| Objective1.To explore the incidence,influencing factors and the distribution characteristics of TCM syndromes of coronary heart disease with anxiety after PCI in Chenzhou,Hunan.2.To observe the clinical efficacy of Shugan Wendan Decoction in the treatment of patients with liver depression and phlegm stasis type coronary heart disease with anxiety after PCI.3.From HPA axis and BDNF-ERK-CREB pathway to explore the mechanism of Shugan Wendan Decoction in improving acute myocardial infarction anxiety in rats.Method:1.Investigation and researchIncluded in the Percutaneous Coronary Intervention(PCI)surgery for coronary heart disease admitted to the Department of Cardiology,Chenzhou First People’s Hospital,Chenzhou Third People’s Hospital,and Chenzhou Fourth People’s Hospital from January 2018 to April 2019 After 687 patients,the self-rating anxiety scale(SelfRating Anxiety Scale,SAS)was used to understand the patient’s anxiety,the general data sheet was used to understand the general condition of the patient,and the TCM syndrome type table was used to understand the TCM syndrome type of the patient,and further analysis The incidence and influencing factors of anxiety disorders in patients with coronary heart disease after PCI,at the same time,the medical syndrome types are summarized and analyzed.2.Clinical researchA total of 80 patients with liver depression and phlegm stasis syndrome with coronary heart disease associated with anxiety after PCI after PCI were enrolled from June 2018 to June 2019,and they were divided into control group and treatment according to the random number table method.Group,the control group were given conventional western medicine treatment,and the treatment group was given Shugan Wendan Decoction on the basis of the control group,taking five days a week for 12 weeks.Analyze the total effective rate of TCM syndromes of the two groups after treatment,compare the SAS scores,Coronary Revascul-arization Outcome Questionnaire(CROQ)scores,TCM syndrome scores,and lipoprotein correlations of the two groups before and after treatment.The changes of phospholipase A2,the changes of serum liver function,renal function,blood sugar,blood lipid,and blood routine before and after treatment were detected,and the adverse reactions of the two groups of patients were recorded.3.Animal researchLigation of the left anterior descending coronary artery combined with chronic emotional restraint was used to construct a rat model of acute myocardial infarction anxiety with liver depression and phlegm stasis syndrome.The rats were divided into a blank control group and a model group.Low-dose group,diazepam group.Shugan Wendan Decoction high,medium and low dose groups were given crude drug doses of 23.6g/Kg/d,11.8g/Kg/d,5.9g/Kg/d by gavage of Shugan Wendan Decoction,diazepam group Diazepam(0.5mg/Kg/d)was given by gavage,the blank control group and model group were given an equal volume of normal saline gavage,and the drug intervention time was 14 days.Observe rat behavior through elevated plus maze test,light-dark box test,and open field test.ELISA method is used to detect serum HPA axis Corticotrophin-releasing factor(Corticotrophin-releasing factor CRF),corticosterone(Corticosterone CORT),and adrenocortical cortex Hormone(Adrenocor-ticotropic hormone ACTH)content,RT-QPCR method to detect hippocampal brain derived neurotrophic factor(BDNF),extracellular regulated protein kinases(extracellular regulated protein kinases ERK),cyclic adenosine phosphate response element binding The expression level of cAMP-response element binding protein CREB mRNA.Result:1.Investigation and research①Of the 687 survey subjects,275(40.02%)patients developed anxiety disorders,including 200 cases of mild anxiety(29.11%),56 cases of moderate anxiety(8.15%),and 19 cases of severe anxiety(2.77%).②Univariate analysis found that age:≥60 years of age are the high-risk population with anxiety after PCI after coronary heart disease,accounting for 56.91%;gender:the incidence of anxiety in men is lower than that in women,39.02%and 42.93 respectively.%;Occupation:There are significant differences in the incidence of anxiety among the three groups of farmers,urban residents,and employees,which are 28.40%,83.12%,and 46.35%respectively;Education level:Anxiety among the three groups of primary school education,middle school education,technical secondary school and above There is no significant difference in the incidence of anxiety disorders,which are 40.11%,38.78%,and 41.67%respectively;medical insurance:urban medical insurance and rural medical insurance have significant differences in the incidence of anxiety disorders,which are 33.62%and 54.21%,respectively;hypertension:combined with hypertension There was no significant difference in the incidence of anxiety in the two groups without hypertension,39.12%and 41.20%,respectively;Diabetes:There was no significant difference in the incidence of anxiety between the two groups with diabetes and without diabetes,which were 45.32%and 37.81%,respectively.;Hyperlipidemia:There is no significant difference in the incidence of anxiety between the two populations with hyperlipidemia and without hyperlipidemia,which are 39.92%and 40.09%;family history of coronary heart disease:family history of coronary heart disease,no There was no significant difference in the incidence of anxiety in the two groups with family history of coronary heart disease,which were 59.48%and 36.08%respectively;the course of the disease:there was no significant difference in the incidence of anxiety in the three groups with course of disease ≤2 years,2-5 years,and>5 years.Respectively 40.83%,38.89%,35.06%;disease severity:there are significant differences in the incidence of anxiety among the three populations of mild,moderate,and severe diseases,which are 53.23%,22.11%,and 73.33%respectively;cardiac function:cardiac function Ⅰ～There is a significant difference in the incidence of anxiety among the two groups of grade Ⅱ and grade Ⅲ～Ⅳ,which are 59.50%and 35.87%respectively.③Binary Logistic regression analysis found that the course of disease[OR=1,895,95%CI(1.124,2.387)],disease severity[OR=1.894,95%CI(0.895,3.324)],family history[OR=2.314,95%CI(1.231,3.624)]and cardiac function classification[OR=2.312,95%CI(1.024,3.285)]are independent risk factors for anxiety associated with coronary heart disease after PCI.④Among the 275 patients with coronary heart disease with anxiety after PCI,the distribution of TCM syndrome types from high to low was 100 cases of liver depression and phlegm stasis syndrome(36.36%),60 cases of liver depression and qi stagnation syndrome(21.82%),and Qi 42 cases(15.27%)of stagnation of blood and blood stasis syndrome,27 cases(9.82%)of stagnation of phlegm and blood stasis syndrome,33 cases(12%)of qi stagnation and transformation of fire syndrome,9 cases(3.27%)of heart and spleen deficiency syndrome,heart and gallbladder qi deficiency syndrome In 4 cases(1.45%),the anxiety score and the rate of combined hypertension of patients with liver depression and phlegm stasis syndrome were significantly higher than those of the non-liver depression and phlegm stasis syndrome group(P<0.05).There was a significant correlation between liver depression and phlegm stasis syndrome and anxiety sex.2.Clinical research①Before treatment,there was no significant difference in the levels of TC,TG,LDL-C,and HDL-C between the two groups(P>0.05);after treatment,compared with the control group,the levels of TC and LDL-C in the treatment group were significantly reduced(both P<0.05),there was no statistically significant difference in the levels of TG and HDL-C(P>0.05);②Before treatment,there was no significant difference in TCM syndrome scores,SAS scores,and CROQ scores between the two groups(P>0.05);after treatment,compared with the control group,the TCM syndrome scores and SAS scores of the treatment group were significantly reduced(P<0.05),the CROQ score was significantly increased(P<0.05);③Before treatment,there was no statistically significant difference in the scores of depression,tingling and limb sleepiness between the two groups(P>0.05);after treatment,compared with the control group,the scores of depression,tingling and limb sleepiness in the treatment group were not statistically significant(P>0.05).The level was significantly reduced(all P<0.05);④After treatment,the total effective rate of TCM syndromes in the control group was 80.0%,and the total effective rate of TCM syndromes in the treatment group was 95.0%,the difference was statistically significant(P<0.05);⑤There was no statistically significant difference in blood routine,liver function and renal function in the treatment group before and after treatment(P>0.05);⑥Two patients in the treatment group had diarrhea symptoms;the control group had no adverse reactions.3.Animal research①In terms of behavior,compared with the blank control group,the elevated plus maze experiment of rats in the model group(the percentage of rat open arms,the percentage of time to open arms,the percentage of time to open arms),the light and dark box experiments(the number of open boxes,the number of open boxes)Time percentage,open box distance percentage),open field test(horizontal score,vertical score)level decreased(P<0.05),open field test(latency period)level extended(P<0.05);compared with the model group,soothing the liver Elevated plus maze experiment of rats in the middle and high dose groups of Wendan Decoction(the percentage of the number of times the rat opened the arm,the percentage of the time that the arm was opened,the percentage of the time that the arm was opened),the light-dark box experiment(the number of times of the open box,the percentage of the time of the open box,the distance of the open box Percentage),open field test(horizontal score,vertical score)level increased(all P<0.05),open field test(latency period)level decreased(P<0.05);②At the molecular level,compared with the blank control group,the levels of serum CRF,ACTH,and CORT in the model group increased(P<0.05),and the expression levels of BDNF,ERK,and CREBmRNA in the hippocampus decreased(all P<0.05);Compared with the model control group,the levels of serum CRF,ACTH,and CORT in the middle and high dose groups of Shugan Wendan Decoction decreased(all P<0.05),and the expression levels of BDNF,ERK,and CREBmRNA in hippocampus increased(P<0.05).Conclusion:1.The incidence of anxiety after PCI for coronary heart disease is high,and the syndrome of liver depression and phlegm stasis is the main syndrome type and core pathogenesis.2.Shugan Wendan Decoction can reduce blood sugar and blood lipids in patients with anxiety after PCI,improve anxiety symptoms,improve quality of life,improve the efficacy of TCM syndromes and relieve TCM symptoms,and is safe and reliable.3.Shugan Wendan Decoction may improve anxiety behavior by activating the BDNF-ERK-CREB pathway and inhibiting the excessive activation of HPA axis. |
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