Coronary Heart Disease Patients With Stable Toxin Induced Change "hypothesis And Its Clinical Manifestations

In recent years,inflammatory reaction and vulnerable atherosclerotic plaque have been highlighted for its role in leading to acute cardiovascular event(ACE),which provides a good opportunity to innovate pathogenesis theory of coronary heart disease in view of traditional Chinese medicine(TCM).Inflammatory reaction results in rupture of vulnerable atherosclerotic plaque and thrombosis.Many pathologic procedures,such as vascular endothelial injury,tissue necrosis and inflammatory media,which involved in this course,are closely associated with 'internal-toxin' and 'external-toxin' of the pathogenic toxin theory in TCM.My tutor academician Chen Ke-ji and his colleagues firstly put forward 'blood-stasis & toxin causing catastrophe' and ACE according to views of TCM on 'blood-stasis' and 'toxin',as well as updated concept of modern medicine on atherosclerosis and coronary heart disease.In order to demonstrate this hypothesis,a prospective study was conducted in stable patients of coronary heart disease(CHD),combining with determination of high-sensitivity C-reactive protein(hs-CRP) and one year follow-up of ACE,in order to define the clinical manifestation of 'blood-stasis & toxin'.Clinical studyⅠ:Study on relationship between syndrome-differentiation and high-sensitivity C-reactive protein in stable patients of coronary heart diseaseObjective:To study the relationship between syndrome-differentiation and hs-CRP in stable patients of CHDMethod:From September 2007 to November 2008,346 stable CHD cases diagnosed by coronary angiography in China-Japan Friendship Hospital were enrolled.The clinical data were recoded and the serum hs-CRP was determined,based on which the correlation between syndrome-differentiation and serum hs-CRP was analyzed.Results:Among 346 stable CHD patients,Qi deficiency and blood-stasis,Yang deficiency and blood-stasis,Qi deficiency, blood-stasis and phlegm- turbidity were the most common complex syndrome types.As for syndrome element,blood-stasis,Qi deficiency and phlegm-turbidity were the dominant ones.According to hs-CRP,there was no significant difference among different complex syndrome types and syndrome elements(P＞0.05).However,for patients with phlegm-turbidity syndrome,the concentration of hs-CRP was much higher in patients of phlegm-heat syndrome than that in patients of non-phlegm-heat syndrome (p＜0.01).Blood-stasis syndrome score did not correlated with the concentration of hs-CRP(person correlation coefficient:0.069, p=0.203).Conclusion:There is close relationship between phlegm-heat syndrome- differentiation in stable CHD Patients and the concentration of hs-CRP.As an inflammatory biomarker,hs-CRP is also one of microcosmic indices of 'toxin' in category of traditional Chinese medicine.This study provided the pathogenesis hinge of 'accumulated heat to transform toxin' with objective evidence,which need demonstration by further study.Clinical studyⅡ:The investigation of tongue manifestation in stable coronary heart disease patients with acute cardiovascular event in one year follow-up.Objective:To study tongue manifestation in stable CHD patients with ACE in one year follow-up.Method:Up to April 2008,254 cases among 346 stable CHD patients in Study I have finished half a year and one year follow-up.The tongue manifestation was recoded by the same size camera.During one year follow-up period,29 patients developed ACE,controls(54 cases) were matched in proportion of 2:1 according to gender,age(±5 years),diabetes mellitus and ACS history,based on which the correlation between tongue manifestation and ACE were analyzed.Results:Tongue manifestation analysis showed that deep red tongue, dark tongue,light purplish tongue,dark purplish tongue and purplish cyan tongue were the most common tongue colour in stable CHD patients.Almost all stable CHD patients manifested sublingnal vessal abnormity,such as coarse and crooked sublingnal vessel,which colour is purplish blue or purplish red.Most stable CHD patients manifested plump tongue and teeth-printed tongue,based on which with greasy fur and fissure.Crimson tongue,thin tongue,exfoliative tongue and rough or dry fur is rarely manifested in these cases.Among 83 patients,15 cases with cyan tongue, 11 cases(37.9%) with ACE,4 cases(7.4%) without ACE,there was significant difference(p=0.002);There was no difference between ACE and non-ACE in other tongue color.29 caes with yellowish fur,3 case(10.3%) in ACE,26 cases(48.1%) in non-ACE,there was significant difference between two groups(p=0.001);The rough and greasy coating of the tongue in patients with ACE is significantly higher than that with non-ACE (p=0.026);Purplish red sublingnal vessal in patients with ACE ishigher than that with non-ACE(p=0.041).By odd rate analysis showed that the rough and greasy coating of the tongue in patients was more likely to experience ACE(OR:3.12,95%CI:0.89～10.92);The purplish redsublingnal vessal in patients also predicted ACE(OR:2.76,95%CI:1.02～7.44);The patients with bluish tongue(or purplish blue tongue) had higher ACE than patients with non-bluish tongue(OR:11.67,95%CI:3.34～40.81).Conclusion:Tongue manifestation analysis manifests that blood-stasis is the major pathogenesis in stable CHD patients.Deficiency of Qi and insufficiency of Yang and hyperactivity of phlegm-dampness is another characteristic of pathogenesis in these patients.The purplish red sublingnal vessel and cyan tongue(or purplish cyan) are probable tongue manifestations of 'blood-stasis & toxin';the tongue coating changing from mucously greasy to roughly greasy or dirty greasy is also probably the main tongue manifestation of 'transforming toxin',which need demonstration by further study.Clinical studyⅢ:The study on clinical manifestation for 'blood-stasis & toxin' in stable coronary heart disease patientsObjective:To study clinical manifestation for 'blood-stasis & toxin' in stable CHD patients according to ACE in one year follow-up.Method:254 cases who finished one year follow-up were enrolled.The relationship between ACE and status of angina pectoris,past history, symptoms,characteristic of onset,TCM Syndrome-differentiation or examination in stable CHD patients was analysed by single-variate and multi-variates logistic stepwise regression method,in order to further define the clinical manifestations of 'blood-stasis & toxin'.Results:According to single-variate analysis,52 patents had retrosternodynia,11 cases(21.2%) with ACE,while 202 patiens had no retrosternodynia,17 cases(8.4%) with ACE,there was significant difference(p=0.009);The average level of TG in patients with ACE was 1.21±0.60,and 1.66±1.15 with non-ACE,there was significant difference between ACE and non-ACE(p=0.009);The average level of atherosclerosis index(AI) in patients with ACE was 3.48±0.99,and 4.04±1.49 with non-ACE,there was significant difference between ACE and non-ACE(p=0.025);FBG in cases with ACE was 6.36±1.59,and 5.97±1.83 with non-ACE,there was significant difference between ACE and non-ACE (p=0.024);Among 226 cases with non-ACE,50 cases(22.1%) with hsCRP≥3mg/L,while 28 cases with ACE,11 case(39.3%) with hsCRP≥3mg/L,there was significant difference between two groups(p=0.045);52 patents had headache,and 11cases(21.2%) with ACE,while 202 patients had no headache, and 17 cases(8.4%) with ACE,there was significant difference between two groups(p=0.009);99 patents had tinnitus,17cases(17.2%) with ACE, while 155 patients had no tinnitus,11 cases(7.1%) with ACE,there was significant difference between two groups(p=0.012);45 cases had pharyngodynia usually,10 cases(22.2%) with ACE,while 209 cases had no pharyngodynia,18 cases(8.6%) with ACE,there was significant difference between two groups(p=0.015);7 cases had hesitant pulse,4 cases(57.1%) with ACE,while 247cases had no hesitant pulse,25 cases(10.1%) with ACE, there was significant difference between two groups(p=0.003);By multivariate logistic regression analysis,hesitant pulse appeared as the most predictive sign for ACE in this study(OR=3.096,95%CI:3.333-146.792, P=0.001),the other signs were retrosternodynia(OR=1.118,95%CI: 1.168-8.007,P=0.023),pharyngodynia(OR=1.033,95%CI:1.013-7.785, P=0.047) and headache(OR=0.994,95%CI:1.013-7.207,P= 0.047) in turn. Hs-CRP≥3mg/L showed a predictive trend for ACE,but logistic analysis showed no statistics difference(P=0.094).Conclusion:Retrosternodynia,headache and hesitant pulse are the typical symptoms of blood-stasis,while pharyngodynia usually and increased hs-CRP hint chronic inflammatory reaction in the body,which is one of clinical manifestation of 'toxin' All the above symptoms, signs and laboratory index may be considered as clinical manifestations of 'blood-stasis & toxin',which need demonstration by further study.