Effects of Ginkgo Leaf Extract on Function of Dendritic Cells and Th1/Th2 Cytokines in Patients with Unstable Angina Pectoris

Objective： To investigate the effects of Ginkgo leaf extract （GLE） on function of dendritic cells （DO） and Th1/Th2 cytokines in patients with unstable angina pectoris（UAP）. Methods： Fifty-four patients with UAP were equally assigned into two groups, the treated group and the control group, both treated with conventional Western medicine, but with GLE given additionally to the treated group. Blood of all patients was taken before and 4 weeks after treatment to prepare the peripheral mononuclear cells, then which were incubated in the completed medium containing granulocyte-macrophage colony stimulatory factor （GMCSF） and interleukin-4 （IL-4） to induce mature DO. The expression of co-stimulating factor CD86 （B7-2） on the surface of DC was detected by flow cytometry, and the stimulating capacity of DC was determined by mixed lymphocyte reaction （MLR）. The blood levels of cytokines, interferon-γ （IFN-γ）, and IL-4, were analyzed by ELISA, and blood C-reactive protein （CRP） level by turbidimetry. Moreover, the direct effect of Ginkgolide B on CD86 expression on DO were also tested in vitro. Results： After treatment, CD86 expression on DO, the stimulating capacity of DO as well as levels of IFN-γ and ORP were lowered in both groups （P〈0.05 or P〈0.01）, but the changes were much more significant in the treated group than those in the control group. Ginkgolide B showed a direct inhibitory effect on the CD86 expression on DO. Conclusion： The inhibition of GLE on DO and thereby the suppression on inflammatory reaction may be one of the mechanisms of GLE in treating patients with UAP.

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.

Comparative Study on the Effects of Small Dose of Aspirin Combined with Ginkgo-damole Injection(银杏达莫注射液) and the Effects of Conventional Dose of Aspirin in Treating Senile Unstable Angina Pectoris

Objective: To evaluate the therapeutic and adverse effect of small dose of aspirin (Asp) combined with Ginkgo-damole injection (GDI,银杏达莫注射液) in treating senile unstable angina pectoris (UA). Methods: One hundred and twenty old in-patients of coronary heart disease with UA were randomly divided into two groups. The 60 patients in the treated group were treated with oral administration of enteric soluble 50 mg Asp once a day and GDI 20 ml per day by intravenous dripping, with 14 days as one therapeutic course, while the other 60 in the control group were treated with enteric soluble Asp 100 mg alone once a day orally. Besides, isosorbide-5-mononitrate 20 mg twice a day was applied to both groups, and the β-ad-renoceptor blocker, blood lipids regulatory agents and nitroglycerin (10 mg by intravenous dripping) were given accordingly. The angina total improving rate, hemorrheologic indexes (whole blood viscosity, plasma viscosity, fibrinogen, platelet aggregation rate), comprehensive clinical terminal event and the total occurrence rate of adverse reaction in the two groups were observed. Results: After treatment, comparison between the two groups showed insignificant difference in aspects of angina total improving rate (75.00% vs 65.00%), hemorrheological indexes and comprehensive clinical terminal event rate (25.00% vs 31.67%), P>0.05, and the hemorrheological indexes were improved in both groups (P<0.05), but the total occurrence rate of adverse reaction in the treated group was lower than that in the control group (6. 67% vs 25.00%), showing significant difference (P<0.05). Conclusion: In treatment of senile UA, small dose of Asp combined with GDI showed therapeutic effect similar to that of conventional dose of Asp, but it has lower adverse reaction.

The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pectoris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 cases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided into three groups in light of the results of the hemodynamic examination: ① diastolic dysfunction group ② systolic dysfunction group ③ normal heart function group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary arteriography and heart function. Results ① Under basic conditions, patients with angina decubitus suffered from the systolic (36%) or diastolic dysfunction (48%). 43 percent of the patients with mixed angina had systolic dysfunction and other 43 percent of them had normal cardiac function. However, patients with accelerated effort angina (AEA) were characterized by diastolic dysfunction (31%) or normal heart function (60%). ② In hemodynamic examination, the pulmonary capillary wedge pressure of positive patients rose, at the same time cardiac index fell to the extreme instantaneously after loading in volume-loading test and then they restored to the basic level until 60 minutes. However, both PCWP and CI of the negative patients reach the peak momentarily after loading. They returned to the basic level within 30 minutes. ③ coronary arteriography show: there are 41% of patient with three-vessel disease, 50% with two-vessel disease, 9% single vessel disease and left main narrowing 22. 7% in AEA. There are separately 76%, 24%, 0% and 36% in AD; and 26.1% , 43.4% , 21.7% , 43.4% in MA. ④ Constituent ratio of the AEA and MA were separately compared with AD, AEA/AD: P < 0.05(P = 0.031); MA/AD: P < 0.01 (P = 0.000313). Conclusions Most of patients with the above three types of unstable angina pectoris suffered from the basic heart dysfunction and cardiac reserve dysfunction which might participate in the occurrence and development of unstable angina pectoris. In angiography, there are the most three-vessel diseases in AD that are, therefore, the most severe UAP.

Relationship Between Serum Creatine Kinase Isoenzyme MM Subbands and the Gradation of Coronary Stenosis in Patients with Unstable Angina Pectoris

Objective To observe the relationship between serum creatine kinase isoenzyme MM sub-bands (CKMM3/MM1 ratio) and the gradation of coronary stenosis and provide a simple, reliable, and economical method for identifying high-risk unstable angina pectoris (UAP). Mehtods Blood samples were drawn at different time after onset of chest pain in 21 patients with UAP and only once in 20 each volunteers for control. CKMM3/MM1 ratio was detected by nonserial buffer agarose gel electrophoresis. CKMB and CK were observed by velocity method. An emergent coronary arteriography was performed as soon as patients were admitted into hospital. Results Patients with UAP were divided into two subgroups: patients with elevated serum enzyme [P( + )] and patients with normal serum enzyme [P( - ) ] according to CKMM3/MM1 ratio < 0. 5. Patients with UAP( + ) had higher serum CKMM3/MM1 ratios from 0.5 to 12hrs and serum CKMB from 2 to 12 hrs than those with UAP( - ) and control ( P < 0. 05) . Serum enzyme concentrations of patients with UAP whose coronary lumen had 90% or more than 90% stenosis were significantly higher than those whose coronary lumen had less than 90% stenosis ( P <0. 01) . Any CK-MM3/MM1 ratio was less than 1. 0 and CK within the normal range in patients with UAP( + ) group. Conclusions CKMM3/MM1 ratios in patients with UAP can reflect severity of myocardial ischemia. SerumCKMM3/MM1 ratio provides a simple, reliable, and economical method for identifying high-risk UAP.

Effects of XUEZHIKANG on Oxidized Low Density Lipoprotein,C - Reactive Protein, Fibrinogen in Unstable Angina Pectoris Patients

Objectives To study the effects of XUEZHIKANG on lipid modulating and the level of oxidized low density lipoprotein(OX - LDL), C -reactive protein(CRP), fibrinogen(FIB) in serum. Methods XUEZHIKANG was given to patients with unstable angina pectoris and hyperlipidemia at a dose of 0. 6 gram bid for 2 months and with half -dose for another 2 months. Vitamin E was given to unstable angina pectoris patients with normal lipid at the dose of 0. 1 gram bid for 4 months respectively. Then compared the level of lipid and OX - LDfL, CRP, FIB in serum at beginning, first - month and second -month. Results XUEZHIKANG can reduce the serum level of total cholesterol, low density lipoprotein in 1 month , and gained better effect in 2 months. It can also reduce triglyceride and increase high density lipoprotein in 2 months. Compared with vitamin E XUEZHIKANG can reduce the level of OX - LDL, CRP, FIB significantly after treatment for 2 months. Conclusions XUEZHIKANG has significant effect in lipid modulating , and it can also inhibit the development of inflammation in coronary plaque.

Danshen Injection as Adjuvant Treatment for Unstable Angina Pectoris： A Systematic Review and Meta-analysis

To systematically evaluate the clinical effectiveness and safety of Danshen Injection ( DS) as one adjuvant treatment for conventional therapy with Western medicine (WM) for unstable angina pectoris (UAP). Using literature databases, a thorough and systematic retrieval of randomized controlled trials (RCTs) comparing DS plus WM with WM was conducted from inception to April 2015. The extracted data from included studies was analyzed by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests conducted by Stata 12.0 were used to evaluate the potential presence of publication bias. A total of 17 RCTs, which involving 1,433 participants, were identified and reviewed. The meta-analysis indicated that the combined use of DS and WM was significantly superior to WM alone for UAP in terms of the total effectiveness rate of angina pectoris [risk ratio (RR) =1.23, 95% confidence interval (CI): 1.17, 1.29, P < 0.01] and the total effectiveness rate of electrocardiogram (ECG) [RR=1.18, 95%CI: 1.06, 1.30, P=0.001]. Additionally, DS could also further reduce the content of fibrinogen, adjust blood lipid level, correct T wave inversion, and so on. Fifteen adverse drug reactions were reported in two studies, Four of which appeared in the experimental group. Based on the systematic review, the combined use of DS and WM was more effective than WM alone, it can be further widely used in clinic, however, there was no exact conclusion for its safety.

Effect of Yiqi Yangyin Decoction(益气养阴方) on the Quality of Life of Patients with Unstable Angina Pectoris

Objective： To observe the effect of Yiqi Yangyin Decoction （益气养阴方, YQYYD） on the quality of life （QOL） of patients with unstable angina pectoris （UAP）. Methods： A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group （treated with YQYYD and conventional therapy of Western medicine） and the control group （treated with conventional therapy of Western medicine）, by the use of the PROC PLAN of the SAS 6.12 software, in a prospective, randomized, controlled design. The clinical total effective rate, symptom score, QOL scale [Seattle Angina Questionnaire （SAQ）] and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. Results： During the study, three cases dropped out in the treated group, one case dropped out in the control group, and 104 cases, including 51 cases in the treatment group and 53 cases in the control group, finished the trial. After four weeks of treatment, the total clinical effective rates in the treated group and the control group were 80.4% and 75.5% respectively, and there was no obvious difference between them （P〉0.05）. However, the symptom score of the treated group （9.31 ± 2.02） was significantly lesser than that of the control group （11.62 ± 3.04, P〈0.05）, and the total score of the QOI scale of the treated group （68.76 ± 5.74） was significantly higher than that of the control group （61.06 ±3.31, P〈0.01）. Among those in the treated group physical limitation, angina stability, angina frequency, and treatment satisfaction were significantly ameliorated when compared with the control group after treatment （P〈0.05, P〈0.01）. The incidence of important clinical events in the treated group （3.9%） was lower than that in the control group （5.7%） during the 8-month follow-up period, but the difference was insignificant （P〉0.05）. Conclusion： YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.

Sodium Tanshinone Ⅱ A Sulfonate Injection as Adjuvant Treatment for Unstable Angina Pectoris: A Meta-Analysis of 17 Randomized Controlled Trials

Objective： To systematically evaluate the effectiveness and safety of Sodium Tanshinone ⅡA Sulfonate Injection（STS） as one adjuvant therapy for treating unstable angina pectoris（UAP）. Methods： Randomized controlled trials（RCTs） of UAP treated by STS were searched in the China National Knowledge Infrastructure Database（CNKI）, VIP Database for Chinese Technical Periodicals（VIP）, Wanfang Database, the Chinese Biomedical Literature Database（CBM）, Web of Science, the Cochrane Library, Embase, and Pub Med, which from inception to January, 2016. The Cochrane Risk Assessment Tool was used to evaluate the methodological quality of the RCTs. The Review Manager 5.3 software was used to conduct the metaanalysis. Results： The results showed that 17 RCTs involving 1,372 patients were included. The meta-analysis indicated that the combined use of STS and Western medicine（WM） in the treatment of UAP can obviously improve the total effective rate [risk ratio（RR）=1.31, 95% confidence interval（CI）（1.24,1.39）, P〈0.0001], and the total effective rate of electrocardiogram [RR=1.43, 95% CI（1.30,1.56）, P〈0.0001], decrease the level of CRP [mean difference（MD）=–3.06, 95%CI（–3.85, –2.27）, P〈0.00001], fibrinogen [MD=–1.03, 95% CI（–1.16, –0.89）, P〈0.00001], and whole blood high shear viscosity [MD=–0.70, 95% CI（–0.92, –0.49）, P〈0.00001]. Additionally, the occurrence of adverse drug reaction of the experimental group was significantly higher than that of the control group [RR=3.57, 95% CI（1.28, 9.94）, P〈0.05]. Conclusions： Compared with WM, the combined use of STS was more effective.

Effect of Xin’anning Nasal Drop (心安宁滴鼻剂) in Treating Coronary Heart Disease with Unstable Angina Pectoris

Objective： To observe the clinical efficacy of Xin＇anning Nasal Drop （XAND,心安宁滴鼻剂） in treating coronary heart disease with unstable angina pectoris （CHD-UAP）. Methods： Sixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden （TIB） in 24-h dynamic EKG were observed. Results： The clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TOM syndrome score reduction, were significantly superior in the treated group to those in the control group （ P〈0.05 or P〈0.01 ）. The degree and extent of myocardial ischemia were significantly improved in both groups （ P〈0.01 ）, but the improvement in the treated group was better than that in the control group （ P〈0.05）. Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption （ immediately after the first administration or by the end of the therapeutic course）, and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference （ P〈0.05 or P〈0.01 ）. Conclusion： XAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of further studies and spreading in clinical practice.

The renal and platelet functions and monitorsinpatients with unstable angina pectoris and diabetes mellitus undergoing interventional therapy with or without the treatment of alprostadil

Background Patients with unstable angina pectoris and diabetes mellitus are very common. When they receive interventional therapy, contrast agentscan causerenal injuryand platelet activation. Alprostadil has been shown to decrease inflammation and microvascular resistance. There is no any report on the protection effects of alprostadilon renal injuryand the platelet activation during cardiac interventional therapy. Methods A total of 57 patients were divided into two groups, alprostadil group （n=35） and normal group n=22）. BUN （blood urea ni- trogen） and SCr （serum creatine） were measured as the renal function parameters. GFR （glomerular filtration rate） was calculated by the MDRD formula. Platelet parameters： PLT （platelet count, 109）, PDW （platelet distribu- tion width, fL）, MPV （mean platelet volume, fL）, PLCR （large platelet scale ratio, %） were measured as the platelet activationindex. T test and Chi-square test were used as statistical methods, and P〈0.05 was considered statistically significant. Results In the alprostadil group, SCr was 71.1±13.8 μmoFL and 65.9±12.6 ＆tool/L, before and after interventional therapy （P〈0.05）. BUN was 5.68±1.79 mmol/L and 3.86±1.19 mmol/L （P〈0.001）, before and after interventional therapy. I n the platelet tests, MPV was seemed to be the only useful platelet parameter, before and after interventional therapy （11.8±1.8 fL and ll.l±1.2fL, P〈0.05）, while the PLT （109/L）, PDW （fl）, PLCR （%） didn＇ t show any significant difference. In the normal group, all these tests＇ results didn＇ t significantly change after interventional therapy. Conclusions The patients with the unstable angina pectoris and diabetes mellitus have on the risk of renal function damage and platelet activation when undertaking cardiac interventional therapy. Alprostadil protects renal function and alleviates olatelet activation.

THE NATIONAL SYMPOSIUM ON UNSTABLE ANGINA PECTORIS CLASSIFICATION, PATHOPHYSIOLOGY AND MANAGEMENT

Althougy the true incidence of unstable angina pectoris(UAP) remains poorly recognized,patients

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.

Preventive effect of Fangshuan capsule on PCI-induced myocardial damage and vascular endothelial injury in patients with unstable angina pectoris

Objective To observe the prevention of Fangshuan Capsule(FC)on percutaneous coronary intervention(PCI)induced myocardial damage and vascular endothelial injury in patients with unstable angina pectoris(UAP).Methods Totally 100 UAP patients undergoing PCI were assigned to the control group and the

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.

Entire process of electrocardiogram recording of Wellens syndrome:A case report

BACKGROUND Wellens syndrome is an electrocardiogram(ECG)pattern seen in high-risk patients with unstable angina pectoris.It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack;however,the mechanism for this condition remains unclear.CASE SUMMARY A 47-year-old male patient experienced repeated,unprovoked episodes of chest pain for>20 d,with worsening during the previous day.On the day of admission,he experienced episodes of paroxysmal chest pain lasting more than 30 min,in addition to radiating pain to the left arm and exertional dyspnea.The patient presented to the emergency department with no chest pain or other discomfort at that time.ECG at presentation showed sinus tachycardia and Twave changes,which were identified as Wellens syndrome when combined with previous ECG findings.ECGs and myocardial enzymology examinations were normal when angina was present,but the ECG showed inverted or biphasic Twaves when angina was absent.After percutaneous coronary intervention,the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0,1,and 2,but normal T-waves on day 3.The ECGs showed no subsequent ischemic ST-T-wave changes.CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.

Danhong Injection Improves Elective Percutaneous Coronary Intervention in UA Patients with Blood Stasis Syndrome Revealed by Perioperative Metabolomics

Objective:To observe the effect of Danhong injection(DHI)on perioperative metabolomics of unstable angina pectoris(UA)with blood stasis syndrome.Materials and Methods:A prospective,randomized,controlled,and single-blind clinical trial was conducted.Sixty-one UA patients with traditional Chinese medicine blood stasis syndrome undergoing elective percutaneous coronary intervention(PCI)were randomly divided into the Danhong and control groups,and 10 healthy volunteers were included as baseline.The Danhong group received western medicine+DHI treatment,while the control group received western medicine+saline.Nontargeted metabolomics was used to analyze the serum metabolites of healthy volunteers in the Danhong and control groups before and 5 days after PCI.Results:Before treatment,there was no significant difference in serum metabolites between the Danhong and control groups,but there was a significant difference between the two groups and the healthy group.Differential metabolites were clustered mainly in glycerophospholipid,sphingolipid,purine,and amino acid groups,which were generated in their metabolic pathways.After 5 days of PCI,the profiles of serum metabolites were significantly closer between the Danhong-or control-treated groups and that of the healthy group.Furthermore,DHI treatment converted the serum metabolite profile more to that of the healthy group than the control treatment.Conclusion:The beneficial effect of DHI on patients with unstable angina is reflected at the level of serum metabolic biomarkers.