关键词:

冠心病, 血瘀证, 清热燥湿, 肠道微生物, 免疫功能

Abstract:

Objective　This study aims to explore the effect of heat-clearing and dampness-drying traditional Chinese medicine (TCM) on improving coronary heart disease with blood stasis syndrome, as well as its influence on patients' gut microbiota and immune function regulation. Methods　This randomized controlled trial divided 106 patients with coronary heart disease and blood stasis syndrome, who were admitted to Affiliated Hospital of Shaanxi University of Chinese Medicine from February 2020 to July 2022, into an experimental group and a control group with the random number table method, with 53 patients in each group. The control group consisted of 31 males and 22 females, aged (58.84±7.16) years; the duration of coronary heart disease was (2.04±0.87) years; the cardiac function classification was grade Ⅱ in 32 cases and grade Ⅲ in 21 cases. The experimental group consisted of 28 males and 25 females, aged (59.23±8.82) years; the duration of coronary heart disease was (2.21±0.91) years; the cardiac function classification was grade Ⅱ in 29 cases and grade Ⅲ in 24 cases. All the patients were treated with conventional western medicine (basic treatment: betaloc 12.5 mg/time, twice a day; aspirin enteric-coated tablets 100 mg/time, once a day), and the experimental group was added with heat-clearing and dampness-drying TCM on this basis, for 4 weeks continuously. The clinical efficacy, TCM syndrome score, gut microbiota level, plasma endothelin-1 (ET-1), immune function, serum oxidative stress indicators, and incidence of adverse reactions were observed and compared between the two groups. Statistical methods included t test and χ² test. Results　After 4 weeks of treatment, the clinical effective rate of the experimental group was 92.45% (49/53), which was higher than that of the control group [77.36% (41/53)], with a statistically significant difference (χ²=4.711, P=0.030). The TCM syndrome score of the experimental group was lower than that of the control group [(16.54±2.56) points vs. (19.88±3.07) points], with a statistically significant difference (t=6.083, P<0.001). The levels of trimethylamine oxide (TMAO) and ET-1 in the experimental group were lower than those in the control group [(5.21±0.84) µmol/L vs. (6.04±1.01) µmol/L, (43.76±4.17) ng/L vs. (51.94±4.82) ng/L], but the total content of short-chain fatty acids (acetate, propionate, and butyrate) was higher than that in the control group [(24.97±2.46) µmol/g vs. (23.61±2.67) µmol/g], with statistically significant differences (t=4.600, P<0.001; t=9.344, P<0.001; t=2.727, P=0.008). After 4 weeks of treatment, the CD4⁺ and CD4⁺/CD8⁺ in the experimental group were higher than those in the control group [(44.79±4.17)% vs. (43.12±4.22)%, (1.82±0.32) vs. (1.56±0.29)], with statistically significant differences (t=2.049, P=0.043; t=4.383, P<0.001), but there was no statistically significant difference in the CD8⁺ between the two groups (P>0.05). After 4 weeks of treatment, the levels of superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in the experimental group were higher than those in the control group [(91.83±10.13) U/L vs. (84.72±9.67) U/L, (1.96±0.19) U/mg vs. (1.53±0.21) U/mg], but the MDA level was lower than that in the control group [(5.13±1.01) µmol/L vs. (7.27±1.06) µmol/L], with statistically significant differences (t=3.696, 11.054, and 10.641, all P<0.001). There was no statistically significant difference in the incidence of adverse drug reactions between the two groups during treatment (χ²=0.210, P=0.647). Conclusion　Heat-clearing and dampness-drying TCM can significantly improve the recovery effect in patients with coronary heart disease with blood stasis syndrome, regulate the balance of gut microbiota, enhance the immune function, and optimize the serum oxidative stress indicators, demonstrating good clinical application value.

Key words:

Coronary heart disease, Blood stasis syndrome, Heat-clearing and dampness-drying TCM, Gut microbiota, Immune function