Network Meta-analysis of clinical efficacy of Chinese herbal injection in adjuvant treatment of unstable angina pectoris / 中国中药杂志

The present study evaluated the curative efficacy of Chinese herbal injection on unstable angina pectoris( UAP) by network Meta-analysis. The databases,including Pub Med,Cochrane Library,Web of Science,CNKI,CBM,VIP and Wanfang were searched for randomized controlled trial( RCT) of Chinese herbal injection in the treatment of UAP. All researchers independently screened the articles,extracted the data and evaluated the quality. Open BUGS and Stata were employed for the analysis of the trials that met the quality standards. Fifty-eight studies were finally included in this study,involving 20 intervention measures. In terms of the effective rate,16 injections such as Dengzhan Xixin Injection,Xuesaitong Injection and Danshen Injection combined with western medicine exhibited significant efficacy. In terms of ECG,Puerarin Injection,Ginkgo Leaf Extract and Dipyridamole Injection( GDI),Breviscapine Injection combined with western medicine were superior to western medicine. In terms of the reduction of the angina attack times,Sodium Tanshinone ⅡASulfonate Injection,GDI and Dazhu Hongjingtian Injection combined with western medicine showed better effects than western medicine. In terms of shortening the angina duration,Shenmai Injection combined with western medicine was superior to western medicine. As revealed by the results,Dengzhan Xixin Injection,Xuesaitong Injection,Danshen Injection,Breviscapine Injection,Danshen Ligustrazine Injection combined with western medicine displayed prominent curative efficacy,which were recommended for clinical application. Meanwhile,appropriate intervention measures should be selected according to individual conditions. Limited by the quality of the included trials,the conclusions still need to be further verified.

Rules of Syndrome and Treatment of Unstable Angina Pectoris Guided by Vessel-collateral Theory and Mechanism Analysis Based on Network Pharmacology / 中国实验方剂学杂志

Objective:Guided by nutrient-defense stages in the vessel-collateral theory， the modern medical cases of unstable angina pectoris（UAP） were systematically collated and analyzed to explore the rules of syndrome and treatment of UAP and the molecular mechanism of core Chinese herbal combination in the treatment of UAP based on network pharmacology. Method:All medical cases with UAP treated by Chinese medicinal compounds were retrieved from PubMed，China National Knowledge Infrastructure （CNKI），Wanfang Data， VIP， and SinoMed published between database inception and November 2020. The syndromes of medical cases were determined based on the nutrient-defense stages of the vessel-collateral theory. Rules of syndrome and treatment of UAP were investigated by data mining methods， such as frequency statistics， cluster analysis， and enhanced FP-Growth algorithm. The molecular mechanism of core Chinese herbal combination in the treatment of UAP was analyzed by network pharmacology. Result:The first four syndromes of UAP with high frequencies were deficiency and stagnation of collateral Qi， blood stasis obstructing collaterals， depression and stagnation of collateral Qi， and turbid phlegm obstructing collaterals. The Chinese herbal medicines with high frequencies included Salviae Miltiorrhizae Radix et Rhizoma， Glycyrrhizae Radix et Rhizoma， Chuanxiong Rhizoma， and Astragali Radix， which were effective in resolving stasis， dredging collaterals， replenishing Qi， consolidating defensive Qi， regulating Qi， relieving depression， and dispelling phlegm. The association analysis indicated that the core Chinese herbal combination in the treatment of UAP was Salviae Miltiorrhizae Radix Chuanxiong Rhizoma-Astragali Radix. Four Chinese herbal combinations were obtained by cluster analysis. As revealed by network pharmacology， the key components of Salviae Miltiorrhizae Radix et Rhizoma-Chuanxiong Rhizoma-Astragali Radix in the treatment of UAP included quercetin， luteolin， and tanshinone Ⅱ_A， and the key targets included serine/threonine-protein kinase 1 （Akt1）， mitogen-activated protein kinase 1 （MAPK1）， Jun， interleukin （IL）-6， and MAPK8. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis showed that phosphatidylinositol-3-kinase （PI3K）/protein kinase B （Akt） signaling pathway might serve as the main pathway for its therapeutic efficacy. Conclusion:The basic pathogenesis of UAP is deficiency/depression and stagnation of collateral qi and turbid phlegm obstructing collaterals. The treatment should follow the principles of replenishing Qi， resolving stasis， and dredging collaterals， assisted with regulating Qi and resolving phlegm. The therapeutic efficacy of Salviae Miltiorrhizae Radix-Chuanxiong Rhizoma-Astragali Radix was achieved via multi-component， multi-target， and multi-pathway. This study is expected to inspire future UAP-related studies at the molecular level based on vessel-collateral theory.

Treatment of Unstable Angina Pectoris with Fleabane Injection / 国际中医中药杂志

Objective To observe clinical effects of fleabane injection treating patients with unstable angina pectoris (UAP). Methods One hundred and sixty cases with UAP were randomly recruited into two groups: a control group (including 80 patients) received Asprin and Nitrate medication, and a treatment group(including 80 patients) received fleabane injection (20 mg/d, ivdrip) on the basis of the control group. Both groups were treated for two weeks. Results Compared with the control group, the treatment group showed significantly better clinical effects and electrocardiograph. Conclusion Fleabane injection has obvious clinical effects for treating patients with UAP.

Observation the short term therapeutic effects in treating UAP with drugs and interventional method / 中国介入心脏病学杂志

Objective To inspect the therapeutic effect and prognosis of treating Unstabled Angina Pectoris (UAP) with drugs and interventional methods.Methods 40 patients were treated randomly with PTCA and stenting or traditional drugs: Beta blockers, Calcium resistants, Ester nitrates, Asprin, Heparin and so on.Compared degrees of angin pectoris, cases of AMI, mortality arising from heart disease or no heart disease before and 8 months after the treatment. Results Happening of AMI and mortality in interventional group were less than those of drugs group. Distinctly improving rate of clinical effect of the former was much more than that of the later.Conclusion In short term interventional treatment (PTCA and stenting) were piror to drugs in therapeutic effects and improving prognosis.

Emergency Coronary Artery Bypass Grafting for Acute Coronary Syndrome / 日本心臓血管外科学会雑誌

Emergency coronary artery bypass grafting (CABG) for the treatment of acute coronary syndrome is still associated with increased operative risk and postoperative morbidity. Thirty-five patients underwent CABG for the treatment of medically refractory unstable angina (UAP), 42 patients for acute myocardial infarction (AMI) and 7 patients for post-infarction angina (PIA). The UAP patients received 2.8 distal anastomoses on average. Five patients (14%) died postoperatively, 3 of them due to perioperative myocardial infarction (PMI). In the AMI patient group, 29 patients were in shock and 3 patients were in cardiac pulmonary arrest (CPA) preoperatively. They received an average of 2.8 distal anastomoses. Fourteen patients (33%) died postoperatively. Ten of them died of postoperative myocardial failure. The operative mortality was extremely high in the shock state patient group (41%) and CPA state patients group (100%). Poor operative results were anticipated in those patients whose infarct-related artery was not recanalized preoperatively. All patients survived the CABG in the PIA group. It was concluded that reduction in mortality in the group of patients undergoing emergency CABG required highly refined myocardial preservation techniques to prevent PMI and to limit intraoperative myocardial damage, as well as powerful mechanical assist systems to provide support in cases of the postoperative myocardial failure.