Effects Of Xiao Ban Tong Mai Pill On Regulation Of Inflammatory Mediators In Rabbits With Atherosclerosis Model And Treatment Of Patients With Unstable Angina Pectoris

Objective To observe the treatment effects of Xiao Ban Tong Mai Pill on patients with unstable angina pectoris and the impression on arteria lipid plaque to explore the possible pharmacological mechanism .Methods 1. Ninety patients with unstable angina pectoris by TCM different the syndrom of phelgn heat and blood stasis were randomly divided into three groups: the Xiao Ban Tong Mai pill treated group , Simvastatin control group and Zhi Jing Ning pill tread group, each of them has 30 cases of patients. All of them have the same basic western medicine combined. The therapeutic course was four weeks, and followed up two monthes, to observe the incidence of acute cardiac events.2. The rabbit aoritic atherosclerotic model was developed by high cholesterol feeding. They were randomly divided into four groups: model group(n=12),Xiao Ban Tong Mai Pill group(n=12) ,Zhi Jiang Ning Pill group(n=12)and Simvastatin group(n=12). At the same time, there were 12 rabbits determined as normal group. By means of Enzyme-Linked Immunosorbent Assay (ELISA), the concentrations of serum TNF-a and IL-6 were measured. By means of Immunoturbidimetry, the concentrations of serum hs-CRP,apolipoprotein A₁( ApoA₁) and apolipoprotein B (ApoB) were measured. By means of enzymatic response mothods, the concentrations of serum total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured. The immunohistochemistry analysis were used to measure the expression of TNF-a and IL-6 in rabbit aortic atherosclerotic plaque and coronary atherosclerotic plaques. Then the aortas and hearts were harvested for morphometry observation.Results: 1. The clinical study showed that:After treatment, the clinical symptoms, electrocardiogram(ECG), cardiac function, TNF-a, sIL-6, hs-CRP, etc, had been obviously improved than that before treatment (P<0.05). The Xiao Ban Tong Mai pill could markedly alleviate pain of patients with unstable angina pectoric, improve the ECG of patients with myocardial ischemia and significantly decrease the dosage of nitroglycerin of patients with unstable angina pectoris, showing significantly higher advantage over simvastatin. The Xiao Ban Tong Mai pill could improve cardiac function and decrease the levels of hs-CRP,TNF-a and IL-6, were abviously superior to that in control group (P<0.05). The total effective rate of the Xian Ban Tong Mai pill on improving clinical symptoms of patients with unstable angina pectoris was 86.67%, and very superior to that of control group (P<0.05). All of the Xiao Ban Tong Mai pill ,simvastatin and Zhi jing Ning pill could decrease the levels of TC,TG,LDL-C,ApoB and promote the levels of HDL-C and ApoA₁, which were significant difference between before and after treatment (P<0.05). During following up, the incidence of acute cardiac events in treated group was lower than that of control group (6.67% ,20% and 26.67%).2.The animal experiment study showed that:The levels of serum TC,TG,LDL-C,ApoB were significantly lower in the Xiao Ban Tong Mai pill group than that in model group (P<0.05), but the levels of serum HDL-C and ApoA₁ were significantly higher in the Xiao Ban Tong Mai pill group than that in model group (P<0.05). The levels of serum TNF-a,IL-6 and hs-CRP in the Xiao Ban Tong Mai pill group were significantly lower than that in model group (P<0.05). The number of aortic atherosclerotic plaques and coronary atherosclerotic plaque were significantly less in the Xiao Ban Tong Mai pill than that in the model group (P<0.05).In addition, the ratio plaque to intimal area, the intima thickness, the thickness of atherosclerotic plaque, the media thinkness, the thickness ratio of intima to media, and positive staining percentage of TNF-a and IL-6 were also significantly less in the Xiao Ban Tong Mai pill group than that in the model group (P<0.01).Conclusion: These results indicate that the Xiao Ban Tong Mai pill could protect myocardial, decelerate the progression of atherosclerosis and eliminate (or stablize) atherosclerotic lipid plaque by decreasing the levels of hs-CRP,TNF-aand IL-6, by inhibiting expression of TNF-a and IL-6 in atherosclerotic plaque, by regulating lipometabolism and the abnormality of blood lipid and improving endothelial function. The mechanism of decelerating atherosclerotic progression and eliminate the coronary lipid plaque by the Xiao Ban Tong Mai pill may be related to inhibiting inflammatory reaction in atherosclerotic plaque, separating combination of CRP in body and inhibiting effect which c-reactive protein could promote inflammatory reaction.