Retrospective Analysis On The Clinecal Efficacy Of 367 Cases COPD And Effect Of Qibai Pingfei Capsule Medicated Serum On Apoptosis Of Rat Pulmonary Artery Smooth Muscle Cells Under Hypoxia

1 Objective1.1 To make a retrospective investigation and analysis of 367 cases of Chronic Obstructive Pulmonary Disease(COPD) patients admitted to our hospital in rescent three years(2012.1~2014.12) who had undergone treatment of integrated traditional Chinese medicine(TCM) and western medicine or western medicine alone. To analyze and compare the clinical efficacy of the two groups and summarize the characteristics of TCM and western medicine treatment of COPD,to provide useful data for standardized treatment of integrated TCM and western medicine.1.2 To observe the effect of Qibai Pingfei Capsule medicated serum on apoptosis and the expression of apoptosis-related proteins of rat pulmonary artery smooth muscle cells(PASMCs) under hypoxia and explore its mechanism, to provide experimental basis and foundation for the clinical application that Qibai Pingfei Capsule can prevent the form of pulmonary vascular remodeling and pulmonary hypertension.2 Methods2.1 Clinical ResearchWith relevant literatures, the table of retrospective questionnaire of 367 cases COPD was made. By collecting the medical records of 367 cases of patients diagnosed with COPD who admitted to our hospital in rescent three years(2012.1~2014.12),we made the retrospective statistics and analysis about the basic information, Symptoms, signs, TCM symptoms, western medicine treatment and TCM treatment, summarized the characteristics of TCM and western medicine treatment of COPD and compared the clinical efficacy of standardized treatment of integrated TCM and western medicine with western medicine treatment alone.2.2 Experimental researchQibai Pingfei Capsule medicated serum, Nifedipine medicated serum and blank serum were prepared. Rat PASMCs were separated by the method of tissue block anchorage and identified by ?-SMA immunofluorescence. The best Qibai Pingfei Capsule medicated serum and the best time of action were determined by the MTT method: divided into normoxia control group,hypoxia model group, 5% Qibai Pingfei Capsule medicated serum,10%Qibai Pingfei Capsule medicated serum,20% Qibai Pingfei Capsule medicated serum group( medicated serum by blank serum dilution)..According to the MTT experimental results, PASMCs were divided into normoxia control group, hypoxia model group, the best Qibai Pingfei Capsule medicated serum group and Nifedipine medicated serum group(Nifedipine medicated serum concentration was the same as the best Qibai Pingfei Capsule medicated serum concentration). Eeach group were effected the best time of action by the grouping condition. TUNEL–FITC/DAPI was used to check the apoptosis status of PASMCs.The Western Blot method was adopted to detect the expression of Bcl-2,Bax, Casepase-9 and Casepase-3 protein.3 Results3.1 Clinical Research3.1.1 The research found that, phlegm yu lung syndrome(33.94%), phlegm obstruct the lung syndrome(27.01%) and phlegm in the lung(12.41%) were the most common syndromes in COPD TCM syndromes, followed by lung and kidney qi deficiency syndrome(10.58%), yang insufficiency(8.39%) and the outer cold drink syndrome(7.66%).This reflected the COPD "phlegm", "stasis", "false" major pathological factors. The main principle of Chinese medicine treatment of COPD was "dealing with phlegm", " dealing with stasis" and "dealing with false". Chinese medicine in the treatment of COPD was mainly used expectorants, antitussives and antiasthmatic drugs, combined with tonics, promoting blood circulation drugs, diuresis medicine,prescription diarrhea, etc. Sometimes the oral chinese medicine or chinese medicine injection whose main effect were stopping cough, phlegm and stasis were used to enhance the efficacy. Western medicine treatment were bronchial dilation,anti-infective, anti-inflammatory, stopping cough and phlegm and other symptomatic therapy.3.1.2 In the comparison of the clinical comprehensive efficacy, the total effective rate of simple western medicine group was 87.10%, and that of integrated TCM and western medicine group was 94.89%. The difference between the two groups was statistically significant(P<0.05).3.1.3 In the comparison of TCM syndrome improvement, the total effective rate of simple western medicine group was 82.80% and that of integrated TCM and western medicine group was 96.35%. The difference between the two groups was statistically significant(P<0.05).3.1.4 In the comparison of spirometry, FEV1, FVC, FEV1 / FVC(%) of the two groups of patients were better than before treatment, and the difference was statistically significant(P<0.01, P<0.05). Compared with simple western medicine group, the improvement degree of the ventilation indexes of integrated TCM and western medicine group were better significantly than simple western group,and the difference was statistically significant(P<0.05).3.1.5 In this study, patients after treatment showed no differences in urine routine,liver function and kidney function from that before treatment.3.2 Experimental research3.2.1 Compared with normoxia control group, hypoxia could accelerate proliferation and inhibit apoptosis of rat PASMCs.3.2.2 Compared with hypoxia model group, Qibai Pingfei Capsule medicated serum could effectively accelerate apoptosis of rat PASMCs under hypoxia, inhibit the expression of Bcl-2 protein and promote the expression of protein such as bax,Casepase-9 and Casepase-3, the difference was statistically significant(P <0.01,P<0.05), second only to nifedipine medicated serum.4 Conclusions4.1 Treatment of integrated TCM and western medicine which is to use TCM flexiblely and reasonably following the guidance of TCM theory on the basis of western conventional treatment, has more outstanding efficacy compared with western medicine treatment alone, and can reduce TCM syndrome score and improve respiratory function of COPD patient more significantly.4.2 Qibai Pingfei Capsule medicated serum can effectively accelerate apoptosis of rat PASMCs under hypoxia via mitochondrial apoptosis pathway to prevent the form of pulmonary vascular remodeling and pulmonary hypertension, to provide experimental basis and foundation for the clinical application of Qibai Pingfei Capsule.