| BackgroundAcute coronary syndrome,including unstable angina pectoris and acute myocardial infarction,is one of the most important death types in cardiovascular diseases.Unstable angina is between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction and is closely related to myocardial ischemia caused by coronary artery stenosis or occlusion.According to the results of the "China cardiovascular disease report 2018" released in 2019,there are about 290 million patients with cardiovascular diseases in China,of which 11 million suffer from coronary heart disease,and the mortality rate ranks first among all diseases.At present,there are still limitations in the diagnosis and conventional treatment of patients with the acute coronary syndrome.TCM can effectively improve the quality of life and clinical symptoms of clinical patients through syndrome differentiation and treatment.As one of the main syndromes,phlegm,and blood stasis syndrome needs to be treated by effective prescription.2.Gulou Danshen granule can improve the levels of homocysteine,lactate dehydrogenase,troponin,high sensitivity C-reactive protein,tumor necrosis factor-α,and interleukin-6 in rats with acute myocardial infarction,and can reduce the damage of myocardial tissue to a certain extent.Objectives1.For patients with unstable angina pectoris with phlegm and blood stasis obstructing each other,the clinical evidence of the efficacy and safety of the promoting blood circulation and resolving phlegm method was studied to provide a preliminary basis for clinical syndrome differentiation and treatment of traditional Chinese medicine and the development of efficient new drugs.2.Based on combining the method of promoting blood circulation and resolving phlegm and classical famous prescriptions,the experimental efficacy of Gualou Danshen granule on acute myocardial infarction rat model was explored.Methods1.Based on evidence-based medicine,the continuous variables were analyzed by the random effect model,Cohen’s D,95%CI,and subgroup analysis methods,respectively.The Seattle Angina scale,blood lipid index,C-reactive protein,high-sensitivity C-reactive protein,and homocysteine were analyzed respectively;the random effect model and relative risk(RR)were used for the binary variables Risk,95%CI and L’Abbe diagram heterogeneity test methods were used to analyze the efficacy of angina pectoris,the rate of stopping and reducing nitroglycerin,the withdrawal rate of patients,the efficacy of TCM syndrome,the efficacy of ECG and adverse reaction events.The heterogeneity between the studies was evaluated by combining Q statistics and I2.The sources of heterogeneity were judged by meta-regression and bubble chart.The results of the analysis were as follows Funnel plot and egger test were used to evaluate the publication bias of the included studies;sensitivity analysis was used in all studies to exclude studies leading to heterogeneity,and then meta-analysis was conducted.2.According to the characteristics of the combination of promoting blood circulation and resolving phlegm and classic prescriptions,a new traditional Chinese medicine Gualou Danshen granule was prepared;the experimental model of acute myocardial infarction was made by ligating the left anterior descending branch of coronary artery;and Gualou Danshen granule was observed from the aspects of homocysteine,lactate dehydrogenase,troponin,high-sensitivity C-reactive protein,tumor necrosis factor-α,interleukin-6 and cardiac histomorphology Effect of Gualou Danshen granule on an acute myocardial infarction rat model.Rresults1.Meta-analysis results based on evidence-based medicine:(1)a total of 1246 literatures were included in the initial search,and 17 studies were finally included,involving 16 kinds of traditional Chinese medicine prescriptions using the method of promoting blood circulation and resolving phlegm;among them,631 cases were in the observation group and 612 cases were in the control group;(2)the effect of angina pectoris in the observation group was more significant than that in the control group(RR=1.21,95%Cl[1.12,1.31],P<0.01);(3)the proportion of patients taking nitroglycerin after treatment in the observation group was significantly less than that in the control group(RR=1.36,95%CI[1.22,1.51],P<0.01);(4)the scores of four dimensions of Seattle Angina scale in the observation group were higher than those in the control group,and the comprehensive score was higher than that in the control group(SMD=0.54,95%CI[0.38,0.70],P<0.05);(5)the withdrawal rate of the observation group was lower than that of the control group,but there was no significant difference(RR=0.60,95%CI[0.18,1.95],P=0.39);(6)in the evaluation of TCM syndrome efficacy,the observation group was higher than the control group(RR=1.21,95%CI[1.13,1.30],P<0.01);(7)in the results of ECG curative effect,the observation group was significantly better than the control group(RR=1.19,95%CI[1.09,1.31],P<0.01);(8)in the results of four indicators of blood lipid,the observation group’s low density lipoprotein(SMD=-0.50,95%CI[-0.75,-0.25],P<0.05),total cholesterol(SMD=-1.57,95%CI[-1.91,-1.23],P<0.05);(9)in the results of other blood indexes,C-reactive protein(SMD=-0.74,95%CI[-0.07,-0.40],P<0.05)and triglyceride(SMD=-0.40,95%CI[-0.60,-0.19],P<0.05)were lower than those of the control group,and the high-density lipoprotein index of the observation group was higher than that of the control group(SMD=0.61,95%CI[0.38,0.84],P<0.05),The incidence of adverse reactions in the observation group was lower than that in the control group,but there was no significant difference(SMD=0.35,95%CI[0.08,1.56],P=0.17).2.Pharmacodynamic experiment results of Gualou Danshen Granule:(1)42 male Wistar rats died of high-dose Gualou Danshen granule group,acute myocardial infarction model group,and Danlou tablet group respectively,and 2 rats in low-dose Gualou Danshen granule group died,with no statistical difference(P>0.05).(2)in the comparison of homocysteine results in each group,acute myocardial infarction was found The second blood collection of the model group was higher than that of the first time,with statistical significance(P<0.05);the second time results of acute myocardial infarction model group were higher than those of low-dose group,middle dose group,high-dose group,and Danlou tablet group,with statistical significance(P<0.05).(3)in the comparison of lactate dehydrogenase results of each group,Gualou Danshen granule low-dose group and acute myocardial infarction The second concentration of model group was higher than that of the first time,with statistical significance(P<0.05);the second blood sampling results of acute myocardial infarction model group were higher than those of Gualou Danshen granule low-dose group,medium dose group and high-dose group,with statistical significance(P<0.05);(4)in the comparison of results of troponin,the second blood sampling results of Danlou tablet group and acute myocardial infarction model group were significantly higher than those of model group In the second blood sampling group,the troponin concentration in the high-dose group was lower than that in the low-dose group and Danlou tablet group(P<0.05),and the results of acute myocardial infarction model group in the second time were higher than those in other groups(P<0.05),with statistical significance;(5)in each group,the high-dose group had higher troponin concentration than the other groups(P<0.05)In the comparison of the results of protein,the second concentration of acute myocardial infarction model group was higher than that of the first time,with statistical significance(P<0.05);in the two blood sampling results of Gualou Danshen granule high-dose group,the results of the first time were higher than that of the second time(P<0.05);in the comparison of the results of the second blood collection,the acute myocardial infarction model group was higher than the low-dose group of Gualou Danshen granule Results of high-dose group,Danlou tablet group and sham operation group(P<0.05);(6)the concentration of tumor necrosis factor-α in the second blood collection was higher than that in the first blood collection(P<0.05);in the comparison of the second blood collection results between groups,the concentration of TNF-a in acute myocardial infarction model group was higher than that in other groups(P<0.05),which had statistical significance;(7)Gualou Danshen granule The concentration of IL-6 in the second time of low-dose group was lower than that of the first time,with statistical significance(P<0.05);the concentration of IL-6 in acute myocardial infarction model group was higher than that in Gualou Danshen granule low-dose group and sham operation group,with statistical significance(P<0.05);(8)in he and Masson staining results,compared with other groups,melon There was a less myocardial injury in the high-dose group of Gualou Danshen granule.Conclusions1.Meta-analysis of evidence-based medicine shows that the method of promoting blood circulation and resolving phlegm can improve the symptoms of angina pectoris,electrocardiogram,blood lipid level,C-reactive protein,high-sensitivity C-reactive protein and homocysteine concentration levels in patients with unstable angina pectoris with phlegm stasis syndrome.It has a good treatment acceptance and no obvious adverse reactions in clinical application.2.Gualou Danshen granule can improve the levels of homocysteine,lactate dehydrogenase,troponin,high sensitivity C-reactive protein,tumor necrosis factor-α,and interleukin-6 in rats with acute myocardial infarction,and can reduce the damage of myocardial tissue to a certain extent. |
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