| Coronary atherosclerotic heart disease(CHD)is one of common serious cardiovascular diserses.West medicine and traditional Chinese medicine(TCM) have reserched it a lot and got great progress.TCM has irreplaceable adventage in the viewpoint of concept of wholism,syndrome differentiation and treatment should search for etiological factor compared with western medicine.Strengthening kidney therapy aiming at pathogenesis and treating the fundamental aspect of the diseases was supported by the TCM theory and clinical effects,and is one of important therapeutic methods of TCM in treating coronary atherosclerotic heart disease.This therapeutic method has a huge application prospect and worthy of deepening research.This thesis is consist of theory study and clinical study.Theory studyReviewing ancient documents and modern research progress,CHD belongs to Thoracic Obstruction,Precordial Pain,Angina Pectoris,which recorded in Chinese ancient classics Canon of Medicine and Golden Chamber.Ancient TCM thinks that Its pathogenesis was Insufficiency of Yang and Endogenous Excess of Yin Pathogens,modern TCM is Qi,yang,blood,yin deficiency of heart or kidney,liver and spleen dysfunction have both phlegm,turbid substance,blood -stasis,Qi stagnation and cold coagulation.Professor Luo Luyi thinks that kidney is the inborn origin of the body,kidney deficiency would cause other visceras deficiency,so all diseases result from kidney disorder.The sick position of coronary atherosclerotic heart disease is in heart,but the disease originates from kidney.Kidney deficiency,especially kidney-yang deficiency has both phlegm,turbid substance,blood-stasis is the basic reason of atherosclerosis and coronary heart disease.Kidney-yang deficiency has both phlegm,turbid substance,blood-stasis syndrome is the most common syndrome.Warm the kidney resolve phlegm activate the blood prescription was given on the treatment of coronary heart disease with angina pectoris can stop its occurrence and development.According to modern medical theory,coronary heart disease is mainly due to coronary atherosclerosis which was the result of arterial wall cells, extracellular matrix,blood component(mononuclear cell,platelet, low-density lipoprotein),local hemodynamics,environmental and genetic multiple factors injury artery endothelial cell to cause arterial wall chronic inflammation.All the IL-18,hs-CRP,Hey was a independent risk factor for coronary artery disease.Clinical studyObjective:To study the relation between the cause and pathogenesis of coronary heart disease with angina pectoris and kidney deficiency,as well as the effects and mechanisms of strengthening kidney prescription in the treatment of coronary heart disease with angina pectoris,which provides beneficial ideas and new evidence for the prevention and treatment of coronary angina pectoris.Methods:105 patients of stable angina pectoris accorded with diagnostic standards were selected and divided by randomly single blind into experiment group (35cases),western medicine group(35cases)and patent traditional Chinese medicine group(35cases),all gave the same base treatment or dosing Aspirin 100 mg each day.Wen Shen Tong Luo Prescription was dosed twice a day in experiment group,Isosorbide Mononitrate Sustained Release Tablets 40mg was dosed once a day in western medicine group and Shexiang Baoxin Wan 50mg was dosed three times a day in patent traditional Chinese medicine group,30 day for one course of treatment.The clinical effects and influence on ECG, discontinue rate of nitroglycerin,blood-lipid,hemorheology,IL-18,hs-CRP,Hcy were observed before and after treatment in each group.Result:In general efficacy,significant difference were found among three groups (P＜0.01),multiple comparison showed significant difference between experiment group and western medicine group,experiment group and patent traditional Chinese medicine group(P＜0.01),no significant difference between western medicine group and patent traditional Chinese medicine group(P＞0.05).In effects of improvement of angina pectoris,intra-group comparisons showed very significant difference on reduce the onset frequency and severity of angina pectoris between pre-and post-treatment(P＜0.01)in each group. Multiple comparison showed significant difference between experiment group and western medicine group,experiment group and patent traditional Chinese medicine group(P＜0.01).There was significant diffierence of curative effect in traditional Chinese medicine symptoms among three groups(P＜0.05).Multiple comparison showed significant difference between experiment group and western medicine group,very experiment group and patent traditional Chinese medicine group (P＜0.01),significant difference between western medicine group and patent traditional Chinese medicine group(P＜0.05).In electrocardiogram improvement,there was significant diffierence of curative effect among three groups(P＜0.05).Multiple comparison showed significant difference between experiment group and western medicine group, experiment group and patent traditional Chinese medicine group(P＜0.01), significant difference between western medicine group and patent traditional Chinese medicine group(P＜0.05).There was significant diffierence of curative effect in discontinue rate of nitroglycerin among three groups(P＜0.05).Multiple comparison showed significant difference between experiment group and western medicine group (P＜0.01),experiment group and patent traditional Chinese medicine group (P＜0.05),no significant difference between western medicine group and patent traditional Chinese medicine group(P＞0.05).Intra-group comparisons showed very significant difference on the TC, TG,LDL-C,HDL-C between pre-and post-treatment(P＜0.01)in experiment group,no significant difference in western medicine group and patent traditional Chinese medicine group(P＞0.05).Multiple comparison showed significant difference on the TC,TG,LDL-C,HDL-C between experiment group and western medicine group,experiment group and patent traditional Chinese medicine group (P＜0.05).In hemorheology improvement,there was significant diffierence of effect in blood viscosity,blood reduced viscosity,plasma viscosity,hematocrit, erythrocyte aggregation index,plasma fibrinogen among three groups(P＜0.01). Multiple comparison showed significant difference between experiment group and western medicine group(P＜0.01),experiment group and patent traditional Chinese medicine group(P＜0.01)on blood reduced viscosity,plasma fibrinogen.Intra-group comparisons showed very significant difference on the IL-18 between pre-and post-treatment(P＜0.01)in experiment group and patent traditional Chinese medicine group,no significant difference in western medicine group(P＞0.05).Multiple comparison showed significant difference between experiment group and western medicine group(P＜0.01),no significant difference between experiment group and patent traditional Chinese medicine group,western medicine group and patent traditional Chinese medicine group(P＞0.05).Intra-group comparisons showed very significant difference on the hs-CRP between pre-and post-treatment(P＜0.01)in experiment group,no significant difference in western medicine group and patent traditional Chinese medicine group(P＞0.05).Multiple comparison showed no significant difference between experiment group and western medicine group,experiment group and patent traditional Chinese medicine group,western medicine group and patent traditional Chinese medicine group(P＞0.05).Intra-group comparisons showed very significant difference on the Hcy between pre-and post-treatment(P＜0.01)in experiment group and patent traditional Chinese medicine group,no significant difference in western medicine group(P＞0.05).Multiple comparison showed significant difference between experiment group and western medicine group,experiment group and patent traditional Chinese medicine group,western medicine group and patent traditional Chinese medicine group(P＜0.01).Conclusion:1.CHD belongs to thoracic obstruction,precordial pain in TCM,was deficiency in origin and excess in superficiality,or deficiency of heart, liver,spleen and kidney,phlegm,turbid substance,blood-stasis block heart vessels.The sick position of coronary heart disease is in heart,but the disease originate from kidney.Kidney-yang deficiency is most common in kidney deficiency syndrome,which lead to deficiency of heart-yang and spleen-yang, stagnation of blood,disorder fluid metabolism to cause production of phlegm, turbid substance,blood-stasis.Therefore,kidney deficiency,especially kidney-yang deficiency has both phlegm,turbid substance,blood-stasis is the main pathogenesis of CHD.Kidney-yang deficiency has both phlegm,turbid substance,blood - stasis syndrome is the most common syndrome.2.Through the clinical observation of 105 patients of stable angina pectoris,it is found that the effect of Wen Shen Tong Luo Prescription is better than the two control groups in general efficacy.All the three groups could remarkably reduce the onset frequency and severity of angina pectoris,but experiment group was better than the two control groups.In electrocardiogram and discontinue rate of nitroglycerin improvement, experiment group was better than the two control groups that show Wen Shen Tong Luo Prescription had a better function to improve coronary blood flow and protect myocardial cells.Wen Shen Tong Luo Prescription was also better than Isosorbide Mononitrate Sustained Release Tablet and Shexiang Baoxin Wan in traditional Chinese medicine symptoms.Wen Shen Tong Luo Prescription could remarkably decrease the level of TC,TG,LDL-C,increase the level of HDL-C;both two controls no effect on TC,TG,LDL-C and HDL-C.The hemorheology observations demonstrated that blood viscosity,blood reduced viscosity,plasma viscosity, hematocrit,erythrocyte aggregation index,plasma fibrinogen in all the three groups reduced remarkably,but experiment group was better than the two control groups that shows Wen Shen Tong Luo Prescription had good effects in lowering blood lipid,lowering blood viscosity and improving the haemorheology.3.Wen Shen Tong Luo Prescription could obviously lower both the level of IL-18 and hs-CRP,restrain inflammatory response,protect vascular endothelial cells,stop atherosclerosis occurrence and development.4.Hcy obviously down-regulation after treatment showed Wen Shen Tong Luo Prescription could regulate the Hcy metabolism,reduce the cardiovascular damage induced by higher levels of HCY,inhibit the proliferation and migration of vascular smooth muscle cells,increase anti-coagulation activity,reduce the platlete adhesion.
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