| Objective:To systematically evaluate the clinical effect of Heart-Spleen treatment together of angina pectoris of coronary heart disease and through the experimental observation Tiaopihuxin prescription on acute myocardial infarction in the rat CK-MB,cTnI,AST,LDH,MDA,SOD,Na1+-K1+ATP enzyme,Ca2+-Mg2+ATP enzyme of compare and then myocardial cell pathology observation,and The influence of the expression of AMPK protein and other indexes.Discussion on the mechanism of Tiaopihuxin prescription on myocardial energy metabolism after acute myocardial infarction,so as to provide theoretical and experimental basis for making clinical diagnosis and treatment plan of integrated traditional Chinese and Western medicine.Methods:1.Meta analysis:A computer search was performed using CJFD,CNKI,CHKD,PubMed and other databases to identify from January 2007 to December 2017 published with the relevant Chinese medicine on randomized controlled trials of treatment of patients with angina pectoris of coronary heart disease from Heart-Spleen treatment together,Manual retrieval of references one by one,and after quality evaluation,the final inclusion of literature and then subjected to meta-analysis using Review Manager 5.3.2.The animal experiment:?1?The 64 standard experimental rats were randomly divided into four groups,namely the Tiaopihuxinprescriptionhigh-dosegroup,Tiaopihuxinprescriptionlow-dose group,trimetazidine group?western medicine group?and model group,16 in each group,at the same time,in addition to select 16 of normal rats as normal control group.?2?The rat model of acute myocardial ischemia was induced by isoproterenol.The rats were intraperitoneally injected with ISO 5mg/kg/d for 5 days.Administration of high dose group respectively according to 23.4mg crude drug/kg/d,low dose group 5.85mg crude drug/kg/d,western medicine group 10mg/kg/d,model group and normal control group were given normal saline 2ml/100g/d,continuous gavage for 28 days,Collection of specimens.?3?Determination of serum myocardial enzyme levels in rats after experiment by enhanced chemiluminescence.?4?After the experiment was evaluated by immunohistochemical method all live in the myocardial tissue of rats Na1+-K1+ATP enzyme,Ca2+-Mg2+ATP enzyme content?5?Observation of pathological changes of myocardium by HE staining under electron microscope.?6?Detection of AMPK protein and mRNA expression in myocardial tissue by Western blot and RT-PCR.?7?The results of the experiment were processed by SPSS 18.0 software for statistical processing.Results:1.Meta analysis:A total of 18 RCTs and 1466 patients were included in the meta-analysis and all for Chinese,Jadad score of 2 studies were 4,5 studies were 3 and others studies were 2.The observation group was added to the traditional Chinese medicine of Heart-Spleen treatment together on the basis of the traditional western medicine,and the control group was the conventional western medicine.The Meta-analysis showed that the observation group improved the clinical curative effect of angina pectoris better?0R=3.47,95%CI[2.45,4.93],p<0.00001?;improve the curative effect of electrocardiogram better?0R=2.35,95%CI[1.73,3.18],p<0.00001?;reduce the total cholesterol?WMD=-0.77,95%CI[-1.19,-0.36],p=0.0003?;reduce low-density lipoprotein?WMD=-0.51,95%CI[-0.75,-0.26],p<0.0001?;reduce triglyceride?WMD=-0.21,95%CI[-0.33,-0.08],p=0.001?.2.The animal experiment:?1?After the end of the experiment of each rat myocardial enzyme test data analysis found that the model group,the western medicine group,low dose group of CK-MB and cTnI index level no obvious difference compared with normal control group,there was no statistically significant difference?P>0.05?,but high dose group compared with model group decreased obviously,the difference was statistically significant?P<0.05?.The western medicine group,high dose group,low dose group of AST,LDH index level were significantly decreased compared with the model control group?P<0.01?,compared with the western medicine group,the LDH index level of the Tiaopihuxin prescription high-dose group was not different from that of the western medicine group?P>0.05?.high dose group and low dose the amount of groups had a significant difference?P<0.01?.?2?After the end of the experiment,the normal control group,western medicine group,low dose group,high dose group MDA values were lower than the model group?P<0.01?,the SOD value is higher than the model control group?P<0.01?,high dose group,low dose group and trimetazidine hydrochloride group showed significant difference between the groups?P<0.01?.?3?After the end of the experiment,observation of pathological changes in the myocardium of each group.It was found that the myocardial fibers in the model group were disorder,twisting,breaking,widening of the muscle fiber gap,local dissolution and necrosis,loosening and edema of the tissue,and the abnormal shape,aggregation and rupture of the myocardial nuclei,and the distraction and confusion.The Tiaopihuxin prescription high-dose group myocardial cell and the trimetazidine group were have different degrees of necrosis,but the spleen mindarmor party myocardial necrosis of Tiaopihuxin prescription high-dose group was obviously better than model group and necrotic degree is lower than the normal control group.In the low dose group,the heart tissue was flaky necrosis,and some of the myocardial cells were partially condensed,dissolved and stained,and the structure was fuzzy,The degree of necrosis in the low dose group was higher than that of the high dose group and the trimetazidine group.?4?After comparing the activities of Na1+-K1+ATP enzyme and Ca2+-Mg2+ATP enzyme in each group,It was found that the activities of Na1+-K1+ATP enzyme and Ca2+-Mg2+ATP enzyme in each group were all higher than those in the model control group?P<0.01?.Compared with trimetazidine group,,including high dose group ofNa1+-K1+ATP enzyme index levels compared with trimetazidine group no significant difference?P>0.05?.Chinese traditional medicine is there was a significant difference in the way?P<0.01?.?5?After the experiment,the expression of AMPK alpha 2 protein and mRNA in each group of rats showed that the expression of AMPK alpha 2 protein and mRNA was significantly different from that of the model group?P<0.01?.There was no significant difference between the high dose group and the western medicine group?P>0.05?.The high dose group,the western medicine group and the low dose group had significant difference?P<0.01?.Conclusion:1.Meta analysis:On the basis of conventional western medicine,the curative effect of Heart-Spleen treatment together of treating angina pectoris of coronary heart disease is better,the benefit is more obvious,and the safety is higher.2.The animal experiment:?1?Tiaopihuxin prescription can reduce myocardial enzymes,reduce MDA activity and improve SOD activity in AMI rats,which can repair and protect the myocardial cells damaged by AMI rats,and it is effective in treatment.?2?Tiaopihuxin prescription can improve the level of Na1+-K1+ATP enzyme and Ca2+-Mg2+ATP enzyme in AMI rats,promote the expression of AMPK alpha 2 protein and mRNA,it can promote the improvement of myocardial energy metabolism in AMI rats,and promote the improvement of treatment.?3?Tiaopihuxin prescription has the relationship of drug dose concentration in AMI,and it can increase the dosage of Tiaopihuxin prescription in a certain range,which can improve the therapeutic effect.?4?There was no obvious adverse drug reaction in the clinical observation and animal experiment of the Tiaopihuxin prescription. |
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