压力与冠心病的相关性研究及越鞠丸对压力致病的干预作用

发布时间：2018-08-21 08:15

【摘要】：目的：1.将有关可感知的压力与冠心病关系的前瞻性队列研究进行汇总,用meta分析合并统计量,对可感知的压力与冠心病的相关性进行研究；2.观察压力下大鼠血清中炎症反应标志物含量的变化,从炎症的角度来探讨压力对冠心病发病的促进作用；并用越鞠丸进行干预,观察中医药在压力致炎症发生中的干预作用,进一步阐明越鞠丸的功效,充分发挥中医药的优势,寻找预防压力所致冠心病的有效方法。方法：1. meta分析：首先确定文献的纳入/排除标准,其次在Pubmed, EMBASE, The Cochrane Library这三大外文数据库中进行检索,检索时间是1990年1月一直到2016年2月,关键词为冠心病及心理压力的主题词和自由词。检索结束后,导入Endnote软件,对检索的结果合并,去掉重复文献。挑选合格的研究,对纳入的研究进行质量评价;并在符合纳入标准的研究中提取所需信息,将数据录入Revman5.3进行统计量汇总。2.动物实验：分为空白组,生理盐水组,越鞠丸低倍剂量组,越鞠丸高倍剂量组,黛力新组(西药组)5组。对后4组施予压力刺激,并予相应药物灌胃,每日1次,持续3周。之后,取大鼠血清检测血清皮质酮、IL-6、 hs-CRP、 sICAM-1,主动脉组织检测E选凝素。结果：1.Meta分析共纳入8项研究,8项研究中有1项的终点事件是冠心病确诊与死亡之和,1项分别列出了确诊与死亡的RR,3项终点事件为确诊,3项为死亡；8项研究中,2项采用了通用的压力测定量表,其余研究均让受试者对自己感受的压力进行评分,根据分数归到不同的压力组中；受试者的例数除1项研究为211外,其余均在1000人以上；除2项研究的RR未经其他危险因素校正,其余均经过常见的冠心病危险因素校正。经QUADAS质量评价,所选文献总体质量不错。统计量合并后,压力所致冠心病的RR是1.25(1.15-1.35)(95%可信区间),压力与患冠心病的风险正向相关。 12=18%,研究基本无异质性。2.动物实验予压力刺激的大鼠血清中皮质酮、hs-CRP、 ICAM-1,主动脉中E-选凝素的含量增加,标志着炎症反应的发生；予越鞠丸干预后,炎症标志物的含量下降,总体来看,下降幅度与黛力新的效果相似,越鞠丸的疗效的剂量效应只表现在hs-CRP含量的测定中。IL-6的含量在各组间无明显的差异。结论：压力可以增加冠心病发病的风险,可作为冠心病的潜在危险因素之一。压力下的大鼠血清中皮质酮、CRP和ICAM-1,主动脉中E-选凝素的含量增加,标志炎症反应的发生,增加冠心病发病的风险；予越鞠丸干预后,炎症标志物的含量下降,总体疗效与黛力新类似,越鞠丸的疗效无明显的剂量效应。予压力应激的大鼠体内IL-6的含量无明显变化。考虑建模时间较短,不足以表现出明显的区别。
[Abstract]:Purpose 1. The prospective cohort study on the relationship between perceived pressure and coronary heart disease was summarized, and the correlation between perceived pressure and coronary heart disease was studied by meta analysis combined with statistics. To observe the changes of inflammatory reaction markers in serum of rats under pressure, to explore the promoting effect of pressure on the pathogenesis of coronary heart disease from the angle of inflammation, and to observe the intervention effect of traditional Chinese medicine in the occurrence of pressure-induced inflammation with Yueju pills. Further clarify the efficacy of Yueju pill, give full play to the advantages of traditional Chinese medicine, and find an effective way to prevent coronary heart disease caused by stress. Methods: meta analysis: firstly, the inclusion / exclusion criteria of the literature were determined, and then the three foreign language databases, Pubmed, EMBASE, The Cochrane Library, were searched. The retrieval time was from January 1990 to February 2016. The key words were coronary heart disease and psychological stress. After the retrieval, the Endnote software is imported, the results of the retrieval are merged, and the duplicate documents are removed. Select the qualified research, evaluate the quality of the included research, and extract the required information in the research according to the inclusion criteria, and input the data into the Revman5.3 for statistical summary. 2. Animal experiment: divided into blank group, physiological saline group, Yueju pill low dose group, Yueju pill high dose group, Delixin group (western medicine group) 5 groups. Pressure stimulation was given to the latter 4 groups, and the corresponding drugs were given orally once a day for 3 weeks. After that, serum corticosterone IL-6, hs-CRP, sICAM-1 were detected in rat serum and E selectin in aorta. Results one of the 8 studies included in the meta-analysis was the sum of diagnosis and death of coronary heart disease. In two of the eight studies, a common stress measurement scale was used. In the rest of the studies, the subjects were rated for the stress they felt and assigned to different stress groups according to their scores; except for one study, the number of cases was 211. The rest were above 1000, except for the RR of 2 studies which were not adjusted for other risk factors, and the others were adjusted for common risk factors of coronary heart disease. After QUADAS quality evaluation, the overall quality of selected literature is good. The RR of pressure-induced coronary heart disease was 1.25 (1.15-1.35) (95% CI), and the pressure was positively correlated with the risk of coronary heart disease. There is no heterogeneity in the study. The levels of corticosterone hs-CRP, ICAM-1 and E- selectin in aorta were increased in the pressure-stimulated rats, indicating the occurrence of inflammatory reaction, and the content of inflammatory markers decreased after the intervention of Yueju pills. The effect of Yueju pill was similar to that of Delixin. The dose effect of Yueju pill was only found in the determination of hs-CRP content. There was no significant difference in the content of IL-6 between groups. Conclusion: stress can increase the risk of coronary heart disease and may be one of the potential risk factors of coronary heart disease. The levels of corticosterone CRP and ICAM-1 in the serum of rats under pressure increased, indicating the occurrence of inflammatory reaction and increasing the risk of coronary heart disease, and the content of inflammatory markers decreased after the intervention of Yueju pills. The overall efficacy was similar to that of Delixine, and there was no significant dose effect of Yueju pill. There was no significant change in the content of IL-6 in stress rats. Considering the shorter modeling time, it is not enough to show the obvious difference.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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