The Clinical Study On Vascular Endothelial Function In Patients With Coronary Heart Disease Treated With Traditional Chinese Medicine For Regulating Qi And Activating Blood

Coronary atherosclerotic heart disease refers to the heart disease caused by myocardial ischemia,hypoxia and even myocardial necrosis caused by coronary artery stenosis or obstruction or(and)coronary artery spasm on the basis of coronary artery atherosclerosis."Endothelial injury theory" is one of the pathogenesises of coronary atherosclerosis,which believes that all kinds of risk factors will cause dysfunction of coronary vascular endothelium or damage of the anatomical structure,and then generate inflammation and fibrous hyperplastic reaction of coronary artery.Vascular endothelial dysfunction is an early manifestation of coronary heart disease,which occurs before the pathological changes of vascular morphology.Traditional Chinese medicine(TCM)has been used to treat coronary heart disease for thousands of years.From the perspective of TCM,the pathogenesis of coronary heart disease is the blockage of the heart arteries.Coronary heart disease patients can be divided into different syndromes(i.e.,different zhengs),among which "qi stagnation and blood stasis syndrome " is the most common subtype.Xuefu zhuyu decoction(XFZY decoction),as a classical Chinese herbal medicine(CHM)used for promoting blood circulation,has been confirmed to be effective in treating coronary heart disease patients.The purpose of this study are as follows:(1)to explore the changes of vascular endothelial function in coronary heart disease patients with qi stagnation and blood stasis syndrome;(2)to evaluate the clinical efficacy of XFZY decoction in the treatment of patients with this syndrome type and to investigate the effect on vascular endothelial function of this prescription.Experiment I:The Biological Study on Vascular Endothelial Function of Coronary Heart Disease(Stable Angina Pectoris)with Qi Stagnation and Blood Stasis SyndromeObjective:To explore the differences of biological indexes of vascular endothelial function in coronary heart disease patients with qi stagnation and blood stasis syndrome.Methods:The coronary heart disease patients with qi stagnation and blood stasis syndrome were selected as the research objects.The coronary heart disease patients with qi deficiency and blood stasis syndrome and healthy volunteers were taken as the control groups,in order to compare the differences in factors related to vascular endothelial function,including hypersensitive C-reactive protein(hs-CRP),nitric oxide(NO),thromboxane B2(TXB2),soluble intercellular adhesion molecules(sICAM-1).Results:(1)Compared with the healthy control group:NO in the qi stagnation and blood stasis syndrome group decreased significantly(P<0.01).sICAM-1 was elevated,with a statistical difference(P<0.01).hs-CRP increased significantly(P<0.01).There was no statistical difference in TXB2(P>0.05).(2)Compared with the healthy control group:NO in qi deficiency and blood stasis syndrome group decreased significantly(P<0.05),while sICAM-1,hs-CRP and TXB2 showed no statistical differences(P>0.05).(3)Compared with the qi deficiency and blood stasis syndrome group:NO in the qi stagnation and blood stasis syndrome group decreased significantly(P<0.05),while sICAM-1,hs-CRP and TXB2 were all higher than those of the qi deficiency and blood stasis syndrome group,but there were no statistical differences(P>0.05).Conclusion:(1)Compared with healthy control group,both of the qi stagnation and blood stasis syndrome group and the qi deficiency and blood stasis syndrome group,the expression of NO decreased.And the decrease was significant in the qi stagnation and blood stasis syndrome group.It is possible that endothelium-dependent vascular diastolic function is more obviously impaired in patients with qi stagnation and blood stasis syndrome.(2)The increase of sICAM-1 in the qi stagnation and blood stasis syndrome group,indicates that patients with this syndrome can directly cause vascular endothelial function damage by increasing the expression of adhesion molecules.(3)The concentration of hs-CRP in the qi stagnation and blood stasis syndrome group was higher than that in the healthy control group and the qi deficiency and blood stasis syndrome group,indicating that inflammatory reaction may have a more prominent effect on vascular endothelial injury in coronary heart disease patients with qi stagnation and blood statistical syndrome.Experiment II:The Research about the Clinical Effects of Traditional Chinese Medicine for Regulating Qi and Activating Blood Circulation on Coronary Heart Disease(Stable Angina Pectoris)and Its Effect on Vasoactive Factors Related to Vascular Endothelial Function.Objective:To evaluate the clinical efficacy of Chinese herbal medicines for qi regulating and blood activating in patients with coronary heart disease and to evaluate the changes of vascular endothelial function.Methods:64 patients who were accorded with our inclusive criteria suffering from CHD were randomly divided into the regulating qi&activating blood group,the activating blood group,the regulating qi group and the placebo group.Patients of each group were given the secondary prophylaxis and TCM respectively(qi regulating and blood activating drugs,blood activating drugs,qi regulating drugs and placebos).The clinical course was 12 weeks.Some indicators should be compared between the 4 groups,including Seattle Angina Questionnaire scores,TCM syndrome scores,echocardiography,total Cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),prothrombin time,(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen,(FIB),nitric oxide(NO),endothelin-1(ET-1),thromboxaneB2(TXB2),6-keto-prostaglandin F1?(6-keto-PGF1?),soluble vascular cell adhesion molecule-1,(sVCAM-1)and soluble intercellular adhesion molecules(sICAM-1).Results:(1)On the basis of conventional treatment of western medicine,TCM for regulating qi and promoting blood can improve TCM syndrome manifestations of coronary heart disease patients with qi stagnation and blood stasis syndrome to different degrees,and the comparison results between the 4 groups were significantly different(P<0.05).(2)On the basis of conventional treatment of western medicine,TCM for regulating qi and promoting blood can improve the quality of life of the coronary heart disease with qi stagnation and blood stasis syndrome to varying degrees,including physical limitation(PL),angina stability(AS),angina frequency(AF),treating satisfaction(TS),disease perception(DP).The self-comparisons of 4 groups:The regulating qi&activating blood group showed that PL,AS,AF,TS and DP improved significantly(P<0.01).The activating blood group showed that AS,TS and DP improved significantly(P<0.01,P<0.01,P<0.05).The regulating qi group showed that AS,TS and DP improved significantly(P<0.01,P<0.05,P<0.01).The placebo group showed that TS and DP improved significantly(P<0.01,P<0.01).The results of intergroup comparisons were as follows:After treatment,compared with the placebo group,in the regulating qi&activating blood group,AS,AF improved significantly(P<0.01);Compared with the activating blood group,in the regulating qi&activating blood group,AS improved significantly(P<0.05);Compared with the regulating qi group,in the regulating qi&activating blood group,TS improved significantly(P<0.05);There were no statistical differences between the activating blood group and the placebo group after treatment.And the intergroup comparison of the regulating qi group and the placebo group after treatment got the same results(P>0.05).(3)The self-comparison of laboratory parameters among 4 groups were as follows:The activating blood group showed that NO increased significantly(P<0.01),LDL-C decreased significantly(P<0.05),and 6-keto-PGF1? increased significantly(P<0.05).The regulating qi group showed that NO increased significantly(P<0.05),6-keto-PGF1? increased significantly(P<0.05).The activating blood group showed that NO increased significantly(P<0.05).The self-comparison of the placebo group showed no statistical differences(P>0.05).And there were no statistical differences in other indicators before and after treatment among the 4 groups(P>0.05).(4)The comparisons of laboratory parameters between 4 groups after treatment were as follows:There were statistical differences among NO and 6-keto-PGF1?(P<0.05);Other indicators,including PT,APTT,TT,FIB,TC,TG,HDL-C,LDL-C,ET-1,TXB2,sVCAM-1,sICAM-1 and hs-CRP,showed no statistical differences(P>0.05).The results of intergroup comparisons were as follows:After treatment,compared with the placebo group,in the regulating qi&activating blood group,NO increased significantly(P<0.01),and 6-keto-PGF1? also increased significantly(P<0.05).There were no statistical differences between the activating blood group and the placebo group after treatment.And the intergroup comparison of the regulating qi group and the placebo group after treatment got the same results(P>0.05).After treatment,compared with the activating blood group,in the regulating qi&activating blood group,the level of 6-keto-PGF1? increased significantly(P<0.05),but NO showed no statistical difference(P>0.05).After treatment,compared with the regulating qi group,in the regulating qi&activating blood group,the level of NO increased significantly(P<0.05),but 6-keto-PGF1? showed no statistical difference(P>0.05).After treatment,there were no statistical diffidences between the regulating qi group and the activating blood group(P>0.05).(5)The comparison of cardiac systolic and diastolic functions,including left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVDd)and E/A ratio,among the 4 groups were as followed.The self-comparisons before and after treatment of the 4 groups,showed no statistical diffidences(P>0.05).There were no statistical differences in LVEF and LVDd between the 4 groups after treatment(P>0.05).While,there was a statistical difference in the E/A ratio(P<0.01).The comparisons of the E/A ratio between the 4 groups after treatment were as follows:Compared with the placebo group,the E/A ratio in the regulating qi group increased significantly(P<0.01);Compared with the regulating qi&activating blood group and the activating blood group,the E/A ratio in the regulating qi group increased significantly(P<0.01).Conclusion:(1)TCM for regulating qi and activating blood has the effect of improving TCM symptoms and the quality of life of coronary heart disease patients,and the regulating qi&promoting blood group is especially prominent.(2)TCM for regulating qi and activating blood has a certain significance to improve the vascular endothelial function,mainly by improving the endothelial dependent vasodilation function and in inhibiting platelet aggregation.More specifically,the regulating qi&activating blood group has the two functions mentioned above;And the activating blood group plays a slightly prominent role in improving vasodilatation function.The regulating qi&activating blood group also has a certain effect on improving blood lipid metabolism.(3)The regulating qi group may be able to better improve the cardiac diastolic function.(4)Improving vascular endothelial function with traditional Chinese medicine is the result of regulating qi and promoting blood circulation.And the clinical application of TCM for regulating qi and promoting blood circulation is safe.