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ObjectiveTo evaluate the efficacy of TCM health management based on tertiary management system for patients with myocardial infarction （MI）. MethodsA total of 277 patients with non-acute MI were enrolled and given comprehensive TCM health management strategies including health education， lifestyle adjustment， risk factors control， medication and TCM appropriate techniques management through a tertiary management system with "the patient as the core， village/community physicians as the main executive body， and tertiary TCM hospital specialists as the leading body"， for a period of 12 months by using a prospective single-arm cohort study. Through patient reporting and medical records surveys， various indicators before and after 12-month management were collected and compared. The primary efficacy indicators were readmission rate and recurrent exacerbation rate， and the secondary efficacy indicators included disease awareness-related indicators， lifestyle behavior-related indicators， cardiovascular risk factor-related indicators and Canadian cardiovascular society （CCS） cardiac function classification. ResultsA total of 255 patients completed the study and were included in the final analysis. The recurrent exacerbation and readmission rates of patients after management were 23.14% （59 cases） and 20.25% （49 cases）， respectively， significantly lower than 36.08% （92 cases） and 53.72% （130 cases） before management （P＜0.05）. Except for knowledge on diabetes diagnostic criteria with no significant difference before and after management （P＞0.05）， awareness of other knowledge with regard to the prevention and treatment of cardiovascular and cerebrovascular diseases were improved after management （P＜0.01）， as well as the total score （P＜0.01）. In terms of daily life behaviors， the rates of salty diet， sweet diet and greasy diet were significantly lower than baseline， while the rate of moderate exercise was significantly higher （P＜0.05 or P＜0.01）； the rates of ongoing smoking and vigorous exercise were not significantly changed （P＞0.05）. For cardiovascular risk factors， patients' total cholesterol， low-density lipoprotein （LDL） cholesterol， triglycerides， fasting glucose， total depression assessment scale score， and total anxiety assessment scale score were significantly reduced after management （P＜0.01）. Systolic blood pressure and body mass index （BMI） were both higher after management （P＜0.05 or P＜0.01）， and there was no statistically significant difference in diastolic blood pressure （P＞0.05）. In terms of the cardiovascular disease risk factors reaching the standard levels， the rate of LDL cholesterol ＜1.8 mmol/L significantly increased （P＜0.01）， while the rate of BMI ＜24 kg/m2 and the rate of systolic blood pressure ＜140 mmHg both decreased significantly （P＜0.05 or P＜0.01） from baseline； the diastolic blood pressure and rate of fasting glucose ＜7.0 mmol/L were not significantly changed （P＞0.05）. The patients' CCS cardiac function classification was significantly reduced （P＜0.05）. ConclusionTCM health management based on the tertiary management system can enhance MI patients' awareness of the disease， change poor lifestyle habits， reduce risk factors such as blood lipids and blood glucose， improve anxiety and depression， increase activity tolerance， and reduce their recurrence exacerbation and readmission rates， which is worthy of clinical promotion.
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Objective:To explore the correlation between differential immune-related genes(DIRGs)and immune cells in the progression of atherosclerosis(AS)and general rule of Chinese medicine for intervening DIRGs.Methods:Firstly,GSE28829 data set was obtained from GEO database,and immune-related genes were downloaded from ImmPort database and MSigDB database.Secondly,differentially expressed genes between early AS plaques(EAP)and advanced AS plaques(AAP)of GSE28829 were screened by limma package,and their intersections with immune-related genes were known as DIRGs.clusterProfiler package was used to enrich the DIRGs.Protein interaction network of DIRGs was constructed and Hub genes were screened.Then,the infiltration patterns of 22 kinds of immune cells were analyzed by CIBERSORT to screen differential immune cells,and the correlation between them and Hub genes were analyzed by Pearson method.Finally,Coremine Medical database was used to predict Chinese herbs for in-tervening DIRGs,the property and flavor of Chinese herbs were collected.Results:Total 63 DIRGs were obtained,and 10 Hub genes(CD86,TLR2,TYROBP,CCR1,ITGB2,CCL2,CCL4,CSF1R,CXCR4,CTSS)were screened out.Enrichment analysis results showed that the molecular functions,biological processes and signaling pathways of DIRGs were closely related to immune regulation.Analysis of immune cell infiltration showed that proportions of regulatory T cells,activated dendritic cells and resting mast cells in EAP were increased.Proportions of memory B cells,γδ T cells,M0 macrophages and M2 macrophages were increased in AAP.Correla-tion analysis showed that CD86 was positively correlated with M2 macrophages in EAP.In AAP,CD86,CTSS,CXCR4,CSF1R,ITGB2 and TYROBP were positively correlated with M0 macrophages,while CCL4 and CCL2 were negatively correlated with resting mast cells.Results of frequency showed that Chinese herbs for intervening DIRGs mainly distributed to liver and lung meridians,and their property and taste were cold and bitter.Conclusion:This study found that in the progression of AS,10 DIRGs were the most important,and 7 kinds of immune cells were dysregulated,among which CD86,CTSS,CXCR4,CSF1R,ITGB2,TYROBP,CCL4 and CCL2 were correlated with resting mast cells,M0 and M1 macrophages.At the same time,immune mechanism of AS progression was closely related to liver meridian,lung meridian,bitter,sweet,cold and warm.The results can provide reference and ideas for Chinese herbs clinical prescription to treat AS and further exploratory the immunological mechanism of AS progression.
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OBJECTIVE：To systematically evaluate the effectiveness and safety of Compound danshen dripping pills in improving aspirin resistance ，and to provide evidence-based evidence for clinical drug use. METHODS ：Retrieved from CNKI ， VIP，Wanfang database ，CBM，PubMed，Embase，the Cochrane L ibrary，randomized controlled trials （RCTs）about Compound danshen dripping pills （trial group ）versus aspirin （control group ）were collected during the inception to Jun. 2020. After literature screening and data extraction ，bias risk assessment tool recommended by the Cochrane evaluation manual handbook 5.1.0 was used to evaluate the quality of the included literatures ，and Rev Man 5.3 software was used for Meta-analysis and publication bias analysis. RESULTS ：A total of 10 RCTs were included ，with a total of 800 patients. Meta-analysis showed that the platelet aggregation rate （PAR）induced by adenosine diphosphate （ADP）in trial group was significantly lower than that of control group [SMD ＝－2.63，95％CI（－3.56，－1.70），P＜0.000 01]. Results of sub-group analysis by treatment cycle showed that PAR induced by ADP in trial group after 2 weeks of treatment [SMD ＝－2.11，95％CI（－2.75，－1.46），P＜0.000 01]，4 weeks of treatment [SMD ＝－2.84，95％CI（－4.26，－1.41），P＜0.000 1] Δ 基金项目 ：国家重点研发计划中医药现代化研究重点专项 and 8 weeks of treatment [SMD ＝－2.63，95％CI（－3.21， （No.2019YFC1710000，No.2019YFC1710003）；国家中医药管理局中 － 2.04），P＜0.000 01] was significantly lower than control 医药循证能力建设项目（No.2019XZZX-XXG003）；河南省创新型科技 团队项目 group. PAR induced by arachidonic acid （AA）of trial group ＊硕士研究生 。研究方向：中西医结合心血管疾病的预防和治 was significantly lower than that of control group [SMD ＝ 疗。E-mail：guohongxin1214@163.com －2.44，95％CI（－3.64，－1.24），P＜0.000 1]. Results of # 通信作者：主任医师，教授，硕士生导师，博士。研究方向：中医 sub-group analysis by treatment cycle showed that PAR 药防治心血管疾病的临床和基础 。电话：0371-66233478。E-mail： induced by AA in trial group after 2 weeks of tre atment [SMD ＝ zhumingjun317@163.com －2.56，95％CI（－3.26，－1.85），P＜0.000 01]，4 weeks of 中国药房 2021年第32卷第6期 China Pharmacy 2021Vol. 32 No. 6 ·743· treatment of [SMD ＝－2.45，95％CI（－4.79，－0.10），P＝0.04]，8 weeks of treatment [SMD ＝－2.38，95％CI（－2.94，－1.82），P＜ 0.000 01] was significantly lower than control group. The decrease of ADP-induced PAR [SMD ＝2.24，95％CI（1.36，3.13），P＜ 0.000 01]，AA-induced PAR [SMD ＝2.42，95％CI（1.94，2.89），P＜0.000 01] and response rate [RR ＝8.56，95％CI（4.38，16.74）， P＜0.000 01] in trial group were significantly higher than control group ，while the incidence of ADR [RR ＝0.30，95％CI（0.15， 0.60），P＝0.000 6]，the incidence of ischemic events [RR ＝0.13，95％CI（0.07，0.27），P＜0.000 01]，CR and RF after treatment （P＜0.05）were significantly lower than control group. There was no statistical significant difference in the incidence of bleeding events between 2 groups [RR ＝0.78，95％ CI（0.34，1.78），P＝0.55]. The results of publication bias showed that there was less possibility of publication bias in this study. CONCLUSIONS ：Compound danshen dripping pills can effectively improve aspirin resistance and has good safety.