| AimThecurrentstudy was to demonstrate the characteristicsandrisk factorsin patients with chest stuffiness associated with anxiety and depression,and to conduct a systematic review and meta-analysis on the effect of Yixinshu capsule on chest stuffiness associated with anxiety and depression.In addition,we carry out experimental study to explore the effect ofremote ischemic postconditioning(RIPOST)on anxiety and depression and its potentialmechanism,as well as to provide evidences for preventing and treating patients with chest stuffiness associated with anxiety and depression.Methods1.From March 2015 to September 2015,182 consecutive chest stuffiness patients who received coronary angiography(CAG)to department of cardiology,Jiangsu Province Hospital of TCM,were included in current study.Anxiety and depression were evaluated by GAD-7 and PHQ-9,respectively.Multiple logistic regression analyses were employed to evaluate risk factors of chest stuffiness associated with anxiety and depression.2.We searched clinical trials that evaluatedthe effects of Yixinshu capsule on chest stuffiness associated with anxiety and depression.Five studieswere included,and a total of 1250 patients were analyzed in currentmeta-analysis.3.24 male SD rats were randomly divided into 3 groups:sham operation group(n = 8),model group(n = 8),RIPOST group(n = 8).The rats in RIPOST group received 6 cycles of tourniquet wound around the right posterior limb and as close as possible to the inguinal region,10 minutes of ischemia and 10 minutes of reperfusion.Three cycles were performed daily at the same time.The intervention last for 2 weeks.The rats were sacrificed 2 weeks after the operation,the gastrocnemius tissues were taken,and some pathological sections were stained with H-E staining.The expression of CD31 was detected by immunofluorescence and the neovascularization density was measured.Western Blot method was used to detect the protein expression of p-AKT and VEGF.Results1.In current study,182 pateints were diagnosed as chest stuffiness,in which 60 patients(33.0%)with coronary artery stenosis less than 50%,and 122 patients(67.0%)with coronary artery stenosis at least 50%.The incidence of anxiety and depression in chest stuffiness patients is 59.34%and 8.79%,respectively.2.In simple correlation analysis,body mass index(BMI),diabetes,use ofhypoglycemic drugs,severity of coronary artery lesions,high density lipoprotein cholesterol,troponin I,and liothyronine were significantly associated(T3)with anxiety(all P<0.05).Further multi-variateanalysis c showed that the severity of coronary stenosis was associated with high risk of anxiety.(OR=2.425,95%CI:1.09?5.40,P=0.03).Subgroup analysis indicated that women with multi-vessel disease were more likely to have anxiety(P=0.04).Chinese medicine physical analysis showed that patients with uneven physique were more likely to have anxiety,and the first three uneven physique were phlegm constitution,blood stasis constitution and hot/humid constitution.3.In simple correlation analysisBMI,diabetes,hypoglycemic drugs,the severity of coronary artery lesions,FBG,HbA1C,left ventricular internal dimension(LVIDd),ejection fraction(EF),and left ventricular systolic dysfunction were significantly associated with depression(all P<0.05).Furthermulti-variate analysis showed that higher left ventricular ejection fraction was a protective factor of depression(OR=0.87,95%CI:0.79?0.97,P=0.009).Chinese medicine physical analysis indicated that chest stiffness patients with qi stagnation constitution were more likely to have depression.4 Meta-analysis indicated that Yixinshu capsule combined with western medicine were superior to single western medicine therapy in coronary artery disease patients with anxiety or depression(WMD =-5.79,95%CI:-7.56?-4.01,P<0.001)and(WMD=-4.76,95%CI:-7.54?-1.98,P<0.001),respectively.Compared to single western medicine therapy,ECG improvement was more significant in combined group(OR= 1.97,95%CI:1.22?3.17,P =0.006).There was no statistic difference between single western medicine therapy group and Yixinshu capsule combined with western medicine group in improvement of angina pectoris(OR= 2.18,95%CI:0.66?7.19,P =0.20).5.In animal study,compared with the model group,RIPOST operation could promote ischemic infarction gastrocnemius angiogenesis,decrease apoptosis and inflammatory state after ischemic infarction.In addition,our study showed that RIPOST could increasethe expreesion of vascular endothelial growth factor(VEGF)and p-AKT,which plays an important role in angiogenesis.Conclusion1.Chest stuffiness,as adiagnosis of traditional Chinese medicine,was not completely consistentto coronary heart disease,which might be associated with psycho-cardiology.2.Patients with higher coronary artery stenosis and women patients with multi-vessel lesion were more likely to have anxiety.Patients with decreased left ventricular function were more likely to have depression.3.Patients with uneven physique were more likely to have anxiety,and the first three uneven physique were phlegm constitution,blood stasis constitution and hot/humid constitution.Patients with qi stagnation constitution were more likely to have depression.4.Yixinshu capsule could effectively improve the status of anxiety and depression in patients with coronary heart disease.Meanwhile,ECG improvement was also observed.There was no statistic difference between single western medicine therapy group and Yixinshu capsule combined with western medicine group in improvement of angina pectoris.5.RIPOST could alleviate pathological changes of ischemic injury and promote angiogenesis.Furthermore,RIPOST may have the potentiality to improve the microcirculation and metabolism of brain,and then relieve the symptom of anxiety and depression. |
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