| Coronary atherosclerotic heart disease is the main cause of disability and death from cardiovascular diseases.According to the China Health Statistical Yearbook 2020,the mortality rate of coronary heart disease in Chinese residents was 120-130/100 000 in 2019,showing a rising trend.Coronary stent intervention is one of the main treatment methods for coronary heart disease.In 2018,the total number of coronary heart disease interventional treatment cases in China was more than 910,000,and the average number of coronary heart disease patients was 1.46 stents.However,after PCI,there are still some patients who will be hospitalized again due to non-specific chest pain,angina pectoris,myocardial infarction or heart failure,and traditional Chinese medicine has unique advantages in the above aspects.In the early stage,a large number of randomized controlled studies have been conducted to verify the efficacy of traditional Chinese medicine on the incidence of MACE in patients after PCI.However,the quality of these randomized controlled trials is uneven,and the inclusion and exclusion criteria are strict,and the extrapolation is poor,so it is difficult to really apply them to clinical practice.Based on this,firstly,the efficacy of integrated traditional Chinese and Western medicine in the treatment of patients after PCI was systematically evaluated by meta-analysis and trial sequential analysis.Second,by real world research method of combining traditional Chinese and western medicine treatment in clinical practice,for the PCI postoperative efficacy and safety of patients,and adopt the method of data mining to involved in the clinical research of traditional Chinese medicine prescription were analyzed,and the results show that huangqi danshen drug compatibility is the most core of PCI postoperative patients with traditional Chinese medicine therapy drugs;Finally,the effects of astragalus salvia miltiorrhiza pretreatment on myocardial injury and apoptosis of myocardial cells in rats with myocardial ischemia-reperfusion were observed by establishing an animal experimental model.Part 1:A meta analysis of integrated traditional Chinese and western medicine medicine in the treatment of patients after PCIObjective:To evaluate the clinical efficacy of the combination of Chinese and Western medicine in patients with PCI based on high quality randomized controlled trials.Methods:PubMed,EMbase,The Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and The Chinese Biomedical Literature Database were searched.Randomized controlled trials of combined traditional Chinese and Western medicine in patients after PCI were collected.The retrieval time was from the establishment of the database to February 2022.After screening the literature,extracting data and evaluating the risk of bias of the included studies according to the inclusion and exclusion criteria,R×64 4.1.2 software was used for meta-analysis,and TSA-0.9.5.10-beta was used for trial sequential analysis(TSA).Results:A total of 48 randomized controlled trials were included,with a total of 12397 patients,including 6138 patients treated with western medicine alone and 6238 patients treated with integrated Chinese and Western medicine.The results of meta-analysis showed that:Compared with western medicine alone,the incidence of cardiogenic mortality[RR=0.48,95%CI(0.30,0.79),I2=0%]and revascularization[RR=0.55,95%CI(0.39,0.77)]in the combined traditional Chinese and western medicine group after PCI.I2=0%],the incidence of recurrent angina[RR=0.34,95%CI(0.26,0.43),I2=0%]and the incidence of heart failure[RR=0.42,95%CI(0.24,0.75),I2=0%]were significantly decreased.For the above outcome indicators,except for cardiac death,TSA results showed that the cumulative Z values crossed the TSA cut-off line,and the sample size of non-fatal myocardial infarction,re-revascularization,re-angina pectoris,and heart failure had reached the desired information volume(RIS).Conclusion:In terms of reducing the recurrence of angina pectoris,myocardial infarction,revascularization and heart failure in patients after PCI,the combined treatment of traditional Chinese and western medicine is superior to western medicine alone.Further trials are needed to verify the reduction of cardiac death in patients after PCI.Part Ⅱ:A real world study of integrated traditional Chinese and western medicine in the treatment of patients after PCIObjective:To evaluate the clinical efficacy of traditional Chinese medicine(TCM)combined with western medicine(WM)in patients with PCI and explore the rules of TCM treatment after PCI based on real world research and data mining.1.Exploring the Clinical Effect of Combination of Traditional Chinese and Western Medicine in the Treatment of PC Patients After Operation Based on Real-World Study Methods:Patients who underwent PCI successfully in Xiyuan Hospital from January 2016 to December 2019 were observed.Through the hospital HIS system to collect patients’demographic data,clinical characteristic,PCI coronary disease,postoperative medication,past medical history and clinical inspection data,etc.,in the form of telephone follow-up,as of December 31,2021,the follow-up records of patients condition and reason for the death,readmission,reascularization occurrence of cardiovascular adverse events.They were divided into non-exposure group(0-14 d),low-dose group(15-30 d),medium-dose group(31-90 d)and high-dose group(90～)according to the days of medication.Kaplan-meier method was used to draw the survival curve,Cox regression analysis and log-rank test were used to explore the effect of TCM decoction group on cardiovascular adverse events.Results:A total of 736 patients were found by His system,and 2 patients were excluded(missing key medical records).A total of 734 patients were included,124 patients(16.9%)were lost to follow-up,and 610 patients were finally followed up.A total of 45 patients died during the follow-up period,and 20 patients died of central origin.Revascularization occurred in 47 cases.255 patients were readmitted for cardiovascular reasons.There were 124,127,168 and 191 patients in the non-exposure group,low-dose group,medium-dose group and high-dose group,respectively.COX multivariate regression analysis showed that low-dose,medium-dose and high-dose groups were independent factors affecting all-cause mortality after PCI,with relative risks of 0.34[95%CI(0.13,0.89),P=0.027]and 0.33[95%CI(0.14,0.79),respectively.P=0.013],0.10[95%CI(0.03,0.31),P=0.000];The high dose group was an independent factor affecting revascularization after PCI,with a relative risk of 0.35[95%CI(0.14,0.91),P=0.031].The medium and high dose groups were independent factors affecting readmission due to cardiovascular disease after PCI,with a relative risk of 0.66[95%CI(0.47,),respectively].0.92),P=0.015]and 0.29[95%CI(0.18,0.44),P=0.000].2.Data Mining Based Study on the Medication Rules of Real-World Patients After PCI Methods:The TCM prescriptions of patients undergoing coronary artery stenting in Xiyuan Hospital from 2016 to 2019 were collected.After proper screening of prescriptions,according to the 2020 Chinese Pharmacopoeia,the name of traditional Chinese medicine was standardized,and the database of traditional Chinese medicine prescriptions for patients after PCI was established.SPSS 25.0 was used for drug frequency statistics,system clustering and factor analysis.IBM SPSS Modeler18.0 software was used for Apriori association rule analysis.Gephi 0.92 software was used for complex network analysis of data and calculation of network topological characteristic parameters.To analyze the core medication of patients after PCI.Results:a total of 4536 prescriptions were included,and the top 5 high-frequency TCM were raw astragalus membranaceus(2082,45.90%),chuanxiong(1794,39.55%),salvia miltiorrhiza(1784,39.33%),poria cocos(1674,36.90%)and angelica sinensis(1568,34.57%).Statistical analysis of the frequency of drug-induced flavor meridians showed that the two most used drugs after PCI were tonifying deficiency drugs(15660.23.6%)and promoting blood circulation and removing blood stasis drugs(9797,14.7%).The top two meridians were spleen meridians(32652,49.2%)and liver meridians(30307,45.7%).In the analysis of association rules,the binomial association drug combinations with support≥10%and rule confidence≥70%were Radix Macrostemon→Trichosanthes trichosanthes,Rhizoma Chuanxiong→Radix Rubens,Rhizoma Chuanxiong→Safflower.The top three groups of the three association drug combinations were Radix Rubens+Radix Rubens→Radix Salvia miltiorrhiza,Radix Rubens+Radix Rubens→Radix Rubens;Complex network analysis found that the core drug pair was Astragalus membranaceus and salvia miltiorrhiza.and the most commonly used dose ratio was astragalus membranaceus 30g+salvia miltiorrhiza 30g.By cluster analysis and factor analysis,9 categories and 13 common factors were obtained.Conclusion:Integrated traditional Chinese and western medicine treatment can reduce the risk of death,revascularization,and delay the first admission time of patients.TCM treatment for patients after PCI is mainly based on tonifying drugs and drugs for promoting blood circulation and removing blood stasis.Astragalus miltiorrhiza drug combination is the core drug combination for TCM treatment of patients after PCI.Part Ⅲ:Effect of Astragalus and salvia on myocardial ischemia-reperfusion injury and its mechanismObjective:To evaluate the efficacy and mechanism of astragalus salvia miltiorrhiza combination in myocardial ischemia-reperfusion rats.Methods:72 SD male rats were divided into sham surgery group,myocardial ischemiareperfusion group(I/R group),low,medium and high dose group and trametazine group according to stratified randomized method.After administration of 10d,the sham surgery group had thoracic threading but no ligation of the coronary arteries.Rats in group I/R and other drug groups were ligated with 45 min of anterior left branch followed by 3 h.The area of myocardial infarction(MI)and myocardial infarction(MI)risk area in rats was measured by Evans Blue and TTC staining after successful molding.Rat cardiomyocyte morphology was observed by HE staining,apoptosis was detected by TUNEL,ROS was detected by immunofluorescence and mitochondrial morphology was observed by TEM.Levels of lactate dehydrogenase(LDH)and creatine kinase isoenzyme(CKMB)were measured by biochemical method in rats,and levels of superoxide dismutase(SOD),malondialdehyde(MDA)and glutathione peroxidase(GSH-Px)were measured by enzyme-linked immunoassay.Expression of LC3II and FUNDC1 was detected by Western blot(WB).Results:Compared to the sham surgery group,I/R mice showed a significant increase in MKMB and MKMB risk areas.High and low doses of MKMB improved the MKMB risk area.while low and medium doses of MKMB improved the MKMB area(P<0.05).MKMB and LDH were significantly increased in the sham surgery group,while low doses of MKMB reduced the MKMB and MKMB were significantly reduced in the MKMB group.Conclusion:The combination of Astragalus salvia can improve myocardial injury,reduce myocardial apoptosis in myocardial ischemia-reperfusion rats,which may be associated with FUNDC1-mediated mitochondrial autophagy. |
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