| Objective:To observe and analyze the changes of TCM syndrome elements after stent implantation in patients with coronary heart disease,explore the relationship between the changes of HO-1 and Betatrophin express levels for TCM syndrome elements before and after stent implantation,finally it will enhance the Integrative Medicine to diagnosis,treatment,and prevention of coronary heart disease.Methods:(1)Inpatients admitted to Affiliated Chinese Medicine Hospital of Southwest Medical University in June 2016 and May 2017 were included in the study,200 patients were enrolled who were diagnosed as CHD and coronary stent implanted.(2)To record the basic information(including gender,age,BMI,blood lipids and blood pressure),elements of TCM syndromes,fill in the CRF form and establish the database.(3)Observations: Gensini score of Blood stasis syndrome,Phlegm-turbid syndrome,Qi deficiency syndrome and other syndromes before coronary stent implantation;To observe the TCM syndrome factors in patients with coronary heart disease at 1st week,1st month,3rd month and 6th month after coronary stent implantation;Major adverse cardiac events(MACE)were observed,including: recurrent myocardial infarction,PCI again,hospitalization again and death;The changed of HO-1 and serum Betatrophin express in different TCM syndrome elements were measured by ELISA in all cases 1 day before and 3 days after coronary stent implantation.(4)Then statistical software SPSS20.0 was used for statistical description and analysis of related data.Results:(1)A total of 200 subjects were included in the study.Among them,4 subjects died during the study and 3 subjects lost their follow-ups.Therefore,193 cases were included in the statistical analysis.Among them,62cases(32.1%)were females and 131 cases(67.9%)were males.The average age was 64.72±10.78 years,the average body mass index was 24.29±3.31 kg/m-2;There were 98(50.8%)smokers,127 patients with hypertension(65.8%),45 patients with diabetes(23.3%),17 patients with heart failure(8.8%),and 12 patients with arrhythmia(6.2%)in the medical history.In the classification of before coronary stent implantation TCM symptom elements,36 patients(18.7%)had Qi deficiency syndrome,102 cases(52.8%)had Blood stasis syndrome,42 cases(21.8%)had Phlegm-turbid syndrome,and 13 cases(6.7%)had other syndromes.Chi-square test and one-way ANOVA showed that there was no significant difference in age,gender,smoking history,hypertension,diabetes,heart failure,and arrhythmia before coronary artery stent implantation in patients with different TCM syndrome elements(P>0.05).One-way ANOVA and rank-sum test showed that there were no significant differences in BMI,blood glucose,LDL-C,BNP,serum uric acid,serum creatinine,and Gensini scores in patients with different TCM syndromes before surgery(P>0.05).(2)Chi-square test results showed that the distribution of TCM syndromes at different time points after coronary stent implantation was statistically significant(P<0.05).The specific changes were: after 1st week: Blood stasis> Qi deficiency syndrome> Phlegm-turbid syndrome;after 1st month and 3rd month:Qi deficiency>Blood stasis>Phlegm-turbid syndrome;postoperative 6th month: Blood stasis>Qi deficiency syndrome>Phlegm-turbid syndrome.(3)Comprehensive analysis suggested that the differences between TCM syndrome elements before coronary stent implantation and TCM syndrome elements at 1st week,1st month,and 3rd month after coronary stent implantation were statistically significant(P<0.05).There was no statistically significant difference in TCM syndrome elements of traditional Chinese medicine 6th month after stent implantation.Therefore,the transformation of TCM syndrome elements in patients may begin one week after coronary stent implantation,during the period of 3-6 months,and the difference between them gradually decreased.(4)The results of the chi-square test showed that the Blood stasis syndrome,Phlegm-turbid syndrome,and Qi deficiency syndrome in patients with coronary heart disease undergone mutual transformation between the syndrome elements after the coronary stent implantation,and the differences was statistically significant(P < 0.05).(5)The paired design t-test analysis showed that there was no significant difference in serum Betatrophin express before and after coronary stent implantation in the Qi deficiency group,Blood stasis syndrome group,and other syndrome groups(P>0.05);The serum level of Betatrophin in Phlegm-turbid syndrome group was 29.20±9.21pg/ml before coronary stent implantation,it was 33.94±11.55 after coronary stent implantation.The level of Betatrophin expression after stent implantation in patients with Phlegm-turbid syndrome was higher than before stent implanted,and the difference was statistically significant(P<0.05).(6)Paired design t-test was used to compare the differences of serum HO-1 levels before and after coronary implantation in patients with different TCM syndromes.The results showed that: Qi deficiency group,Blood stasis group,and other syndromes was no significant difference in the expression of HO-1 before and after stent implantation(P>0.05).In the Phlegm-turbid syndrome group,the serum HO-1 before coronary stent implantation was 14.02±2.88ng/m L,after coronary stent implantation was 12.80 ± 2.54ng/mL.The postoperative HO-1 expression level in the patients with Phlegm-turbid syndrome was lower than before coronary stent implantation,and the difference was statistically significant(P < 0.05).In addition,the results showed that there were no differences in serum HO-1 levels in patients with different TCM syndromes before coronary stent implantation(P>0.05);Postoperative serum HO-1: Blood stasis syndrome>Qi deficiency syndrome> Phlegm-turbid syndrome;Serum HO-1 of patients with different TCM syndromes after coronary stent implantation had statistical difference Significance(P < 0.05).(7)The results of rank-sum test analysis showed that there was no significant difference in the number of stent and the number of vessel lesions of coronary artery lesions between the 1st week and 6th months after coronary stent implantation(P>0.05).Chi-square test analysis showed that: 1st week after coronary stent implantation,the proportion of ACS in patients with blood stasis syndrome group was larger,the difference was statistically significant(P<0.05);After coronary stent implanation 6th month,there was no significant difference in the proportion of coronary heart disease among patients with different TCM syndrome elements(P>0.05).(8)MACE results: There were 4 deaths in total,which all were blood stasis syndrome.11 cases were rehospitalized in the Blood stasis syndrome group,and 2 in the Qi deficiency syndrome group,and 3 in the Phlegm-turbid syndrome group.No recurrent myocardial infarction and coronary stent restenosis was observed in the observed cases.Conclusion:(1)The changed rule of TCM symptom elements at different time points after coronary stent implantation in CHD patients was: afte 1st week after: Blood stasis syndrome>Qi deficiency syndrome> Phlegm-turbid syndrome;after 1st month and 3rd month: Qi deficiency> Blood stasis> Phlegm-turbid syndrome;6th month after coronary stent implantation:Blood stasis syndrome>Qi deficiency syndrome> Phlegm-turbid syndrome.2.The transformation of TCM syndrome elements in patients undergone coronary artery stent implantation may start 1st week after surgery,the differences between TCM syndrome elements and preoperative TCM symptom elements gradually decreased between 3rd to 6th month.3.This study founded that the Phlegm-turbid syndrome in the TCM syndrome elements of coronary heart disease was closely related to serum Betatrophin and HO-1.4.There was a high incidence of major adverse cardiac events in blood stasis. |
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