| ST-segment elevation myocardial infarction(STEMI)is the most severe type of coronary artery disease,whose basic etiology is coronary atherosclerosis,resulting in luminal stenosis of one or more branches and inadequate myocardial blood supply,while the collateral circulation is not sufficiently established,on the basis of which a sharp reduction or interruption of coronary blood supply occurs,causing the corresponding myocardium develops severe and persistent acute ischemia.Ischemic preconditioning refers to the presence of transient ischemic symptoms prior to the onset of myocardial infarction,thereby increasing tolerance to persistent severe myocardial ischemia and reperfusion injury.Patients without ischemic preadaptation have more severe symptoms,higher risk,and a worse prognosis due to exogenous factors such as long prehospital delays and endogenous factors such as the inactivation of self-protection mechanisms,which deserve attention.Traditional Chinese medicine has long accumulated a wealth of theory and experience in the prevention and treatment of cardiovascular diseases.This study is divided into two parts:a retrospective clinical study and an experimental study.Through the retrospective study of cases of patients with STEMI without ischemic preconditioning and the experimental study of the effect of Shenqisuxin(SQSX)formula to improve acute myocardial ischemia in rats,this study provides ideas and an experimental basis for the combined treatment of STEMI without ischemic preconditioning with Chinese and Western medicine.Study 1:Pre-and post-adaptation changes of Traditional Chinese Medical(TCM)syndrome in STEMI without ischemic preconditioning.1 Objective:To explore the correlation between TCM syndrome and coronary lesions and the changes in TCM syndrome before and after percutaneous coronary intervention(PCI)through a retrospective study of patients with STEMI without ischemic preconditioning.The aim was to investigate the disease characteristics of STEMI without ischemic preconditioning,improve the level of diagnosis and treatment of patients,and provide ideas for the combined treatment of STEMI without ischemic preconditioning.2 METHODS:Patients with STEMI without ischemic preconditioning admitted to the cardiovascular department of Xiyuan Hospital,Chinese Academy of Traditional Chinese Medicine,from September 1,2019 to September 1,2022,were selected.General data,laboratory indices,coronary angiography results,pre-and post-PCI symptoms,and tongue and pulse signs of patients were collected,and the distribution of pre-PCI evidence,correlation with the degree of coronary lesions,and changes in TCM syndrome before and after PCI were analyzed using SPSS 25.0 software.3 Results:3.1 A total of 79 patients were included in this study,with 22 cases of qi deficiency and blood stasis,32 cases of phlegm and blood stasis,9 cases of qi stagnation and blood stasis,6 cases of cold clotting in the heart veins,3 cases of qi and yin deficiency,and 7 cases of positive deficiency and yang detachment.3.2 There were 61 males and 18 females,with no significant statistical differences in TCM syndrome of male and female TCM patterns.The average age of the patients was 60.37±11.82 years,with no significant statistical differences in age between the groups.There were 40 smokers and 39 non-smokers,with no significant statistical differences in TCM syndrome between the two groups.There were 26 drinkers and 53 non-drinkers,with no significant statistical differences TCM syndrome between the two groups.There were 47 cases of hypertension and 32 cases of no hypertension,with no significant statistical difference in TCM syndrome between the two groups.There were 34 cases of diabetes mellitus and 45 cases of no diabetes mellitus,with no significant statistical difference in TCM syndrome between the two groups.There were 38 cases of hyperlipidemia and 41 cases of no hyperlipidemia,and there was no statistically significant difference in TCM syndrome between the two groups.There was no significant difference in Total cholesterol(TC),Triglyceride(TG),Low density lipoprotein cholesterol(LDL-C),and Lipoprotein(a)(Lp(a))between the groups;but High density lipoprotein cholesterol(HDL-C)in the group with qi stagnation and blood stasis was lower than that in the group with qi deficiency and blood stasis and the group with both qi and yin deficiency,and the difference was statistically significant(P<0.05),and HDL-C in the group with qi stagnation and blood stasis was significantly lower than that in the group with phlegm and blood stasis,and the difference was also statistically significant(P<0.01).There was no significant statistical difference in the level of glycosylated hemoglobin between the groups.There was no significant statistical difference in the level of glycosylated hemoglobin between the groups.3.3 The number of lesion branches in the cold clotted heart group was higher than that in the qi deficiency and blood stasis group,and the difference was statistically significant;the number of lesion branches in the cold clotted heart group was significantly higher than that in the phlegm-stasis interconnection group,and the difference was statistically significant.3.4 The distribution of the postoperative patterns was 42 cases of qi deficiency and blood stasis,22 cases of phlegm and blood stasis,6 cases of qi stagnation and blood stasis,1 case of cold clotting in the heart,8 cases of both qi and yin deficiency,and 0 cases of positive deficiency and yang detachment.The most frequent conversion to other types of evidence was phlegmstasis evidence,with 15 cases,accounting for 44.12%of the total;the most frequent conversion of phlegm-stasis evidence to qi deficiency and blood stasis evidence was 10 cases,accounting for 29.4%of the total.4 Conclusion:4.1 Patients without ischemic preadaptation to STEMI are predominantly middle-aged and elderly,mostly between 51 and 70 years old,with a higher incidence in men than in women.4.2 The Chinese medical evidence of STEMI without ischemic preconditioning was dominated by phlegmostasis,qi deficiency,and blood stasis.The distribution of each evidence type was related to HDL-C;the correlation with gender,age,hypertension,diabetes,hyperlipidemia,TC,TG,LDL-C,Lp(a),uric acid,and glycosylated hemoglobin was not statistically significant and needs to be further explored.4.3 In the present study,the number of coronary artery lesions in the cold clotting group was higher than that in the qi deficiency and blood stasis group and the phlegm-stasis interconnection group,and there were no statistically significant differences in Gensini scores between the evidence types.The correlation between the degree of coronary artery lesions and ischemia-free preadaptation to STEMI in Chinese medical evidence needs to be further investigated.4.4 There was a statistically significant change in STEMI without ischemic preconditioning TCM evidence before and after PCI.predominantly solid evidence before PCI,and postoperatively,solid and critical evidence decreased to predominantly deficient evidence.Study 2:Improvement of acute myocardial ischemia in rats by SQSX Formula.1 Objective:To provide an experimental basis for the treatment of STEMI wthout ischemic preadaptation by combining Chinese and Western medicine through the experimental study of the effect of the empirical formula SQSX formula on acute myocardial ischemia in rats caused by pituitrin.2 Methods:SD rats,SPF grade,male and female,were randomly divided into 4 groups,namely,the normal group(gavage with equal volume of pure water),the model group(gavage with equal volume of pure water),the perindopril group(perindopril tert-butylamine tablets,0.36 mg/kg-1 body mass),and the SQSX group(6.40 g of raw drug/kg-1 body mass),gavage for 7 days,and sublingual injection of equal volume of saline in the blank group.ELISA was used to determine whole blood troponin T(cTnT),6-keto-prostaglandin F1α(6-keto-PGF1α)and endothelin-1(ET-1).Immunocompetitive assay was used to determine creatine kinase isoenzyme MB(CK-MB)and thromboxane B2(TXB2).Nitrate reductase assay was used to nitric oxide(NO).Colorimetric assay was used to superoxide dismutase(SOD),catalase(CAT),total antioxidant capacity(T-AOC),malondialdehyde(MDA),Ca2+-Mg2+-ATPase,and Na+-K+ATPase activity indexes.3 Results:Compared with the model group,lesions were reduced to varying degrees in all dosing groups,myocardial cells were roughly aligned,and sarcoplasmic homogeneity tended to be normalized.Compared with the model group,the perindopril and SQSX groups had significant inhibition of cTnT and CK-MB levels(P<0.01).Compared with the model group,the 6-keto-PGF1 and TXB2 levels were reduced in the perindopril and SQSX groups(P<0.01);the perindopril group significantly corrected the 6-keto-PGF1/TXB2 balance,and the SQSX group had the same effect,and the differences were statistically significant(P<0.01,P<0.05).Compared with the model group,both the perindopril group and the SQSX group had a significant effect on inhibiting ET-1 levels(P<0.01);both the perindopril group and the SQSX group had a significant effect on increasing NO levels(P<0.01).The NO levels in the perindopril group were significantly higher than those in the ginsenoside group,and the difference was statistically significant(P<0.01).Compared with the model group,both the perindopril tablet group and the SQSX group significantly increased SOD,CAT,and T-AOC levels(P<0.01)and inhibited the increase of MDA(P<0.01).The SOD levels in the SQSX group were significantly higher than those in the Perindopril group,and the MDA levels in the SQSX group were lower than those in the Perindopril group,with statistically significant differences(P<0.01,P<0.05).Compared with the model group,Ca2+-Mg2+-ATPase activity and Na+-K+-ATPase activity were elevated in the SQSX group,with statistically significant differences(P<0.01,P<0.05);Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were significantly higher in the SQSX group than in the perindopril group(P<0.01).4 Conclusions:SQSX formula.can reduce pit-induced myocardial ischemia and vascular injury by inhibiting oxidative stress,protecting vascular endothelium,inhibiting vasoconstriction,promoting vasodilation,and inhibiting calcium overload,among other pharmacological effects. |
PDF Full Text Request