Guan Tong Prescriptions’ Clinical Efficacy And Compatibility Mechanism On Prevention And Cure Of Implantation Restenosis After Stent

Restenosis rate of percutaneous coronary angioplasty and stent implantation is up to 20-30%, it seriously affects the implantation’s clinical efficacy. The restenosis of coronary heart disease is one of the difficulties and key issues affecting the prognosis of percutaneous coronary intervention. Prescription compatibility theory is the essence of medicine as well as a focal point on proprietary research study. Guan Tong Prescription, guided by traditional Chinese medicine theory, is created on the base of systematic analysis of the pathogenesis of implantation restenosis after stent, combined with modern medical theory and the researches related to pharmacology. The objective of this thesis is to explore the Guan Tong Prescriptions’clinical efficacy and compatibility mechanism on prevention and cure of implantation restenosis after stent (IRS).The first part covers clinical research. Objective:To investigate the clinical efficacy of Guan Tong Prescription’s prevention and treatment efficacy on IRS. Methods:randomly divided 120 coronary artery disease cases with successful stent implantation into control group (conventional western medicine group) and treatment group (conventional Western medicine+Guan Tong Crown),60 cases of each, and have systematical clinical research on the groups respectively. Results:1. Guan Tong reduced the rate of coronary IRS. Though of no statistical significance compared with the control group, (P> 0.05), it provided better prevention and treatment to postoperative recurrence of angina (P<0.01); 2.6 months after operation, the quantitative coronary angiography (CAG) review of both groups showed that the treatment group’s smallest diameter inside stent lumen diameter, lumen inner diameter and lumen area, were larger than the control group separately. Terminal diameter loss of treatment group is less than the control group (P<0.01); 3. Compared with control group,24h,7 days after stent implantation, Guan Tong significantly reduced inflammatory factors in serum C-reactive protein (CRP), tumor necrosis factor (TNF-a) and IL--6 (IL-6) levels (P <0.01).The second part covers experimental study. Vascular smooth muscle cells (VSMC) proliferation and migration is one of the main pathological bases of the IRS. Objective:make VSMC the target cells. With serum pharmacology research methods, observed the impact of Guan Tong and its disassembled prescription (Yiqi disassembled prescription, Stasis Resolving and Phlegm Eliminating disassembled prescription) on AngⅡ-induced rats’VSMC proliferation and related factors, in the hope to explore the mechanism of compatibility and restenosis control from cellular and molecular level. Methods:set rats’thoracic aorta VSMC cultured by tissue-sticking method as the object of study, induced the VSMC proliferation with Ang II. Cases were randomly divided into blank group, model group (Ang II group), Guan Tong group, Yiqi disassembled prescription group, and Stasis Resolving and Phlegm Eliminating disassembled prescription group. Observed the impact of the overall activity of VSMC proliferation through MTT colorimetry; observed cytoplasmic protein a-actin expression through immunochemistry staining (DAB color); detected the expression of regulatory gene c-fos and c-myc of VSMC with semi-quantitative detection through RT-PCR method.The results:1.Ang II promoted the VSMC proliferation by lowering a-actin expression, increasing the vitro-cultured proliferative activity values of VSMC(OD), and increasing the expression of regulatory gene c-fos and c-myc of VSMC;2. Guan Tong inhibited the inducement of Ang II and combining effect of VSMC proliferation (P<0.01) by increasing the expression of a-actin, reducing the expression of c-fos and c-myc. Though Yiqi disassembled prescription and Stasis Resolving and Phlegm Eliminating disassembled prescription group may have shown the inhibition to the VSMC, it is inferior to the description of Guan Tong.Conclusion:1. Guan Tong Fang can prevent the coronary restenosis after stent implantation, and have better control on prevention and treatment of postoperative recurrence of angina pectoris.2. Quantitative coronary angiography analysis showed that Guan Tong can improve the situation of vascular lesions.3. In the early period of stent implantation, Guan Tong Fang can significantly reduce inflammatory factors levels such as serum CRP, TNF-a, and IL-6.4. The inhibition of VSMC proliferation of Guan Tong Fang is related to its ability to increase the a-actin expression of vascular smooth muscle cells, change the phenotype of vascular smooth muscle cells, and reduce the VSMC regulatory gene c-fos and c-myc’s expression.5. The synergy of Yiqi, Stasis Resolving and Phlegm Eliminating medicine to the prevention and treatment of ISR indicates the description of Kwun Tong is scientific and rigorous.