| Chinese medicine has made remarkable achievements in the treatment of patients with acute coronary syndrome after interventional therapy.Syndrome differentiation is the basic characteristics of Traditional Chinese Medicine.The modern specificity examination and inspection indexes provided the basis making TCM syndrome differentiation more objective and quantitative.Acute Coronary Syndrome belongs to "true heartache", "Chest pain" in Traditional Chinese Medicine. Patients with acute coronary syndrome after percutaneous coronary intervention can be treated with traditional Chinese medicine and can get significant effect.Conventional Western medicine combined with traditional Chinese medicine can significantly improve the symptoms of patients after intervention.This paper analyzes the correlation between TCM Syndrome Types and ejection fraction in patients with acute coronary syndrome after interventionaltherapy,observes the efficacy of conventional Western medicine combined with traditional Chinese medicine dialectical therapy on patient after an acute coronary syndrome,to provide the basis for clinical differentiation of TCM and evidence for evidence-based medicine in the treatmentThis thesis is divided into two parts:literature review and clinical study.Literature review:including the following two parts1.The progress of acute coronary syndrome type of TCMThis part sorts out the research progress of Chinese medicine in the etiology and pathogenesis of ACS,summarizes its syndrome differentiation relating to the state, industry classification standards and the relationship between biological indicatorsand Chinese Medicine Syndrome Classification.Most of the studies are of different sample size or of sample size and other limitations.Therefore,there has practical significance to study the correlation between objective biological index and TCM syndrome differentiation type.2.Research progress of TCM syndrome differentiation in patients with acute coronary syndrome by Ultrasonic echocardiographyBy summarizing the pathogenesis of acute coronary syndrome, the principle and the index of echocardiography in the diagnosis of ACS and the relationship between various echocardiographic indexes and TCM syndrome types,we found that some indexes of echocardiography are related to phlegm turbidity and blood stasis, but its relevance needs further clinical studies to confirm.Clinical research:including the following two parts:Study I:the correlation between ejection fraction and TCM syndrome after interventional therapy in acute coronary syndrome patients.Objective:To analyze the correlation between the three types of TCM Syndrome Types and ejection fraction in patients with acute coronary syndrome after interventional treatment, and to provide the basis objective of TCM syndrome differentiation.Methods:A total of 357 cases of acute coronary syndrome patients after interventional therapy was enrolled and classified into three types:Qi deficiency and blood stasis, phlegm and blood stasis, blood stasis. The three syndrome types as the dependent variable, ejection fraction as the independent variable, non conditional logistic regression analysis is performed.Results:1.On the ejection fraction,there is no significant difference among Qi deficiency and blood stasis, phlegm and blood stasis, blood stasis. (p=0.263).2.There is no correlation between the three types of syndrome and ejection fraction after ACS intervention.Conclusion:There is no correlation between the ejection fraction and the three types of TCM Syndrome Types in patients with acute coronary syndrome after interventional therapy.Study II:the effect of TCM syndrome differentiation treatment on patients with acute coronary syndrome after PCI.Objective:To explore the clinical effect of TCM syndrome differentiation treatment on acute coronary syndrome after interventional therapy.Methods:A total of 357 cases was randomly divided into two groups:treatment group 208 cases and control group 149 cases.The treatment group is divided into Qi deficiency and blood stasis, phlegm and blood stasis type, blood stasis type,and treated with Qishen Yiqi Dropping Pills, Danlou tablets and Guanxin Danshen Dropping Pills for six month respectively based on conventional western medicine. Patients in control group are given only the routine treatment of Western medicine drugs. The ejection fraction, left ventricular end diastolic diameter, blood lipid, blood coagulation, blood stasis syndrome integral and TCM symptom score were recorded and compared between the two groups.Result:1. Ejection fraction and left ventricular end diastolic diameter:(1) In sixth months,the ejection fraction of the treatment group is higher than that of the control group, the difference is statistically significant (P=0.040); In twelfth months,the ejection fractionbetween the treatment group and the control group is not statistically significant (P>0.05). In sixth mouths,there is no significant difference in left ventricular end diastolic diameter between the two groups (P>0.05). The left ventricular end diastolic diameter of the treatment group is lower than that of the control group in twelfth months (P=0.030). (2) At the time of entry, because of the differences in left ventricular end diastolic diameter and ejection fraction between the two groups forQi deficiency and blood stasis type,so we further compare the difference showing in the two groups for 6 months and 12 months later.We find the change of the treatment group in left ventricular end diastolic diameteris greater than the control group, the treatment effect is better than the control group (P=0.036P=0.042).There is no significant difference in ejection fraction (P>0.05).(3) In phlegm and blood stasis type,in sixth months and twelfth months,the ejection fraction in the treatment group is higher than in the control group, the difference is statistically significant (P=0.017, P=0.032),and the left ventricular end diastolic diameter in the treatment group is significantly lower than thatin the control group, the difference is statistically significant (P=0.034, P=0.004). (4) In blood stasis type,there is no significant difference in ejection fraction and left ventricular end diastolic diameter between the treatment group and the control group in sixth months and twelfth months (P>0.05).2.TCM symptom score:(1) At the time of entry,there have differences score between the two groups in TCM symptom,so we further compare the phase difference,and find the differences between the two groups is not obvious in sixth months (P>0.05), and the changes in the treatment group are greater than in the control group in sixth months(P<0.001). (2) In Qi deficiency and blood stasis type,there has no significant difference in TCM symptom score between the treatment group and the control group in sixth months and twelfth months (P>0.05).(3) At the time of entry,there have differences in TCM symptom score between the two groups for Phlegm and blood stasis type,so we further compare the phase difference,and find the changes in the treatment group is higher than in the control group in sixth months and twelfth months(P=0.005, P<0.001).(4)In blood stasis type,there is no significant difference in TCM symptom score between the treatment group and the control group after 6 months (P>0.05),but the TCM symptom score of the treatment group is lower than the control group, the difference is statistically significant (P= 0.011).3.Blood stasis score:(1) At the time of entry,there has difference in blood stasis score between the two groups,so we further compare the phase difference,and find that the differences between the two groups are not obvious in sixth months (P>0.05), and the changes in the treatment group are higher than in the control group in twelfth months(P<0.001).(2) In qi deficiency and blood stasis type,there is no significant difference in blood stasis score between the treatment group and the control group in sixth months and twelfth months (P>0.05).(3) At the time of entry,there have differences in blood stasis score between the two groups for Phlegm and blood stasis type,so we further compare the phase difference,and find that the differences between the two groups are not obvious in sixth months (P>0.05), and the changes in the treatment group are higher than in the control group in twelfth months(P=0.004). (4) In blood stasis type,there have no significant differences in blood stasis score between the treatment group and the control group in sixth months and twelfth months (P>0.05).4.Blood lipids:(1)The level of TC in the treatment group is lower than the control group in sixth months and twelfth months, (P=0.011, P=0.004),the level of TG, HDL-C and LDL-C between the treatment group and the control group are not statistically significant (P>0.05).Because of the differences of the TC between the treatment group and the control group at the time of entry, we further compare the phase difference.We find that there is no significant difference between the two groups in sixth months and twelfth months(P>0.05).(2).Because of the differences of TC between the treatment group and the control group in qi deficiency and blood stasis type, we further compare the phase difference,we find that there is no significant difference between the two groupsafter the 6 months and 12 months (P>0.05),the level of TG, HDL-C and LDL-C between the treatment group and the control group are not statistically significant too (P>0.05).(3)In Phlegm and blood stasis type,there is no significant difference in TC、TG、HDL-C and LDL-C between the treatment group and the control group in sixth months and twelfth months (P>0.05).(4)In blood stasis type,there is no significant difference in TC、TG、 HDL-C and LDL-C between the treatment group and the control group in sixth months and twelfth months (P>0.05).5.Coagulation function:(1) At the time of entry,there has differencein APTTbetween the two groups,so we further compare the phase difference.We find that the level of APTT in the treatment group is higher than in the control group in sixth months and twelfth months(P=0.014, P=0.013),and the level of Fbg in the treatment group is lower than in the control group in sixth months and twelfth months (P=0.025, P<0.001),the rest of the PTS TT are not statistically significant (P>0.05).(2)In qi deficiency and blood stasis type,there is no significant difference in coagulation functionbetween the treatment group and the control group in sixth months and twelfth months (P>0.05).(3)ln Phlegm and blood stasis type,there is no significant difference in coagulation function between the treatment group and the control group in sixth months (P>0.05) but we find that the level of APTT in the treatment group is higher than in the control group in sixth months(P=0.002),and the level of Fbg in the treatment group is lower than in the control group in twelfth months (P=0.018),the PT、 TT are not statistically significant (P>0.05).(4)At the time of entry,there has differencein APTTbetween the two groups for blood stasis type,so we further compare the phase difference.We find that the level of APTT has no statistically significant difference in sixth months and we also find the level of APTT in the treatment group is different from thatin the control group in twelfth months (P=0.014),the level of Fbg in the treatment group is lower than in the control group in sixth months and twelfth months(P=0.045,P=0.002),the PT、TT are not statistically significant (P>0.05).Conclusion:1.Western medicine combined with traditional Chinese medicine treatment can improve the ejection fraction and left ventricular end diastolic diameter in different degree, which is much more obvious in Qi deficiency and blood stasis type and phlegm and blood stasis type.2. Western medicine combined with traditional Chinese medicine treatment can improve the symptoms, which is more obvious in patients with phlegm and blood stasis type and blood stasis type.3.Western medicine combined with traditional Chinese medicine treatment can reduce blood stasis syndrome, which is more obvious in patients with phlegm and blood stasis type.4.TCM syndrome differentiation treatment combined with routine western medicine treatment can not improve the patient’s blood lipid obviously.5.Western medicine combined with traditional Chinese medicine treatment can improve the level of APTT, Fbg,which is more obvious in patients with phlegm and blood stasis type and blood stasis type. |
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