipoprotein ratio and apolipoprotein A- I level rose markedly in the former type (P < 0. 05), while an opposite trend was seen in the Heat Syndrome type. Garlicin was more effective in the SBS type than that in the MBS type, and it markedly decreased GMP-140 in the MBS type. Conclusions: Garlicin is effective in UAP, especially the Cold Syndrome and SBS types. Its mechanism may involve improving blood lipid levels and inhibiting platelet activation.

Effect and Safety of Guanxinning Tablet(冠心宁片) for Stable Angina Pectoris Patients with Xin(Heart)-Blood Stagnation Syndrome:A Randomized,Multicenter,Placebo-Controlled Trial

Objective: To investigate the effect and safety of Guanxinning Tablet(冠心宁片, GXN) for the treatment of stable angina pectoris patients with Xin(Heart)-blood stagnation syndrome(XBSS). Methods: One hundred and sixty stable angina pectoris patients with XBSS were randomly assigned to receive GXN(80 cases) or placebo(80 cases, Guanxinning simulation tablets, mainly composed of lactose), 4 tablets(0.38 g/tablet), thrice daily for 12 weeks. After treatment, an exercise stress test(treadmill protocol), Chinese medicine(CM) syndrome score, electrocardiogram(ECG), and nitroglycerin withdrawal rate were evaluated and compared in the patients between the two groups. Meanwhile, adverse events(AEs) were evaluated during the whole clinical trial. Results: Compared with the control group, the time extension of exercise duration in the GXN group increased 29.28±17.67 s after treatment(P>0.05);moreover, the change of exercise duration in the GXN group increased 63.10±96.96 s in subgroup analysis(P<0.05). The effective rates of angina pectoris, CM syndrome and ECG as well as nitroglycerin withdrawal rate were 81.33%, 90.67%, 45.76%, and 70.73%, respectively in the GXN group, which were all significantly higher than those in the control group(40.58%, 75.36%, 26.92%, 28.21%, respectively, P<0.05). Conclusion: GXN was a safe and effective treatment for stable angina pectoris patients with XBSS at a dose of 4 tablets, thrice daily.

Serum Low-Density Lipoprotein and Heart Rate Related to the Effectiveness in the Treatment of Angina Pectoris with Two Similar Chinese Medicine Herbal Formulae

Objective： To explore the effectiveness related indicators which might help identify the indications of Tongxinluo Capsule （通心络胶囊） and Kangxin Capsule （康欣胶囊） targeting on qi deficiency and blood stasis pattern in Chinese medicine （CM） in the treatment of angina pectoris. Methods： The data from a multicenter, randomized and double-blinded study conducted at 5 centers in China were obtained for the analysis. A total of 239 patients with angina pectoris and CM syndrome of qi deficiency and blood stasis were randomly assigned in a 1：1 ratio to Tongxinluo Capsule group （119 cases） and Kangxin Capsule group （120 cases）. Angina effectiveness and electrocardiogram （ECG） improvement were selected as the therapeutic outcomes. Results： After a 4-week treatment, the effective rates of Tongxinluo Capsule and Kangxin Capsule were 43.70% and 25.00%, respectively （P〈0.05）. Serum low-density lipoprotein （LDL） level was found to influence the effectiveness of Tongxinluo Capsule which had higher effective rate in the patients with lower level of LDL. Heart rate was found to influence the effectiveness in the patients treated with Kangxin Capsule which had higher effective rate in the patients with heart rate ≤80 beats/min. Conclusion： LDL level and heart rate were the indicators which help indentify the indications of Tongxinluo Capsule and Kangxin Capsule, respectively, in the treatment of angina pectoris with CM syndrome of qi deficiency and blood stasis.

Effect of Xuefu Zhuyu Pill (血府逐瘀丸) on Platelet Activating Factor Expression in Patients with Unstable Angina Pectoris

Objective: To explore the significance of platelet activation (PA) in patients with unstable angina pectoris (UA) and the effect of Xuefu Zhuyu pi ll (XZP, a Chinese composite recipe) on it, by way of determining platelet membr ane glycoprotein CD62P, CD41/CD45 expressions in whole blood of healthy persons and UA patients.Methods: XZP was given orally to 45 UA patients for 2 weeks. The ir expressions of CD62P and CD41/CD45 in peripheral blood were determined before and after treatment by whole blood flow cytometry with special marked antibody, and compared with those in 10 healthy persons of the same age as a normal cont rol group. Results: Amount of expressions of CD62P and CD41/CD45 (FC%) in UA patients before treatment were 24.22±7.92 and 25.89±8.10 respectively, all hig her than those in the control group ( P <0.01 and P <0.05). After treatment , CD62P lowered to 20.42±8.01, significantly different from that of before tr eatment( P <0.05), and CD41/CD45 also showed a trend of lowering ( P >0.05). Platelet adhesion rate reduced significantly ( P <0.05) at the same time, as compared with that of before treatment.Conclusion: Highly platelet activated state exists in UA patient s. XZP could inhibit platelet membrane glycoprotein CD62P and CD41/CD45 express ions, which might be the molecular mechanism of it in antagonizing PA.

张艳自拟冠心方治疗冠心病心绞痛临证经验

冠心病心绞痛在心血管疾病中较为常见,属于中医学中“胸痹”“心痛”等范畴。张艳教授行医四十余载,治疗胸痹心痛疗效显著。认为其发病以气虚痰瘀交阻证型较为多见,提出“虚痰瘀”理论,自拟“冠心方”从脾论治冠心病心绞痛,治法为补气健脾,养血活血,化瘀止痛,化痰祛湿。该文章将张艳教授自拟冠心方治疗冠心病心绞痛的临证经验总结作出详细介绍。

稳定型心绞痛证候特点及其痰瘀互结型的影响因素

目的:探讨稳定型心绞痛证候特点及其痰瘀互结型与理化指标的相关性分析。方法:选取2018年1月—2020年12月就诊于北京中医药大学东直门医院的稳定型心绞痛病人194例,统计受试者基线资料及相关实验室检查指标,并根据中医四诊信息归纳病人证候信息。结果:194例受试者中,痰瘀互结型86例(44.3%),气虚血瘀型52例(26.8%),气阴两虚型29例(14.9%),气滞血瘀型27例(13.9%)。单因素分析结果提示稳定型心绞痛的中医证候影响因素包括体质指数(BMI)、血红蛋白(Hb)及天门冬氨酸氨基转移酶(AST)。Logistic回归分析提示痰瘀互结型独立影响因素为BMI、Hb、AST。结论:稳定型心绞痛证候分布中痰瘀互结型占比最高;BMI、Hb、AST是稳定型心绞痛中医辨证为痰瘀互结型的独立影响因素。

丹篓片联合阿托伐他汀钙片对痰瘀互结证稳定性心绞痛患者的临床疗效

目的 考察丹篓片联合阿托伐他汀钙片对痰瘀互结证稳定性心绞痛患者的临床疗效。方法 80例患者随机分为对照组和观察组,每组40例,对照组给予阿托伐他汀钙片,观察组在对照组基础上加用丹篓片,疗程8周。检测临床疗效、中医证候评分、血管内皮功能指标(NO、VEGF、ET-1)、血脂相关指标(TC、TG、HDL-C、LDL-C、脂蛋白a、ApoB/A1)、24 h动态心电图指标(缺血发作次数、最长持续时间、心脏缺血总负荷)、SAQ评分、安全性指标(AST、ALT、Scr、BUN)变化。结果 观察组总有效率高于对照组(P<0.05)。治疗后,2组中医证候评分、ET-1、TC、TG、LDL-C、脂蛋白a、ApoB/A1、24 h动态心电图指标降低(P<0.05),NO、VEGF、HDL-C、SAQ评分升高(P<0.05),以观察组更明显(P<0.05)。2组安全性指标比较,差异无统计学意义(P>0.05)。结论 丹篓片联合阿托伐他汀钙片可安全有效地改善痰瘀互结证稳定性心绞痛患者心肌缺血程度、临床症状,调节血脂,减轻血管内皮损伤。

从“扶正祛邪”辨治不稳定型心绞痛探析

不稳定型心绞痛(UAP)属于急性冠脉综合征,是一种由于突发诱因导致的斑块破裂、糜烂,产生心肌缺血,以频发加剧的心前区绞痛为特征的严重疾病。中医认为本病属虚实夹杂,邪盛正虚,斗争剧烈,虚在脾胃受损与阳气亏虚,导致水湿痰浊不化,与瘀血互结于心脉,脉管狭窄,供血不足导致心肌受损。日久后痰瘀互结形成的斑块受到突发不良条件的刺激,致血管中斑块从底层糜烂、破裂,成为毒邪,堵塞心脉,发为UAP疾病。治疗时先祛邪后扶正,祛邪不伤正。扶正不恋邪,其中祛邪除痰、瘀、气滞,用药平和,不用峻猛之品,辅以补气、养血扶正。祛邪后舌腻减退,扶正时补气而不燥,补血养血而不滋腻,若病势转坏,急剧疼痛,亡阴亡阳,那么应中西医配合,救命为主,扶正固脱,使用中医注射液、汤剂、针刺与芳香疗法结合的方式,多剂型、多给药途径进行治疗。

新加宁心通痹汤治疗老年冠心病稳定型心绞痛(气虚血瘀兼气滞证)的临床观察

目的观察新加宁心通痹汤治疗老年冠心病稳定型心绞痛(气虚血瘀兼气滞证)的临床疗效。方法将60例入组患者随机分为观察组与对照组各30例,两组均予以西医冠心病二级预防用药,观察组加予新加宁心通痹汤口服,疗程均为4周,观察两组治疗前后中医证候疗效、心绞痛改善情况、主要症状评分、西雅图心绞痛量表(SAQ)评分及心电图疗效。结果观察组总有效率为86.21%,高于对照组的71.43%(P<0.05);观察组心绞痛改善总有效率优于对照组(P<0.05);观察组治疗后胸闷、胸痛、气短、心悸症状评分明显低于对照组(P<0.05);两组患者西雅图心绞痛量表(SAQ)评分均较治疗前升高(P<0.05),观察组升高更显著(P<0.05);治疗后观察组的心电图改善优于对照组(P<0.05)。两组治疗前后血尿便三大常规、肝肾功能均未出现异常。结论新加宁心通痹汤治疗气虚血瘀兼气滞证之老年冠心病稳定型心绞痛可有效改善患者症状,提高患者生活质量。

芎芍胶囊治疗冠心病心绞痛临床疗效及安全性的系统评价

目的:系统评价芎芍胶囊治疗冠心病心绞痛的临床效果及安全性。方法:计算机检索Web of SCI、PubMed、EMbase、the Cochrane Library、万方数据资源系统(WanFang Database)、维普中文科技期刊全文数据库(VIP)、中国知网(CNKI)、中国生物医学文献服务系统(SinoMed)等数据库,纳入芎芍胶囊对比单独使用常规西药或血府逐瘀胶囊干预冠心病心绞痛的随机对照试验研究(RCT)。由2位评价者独立筛选提取文献资料、评定偏倚风险,使用RevMan 5.3进行Meta分析。结果:纳入12项研究,涉及1309例病人。Meta分析结果显示,试验组在提高临床总有效率[RR=1.17,95%CI(1.11,1.23),P<0.00001]、提高心电图疗效[RR=1.22,95%CI(1.09,1.36),P=0.0003]、降低三酰甘油(TG)[MD=-0.19,95%CI(-0.35,-0.04),P=0.02]、升高高密度脂蛋白胆固醇(HDL-C)[MD=0.13,95%CI(0.07,0.19),P<0.0001]方面均优于对照组,而两组在减低总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及不良反应发生率方面比较差异无统计学意义(P>0.05)。结论:现有证据表明,芎芍胶囊治疗冠心病心绞痛的临床效果明确,安全性较好。

脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效及转录组学研究

目的观察脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效,并通过转录组学方法初步阐明其可能的作用机制。方法将符合纳入标准的140例气虚血瘀型冠心病心绞痛患者依据随机数字法分为治疗组、对照组各70例,治疗期间对照组脱落3例。对照组予冠心病二级预防西医基础治疗,治疗组在对照组治疗基础上加服脉通君安汤,2组疗程均为8周。治疗前后评估2组患者中医证候积分、加拿大心血管学会(Canadian cardiovascular society,CCS)心绞痛分级、西雅图量表(Seattle angina questionnaire,SAQ)评分、焦虑自评量表(Self-rating anxiety scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分及不良反应,并基于性别、年龄、病程相匹配原则选取9例患者治疗前后外周血进行转录组学测序。结果治疗后,2组患者中医证候积分均明显下降(P<0.01),治疗组在改善胸痛、胸闷、气短、神倦乏力及总分方面优于对照组(P<0.05,P<0.01);治疗组CCS心绞痛分级总改善率优于对照组(P<0.05);2组治疗前后SAQ、SAS及SDS评分均显著改善(P<0.01),治疗组SAQ评分改善优于对照组(P<0.05,P<0.01)。转录组学结果显示,治疗前后具有显著差异表达的mRNA有862个,包括509个上调,353个下调;GO分析结果显示差异表达的mRNA生物学过程有666条,主要包括病毒基因表达、翻译启动、RNA分解代谢过程等,细胞组分112条,主要包括黏着斑、核糖体亚基、核斑点等;分子功能有94条,主要包括双链RNA结合、钙黏蛋白结合、转录共调节因子活性等;KEGG分析结果显示差异mRNA富集信号通路包括20条,主要包括甘油磷脂代谢通路、单磷酸腺苷激活的蛋白激酶(AMP-activated protein kinase,AMPK)信号通路、核糖体通路等。结论脉通君安汤能够改善气虚血瘀型冠心病心绞痛患者临床症状,其作用机制为多靶点多通路,可能与甘油磷脂代谢通路、AMPK信号通路、核糖体通路的调节相关。

基于证素理论探讨胸痹心痛的基本病机

目的:本文通过临床调查及文献研究的方式,通过分析冠心病心绞痛中医证素和证型分布情况,探寻冠心病心绞痛,即胸痹心痛的基本病机与证素。方法:回顾性收集2022年1月至2022年4月北京中医药大学东直门医院冠心病心绞痛住院病例,研究其证素分布情况;以“冠心病”“胸痹心痛”“心绞痛”“证候”“证素分布”“病机”等关键词检索中国知网数据库(CNKI)、万方数据库、重庆维普数据库(VIP)、中国生物医学文献数据库(CBM)自建库至2022年12月的文献,对文献进行归纳,探讨胸痹心痛的基本病机与证候要素。结果:共收集冠心病心绞痛住院病例143例,其中有血瘀证素的134例,占93.70%;检索得到的相关文献,明确指出血瘀是冠心病心绞痛的基本病机与证候要素。结论:血瘀是冠心病心绞痛(胸痹心痛)的基本病机及证素,活血化瘀法是治疗冠心病心绞痛的有效方法,对于治疗胸痹心痛具有指导意义;主张在活血化瘀治疗同时和其他药配伍,提高临床疗效。

化瘀通脉汤对冠心病血运重建术后心绞痛患者血脂、血液流变学水平的影响

目的 研究化瘀通脉汤对冠心病血运重建术后心绞痛患者血脂、血液流变学水平的影响。方法 选取2019年1月—2020年12月期间濮阳市中医医院收治的冠心病血运重建术后心绞痛患者96例纳入研究,通过随机数字表法分为对照组和观察组,每组各48例。两组患者均给予低脂饮食、休息等常规干预。对照组给予西医常规药物治疗,观察组在对照组基础上给予化瘀通脉汤治疗。治疗1个月后,观察比较两组患者临床疗效、不良反应发生情况,治疗前后中医症状积分、血脂指标[三酰甘油(Triglyceride,TG)、总胆固醇(Total cholesterol,TC)、高密度脂蛋白(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(Low density lipoprotein cholesterol,LDL-C)]水平、血液流变学指标[全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原]水平。结果 治疗后观察组总有效率93.75%(45/48)明显高于对照组79.17%(38/48),差异有统计学意义(P<0.05)。治疗后两组患者胸痛、胸闷、心悸、食少纳呆、胃脘痞满积分较治疗前降低,差异有统计学意义(P<0.05);且观察组明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者TG、TC、LDL-C水平较治疗前降低,HDL-C水平较治疗前升高,差异有统计学意义(P<0.05);且观察组TG、TC、LDL-C水平明显低于对照组,HDL-C水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原水平较治疗前降低,差异有统计学意义(P<0.05);且观察组明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 化瘀通脉汤对冠心病血运重建术后心绞痛患者有较好疗效,能够有效缓解患者临床症状,并改善其血脂、血液流变学水平,同时安全性较高,具有临床应用价值。