| Objective To explore the clinical efficacy and mechanism of "tonifying kidney and invigorating spleen" method in treating stable angina pectoris of coronary heart disease under the guidance of Professor Zhang Junping's concept of "blood-pulse-heart-spirit".The effects of Bushen Kangshuai tablet on the formation and development of AS in Apo E-/-mice were observed through the intervention of kidney-tonifying and spleen-strengthening Chinese medicine,and its possible mechanism AS explored from the point of view of immune inflammation,so as to clarify the mechanism of "tonifying kidney and invigorating spleen" method to improve AS.Method A total of 90 patients with stable angina pectoris due to deficiency of spleen and kidney were included in the clinical study,which were divided into treatment group and control group with 45 cases in each group.The control group was treated with conventional western medicine,while the treatment group was treated with traditional Chinese medicine decoction for tonifying kidney and invigorating spleen on the basis of conventional western medicine.The time points of 0 weeks and 4 weeks were observed,and the clinical data of patients were recorded,and venous blood of the treatment group was taken for later use.To evaluate the clinical efficacy of "tonifying kidney and invigorating spleen" method in treating stable angina pectoris of coronary heart disease under the guidance of the concept of "blood-pulse-heart-spirit" from three aspects: TCM syndrome efficacy,angina pectoris efficacy and angina pectoris-related quality of life efficacy,and to explore its possible mechanism from the angle of immune inflammation.Eight wild-type C57BL/6J mice were selected AS the blank control group,and 32 Apo E-/-mice(C57BL/6J background)were divided into model group,atorvastatin group and Bushen Kangshuai tablet group,with 8 mice in each group.After one week of adaptive feeding,AS model was established by feeding with high-fat diet,and samples were taken at the end of 12 th week.The pathological changes of aorta were observed by oil red O staining.The levels of TC,TG,HDL-C,LDL-C,M-CSF and IFN-?,which are related to blood lipids,were measured.The content of monocytes and macrophages in fresh bone marrow,peripheral blood and spleen of mice was detected by flow cytometry,and the expression of Foxp1 protein in mouse aorta was detected by immunofluorescence.Results1 There is no significant difference in baseline data between the treatment group and the control group before treatment,which is comparable.2 There were significant differences between the treatment group and the control group in TCM syndrome curative effect,angina pectoris curative effect and angina pectoris related quality of life curative effect at 0 and 4 weeks(P< 0.05).After 4weeks of treatment,the scores of TCM general symptoms,TCM main symptoms,TCM minor symptoms,angina pectoris,physical activity limitation,angina pectoris stability,angina pectoris attack,treatment satisfaction and disease awareness in the two groups were significantly lower than those before treatment(P< 0.05).3 The levels of IFN-?,MCP-1 and M-CSF in serum decreased after 4 weeks compared with those at 0 weeks(P< 0.05),and the value of s ST2 in serum decreased slightly after 4 weeks,with no statistical difference compared with that before treatment(P> 0.05).4 Compared with the control group,the levels of TC,TG and LDL-C in the model group increased(P< 0.01),while the level of HDL-C decreased(P< 0.01).HDL-C values in Bushen kangshuai tablet group and atorvastatin group were significantly higher than those in model group(P< 0.01).The LDL-C value in atorvastatin group was lower than that in model group(P< 0.05).Compared with the control group,the levels of M-CSF and IFN-? in the model group were significantly higher(P< 0.01).Compared with the model group,Bushen Kangshuai Tablet Group and Atorvastatin Group were significantly reduced,with statistical significance(P<0.01).5 Compared with the control group,the percentage of Ly6 Chigh monocytes in bone marrow,peripheral blood and spleen in the model group was significantly higher(P < 0.01).In bone marrow and spleen,compared with model group,the percentage of Ly6 Chighmonocytes in Bushen Kangshuai tablet group and atorvastatin group decreased significantly(P < 0.01).In peripheral blood,compared with the model group,the percentage of Ly6 Chighmonocytes in Bushen Kangshuai tablet group and atorvastatin group decreased;Compared with the control group,the percentage of Ly6Clow monocytes in bone marrow,peripheral blood and spleen in the model group decreased(P < 0.05,P < 0.01).In bone marrow,the percentage of Ly6 Clow monocytes in Bushen Kangshuai Tablet Group and Atorvastatin Group increased.In the peripheral blood,compared with the model group,the percentage of Ly6 Clow monocytes in Bushen Kangshuai tablet group increased,and that in atorvastatin group increased(P < 0.05).In the spleen,compared with the model group,the percentage of Ly6 Clow monocytes in Bushen Kangshuai tablet group and atorvastatin group increased(P < 0.05,P < 0.01).6 Compared with the control group,the percentage of macrophages in spleen and bone marrow of model group increased significantly(P < 0.01).In bone marrow,peripheral blood and spleen,compared with the model group,the percentage of macrophages in Bushen Kangshuai tablet group decreased In peripheral blood,compared with the model group,the percentage of macrophages in atorvastatin group decreased;Compared with the model group,the percentage of macrophages in atorvastatin group decreased significantly(P<0.01).7 Compared with the control group,Foxp1 protein expression in the model group decreased significantly(P< 0.01),while Foxp1 protein expression in Bushen Kangshuai tablet group and atorvastatin group increased significantly(P< 0.01).Conclusion1 The method of "tonifying kidney and invigorating spleen" guided by the concept of "blood-pulse-heart-spirit" can obviously relieve the clinical symptoms of TCM and angina pectoris symptoms of patients with stable angina pectoris of coronary heart disease,and can improve the quality of life of patients.2 Treatment of patients with stable angina pectoris of coronary heart disease with "tonifying kidney and invigorating spleen" guided by the concept of "blood-pulse-heart-spirit" can reduce the levels of serum IFN-?,MCP-1 and M-CSF,which may be effective by inhibiting inflammatory reaction and regulating immune damage.3 The method of "tonifying kidney and invigorating spleen" can reduce the percentage of Ly6 Chigh monocytes in bone marrow and spleen,increase the percentage of Ly6 Clow monocytes in spleen,influence the percentage of macrophages and improve the differentiation of monocytes and macrophages. 4 "Tonifying kidney and invigorating spleen" method can effectively promote the expression of Foxp1 protein in aorta,suggesting that Foxp1 may regulate immune inflammation and improve atherosclerosis. |
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