The Clinical Observation Of Replenishing Qi, Warming Yang, Resolving Stagnation Therapy On Diabetic Patients With Coronary Heart Disease And The Effects Of Serum Cystatin C

1 BackgroundWith the incidence of DM with CHD increased,it has become the main reason for disability or death in diabetic patients;it will not only affect the quality of life for patients and pose a serious threat to life,but also create an enormous financial burden for the society.Prevention and treatment of DM with CHD has become the focus of research in recent years.Domestic and foreign scholars attach great importance to this problem and have carried out a number of studies on DM with CHD.So far,however,the pathogeny has not yet been fully clarified;its clinical treatment is still mainly symptomatic treatment.Therefore,the search for effective disease control programs has become a top priority.TCM in the treatment of diabetes and its complications have a long history and rich experience,especially in the treatment of flexibility based on the prescription medication is the advantages of TCM,Therefore,the search for DM with CHD in Chinese medicine effective treatment methods will become more necessary.2 ObjectivesThe objectives of this clinical observation are to judge the curative effect of Replenishing Qi,Warming Yang,Resolving Stagnation Therapy(Ramuli Cinnamomi and Glycyrrhizae Decoction combined Gualou Xiebai Decoction) on DM with CHD according to the curative standard and verify the advantages of TCM; to explore its etiology and pathogenesis and probe into treatment of the law; to reveal its mechanism according to the changes of clinical symptoms and laboratory indexes before and after treatment;to search for the effective prescriptions and provide new ideas and methods for the prevention and treatment of DM with CHD.3 Contents and methods of studyThis paper consists of two parts,which are summaries of documents and a clinical observation.3.1 Theoretical and document researchTheoretical and document research includes the three parts.First of all, we review the modern medicine studies on DM with CHD in recent years,including epidemiological study,clinical manifestation,etiopathogenesis,laboratory examination and treatment,etc.Secondly,we focus on the biological characteristics of serum cystatin C,its determination and the relationship between Cys C and cardiovascular disease.Finally,introduce the traditional Chinese medical research progress about MD with CHD,including awareness of the Names of Disease,etiology and pathogenesis,experimental research, treatment based on syndrome differentiation,Chinese formulated products treatment,single drug research.3.2 Clinical observationThe clinical study observes the clinical effect of Replenishing Qi, Warming Yang,and Resolving Stagnation Therapy on treating DM with CHD.88 patients conforming to the diagnostic criterion were randomly divided into two groups,which are treatment group(45 patients) and control group(43 patients).Education and psychological adjustment,alimentary control,proper exercise,control blood glucose and symptomatic therapy were given to the control group,on the basis of suitable remedy,Chinese medicine was applied in the treatment group,which has the function of Replenishing Qi,Warming Yang,Resolving Stagnation.Take a dose twice a day.Two groups were treated for 8 weeks.The clinical symptoms,serum cystatin C,mALB,FPG,2hPG, glycosylated hemoglobin,blood lipid,electrocardiogram and ultrasonic cardiogram were observed.4 Results4.1 The result of clinical comprehensive efficacy:In treatment group, among the 45 cases,11 cases were markedly effective,18 cases were effective and 16 cases were ineffective,the total effective rate was 64.4%.As for the control group,among the 43 cases,9 cases were markedly effective,13 cases were effective and 21 cases were ineffective,the total effective rate was 51.1%.The total effective rate in treatment group is higher than in control group.By statistics,no-significant difference was revealed(P＞0.05).4.2 The result of Chinese medicine syndromes:In treatment group,among the 45 cases,5 cases were cured,11 cases were markedly effective,25 cases were effective and 4 cases were ineffective,the total effective rate was 91.1%.As for the control group,among the 43 cases,2 caseswerecured,8cases were markedly effective,15 cases were effective and 18 cases were ineffective, the total effective rate was 58.1%.The treatment group was superior to the control group in Chinese medicine syndromes efficacy(P＜0.01).4.3 Scores of syndrome of TCM:Compaired with pre-post treatment,scores of syndrome of TCM descented obviously(P＜0.01).It is clear that the scores of syndrome of TCM in treatment group and control group after treatment were significantly lower than that before treatment.Comparing the scores of syndrome of TCM between the two groups,there was significant difference between treatment group and control group(P＜0.01).4.4 Compaired with pre-post treatment,fasting plasma glucose descented in treatment group(P＜0.01).There was no significant difference in control troup before and after treatment(P＞0.05).Comparing the level of FPG between the two groups,there was significant difference(P＜0.01).The treatment group was superior to the control group in decreasing FPG.Compaired with pre-post treatment,two-hour postprandial plasma glucose descented in treatment group(P＜0.01).There was no significant difference in control troup before and after treatment(P＞0.05).Comparing the level of 2hPGbetweenthe two groups,there was significant difference(P＜0.05). The treatment group was superior to the control group in decreasing 2hPG.After treatment HbAlc was decreased in treatment group and control group. Compaired with pre-post treatment,the difference was statistically significant(P＜0.05).Comparing the level of HbAlc between the two groups, there was no significant difference(P＞0.05).4.5 After treatment mALB was decreased in treatment group and control group. Compaired with pre-post treatment,the difference was statistically significant(P＜0.05).Comparing the level of mALBbetweenthe two groups, there was no significant difference(P＞0.05).4.6 After treatment serum Cys C was decreased in treatment group and control group.Compaired with pre-post treatment,the difference was statistically significant(P＜0.01).Comparing the level of serum Cys C between the two groups,there was significant difference(P＜0.05).The treatment group was superior to the control group in decreasing serum Cys C.4.7 After treatment CHOL,TG and LDL-C were decreased in treatment group and control group.At the same time,HDL-C was increased.Compaired with pre-post treatment,the difference was statistically significant(P＜0.05). Comparing the levels of CHOL and HDL-C between the two groups,there were no significant differences(P＞0.05).Comparing the levels of TG and LDL-C between the two groups,there were significant differences(P＜0.05).The treatment group was superior to the control group in decreasing TG and LDL-C.4.8 The result of electrocardiogram efficiencies:In treatment group, among the 45 cases,16 cases were markedly effective,19 cases were effective and 10 cases were ineffective,the total effective rate was 77.8%.As for the control group,among the 43 cases,10 cases were markedly effective,14 cases were effective and 19 cases were ineffective,the total effective rate was 55.8%.The treatment group was superior to the control group in electrocardiogram efficiencies(P＜0.05).4.9 During treatment the two groups had no obvious side effects.Compaired with pre-post treatment,there were no significant differences in hemanalysis, hepatic funtion or renal function(P＞0.05).5 Conclusions5.1DM with CHD is nearly equivalent to "wasting-thirst" and "chest pain" according to TCM term,which can be referred to as the "Heart of Diabetes" It always changes from a long period of time.Some factors are relevant to the development of DM with CHD,such as old age and weakness, overstrain and internal injuries,improper diet,emotional maladjustment, obstinate disease,etc.Its disease-bit heart,lung,spleen,liver and kidney are closely related,which is syndrome of deficiency Ben and excessive Biao, deficiency and excess interlace each other.5.2 Qi and Yin Deficiency is the foundation of DM with CHD which makes deficiency of yin,yang,qi,blood.Among these,asthenia of heart qi and yang is the the key of pathogenesis,deficiency of spleen and kidney is central segment,phlegm turbidity and blood-stasis are present during the through course.5.3 We should strengthen body resistance to dispel pathogenic factors, be weighed against the lack of qi blood yin and yang,adjusting the partial failure of internal organs,especially paying attention to replenishing heart Qi and Wen Tong Xin Yang.At the same time,we should regulate Qi,activate the blood,Wen Tong and dissolve phlegm flexibly according to the actual situation,especially activating blood circulation and dredging the collaterals.In a word,Replenishing Qi,Warming Yang,Resolving Stagnation Therapy was emphasizing in particular.5.4 This clinical observation confirms that Replenishing Qi,Warming Yang, Resolving Stagnation Therapy can significantly alleviate the patients' clinical symptoms such as chest tightness,chest pain,etc.It can improve quality of life,reduce FPG and 2hPG,improve the state of myocardial ischemia, correct the disorders of lipid metabolism and reduce serum cystatin C.5.5 Its mechanism may be correlated with the regulation of glucose metabolism,correct the disorders of lipid metabolism,improve the state of myocardial ischemia and protect cardiac and renal function.5.6 The results show that the treatment group can reduce the level of serum Cys C.Dynamic detection of serum Cys C can be an index,the level of serum Cys C can provide reference for clinical medication because it can reflect the severity of CHD to a certain extent,it is an important predictor for secondary cardiovascular events and the risk of death among patients with known CHD.The relationship between Serum Cys C and DM with CHD also need more in-depth research,its mechanism remains to be further explored.Clinically,Cys C should be combined with other indicators of a comprehensive analysis,in order to make an objective assessment of development and prognosis of DM with CHD.5.7 During the course of the study,we have not found any adverse reactions.We think that this traditional Chinese medicine is safe and sure.This preliminary observation shows that traditional Chinese medicine has the following advantages,such as alleviate clinical symptoms,improve quality of life and amelioration clinic laboratory tests.Replenishing Qi,Warming Yang,Resolving Stagnation Therapy used in treating DM with CHD has the exact clinical efficacy,which is safety and hit the pathogenesis.So it is worthy of spreading.