壓力與冠心病的相關(guān)性研究及越鞠丸對壓力致病的干預(yù)作用
發(fā)布時間：2018-08-21 08:15
【摘要】：目的：1.將有關(guān)可感知的壓力與冠心病關(guān)系的前瞻性隊列研究進行匯總,用meta分析合并統(tǒng)計量,對可感知的壓力與冠心病的相關(guān)性進行研究；2.觀察壓力下大鼠血清中炎癥反應(yīng)標志物含量的變化,從炎癥的角度來探討壓力對冠心病發(fā)病的促進作用；并用越鞠丸進行干預(yù),觀察中醫(yī)藥在壓力致炎癥發(fā)生中的干預(yù)作用,進一步闡明越鞠丸的功效,充分發(fā)揮中醫(yī)藥的優(yōu)勢,尋找預(yù)防壓力所致冠心病的有效方法。方法：1. meta分析：首先確定文獻的納入/排除標準,其次在Pubmed, EMBASE, The Cochrane Library這三大外文數(shù)據(jù)庫中進行檢索,檢索時間是1990年1月一直到2016年2月,關(guān)鍵詞為冠心病及心理壓力的主題詞和自由詞。檢索結(jié)束后,導(dǎo)入Endnote軟件,對檢索的結(jié)果合并,去掉重復(fù)文獻。挑選合格的研究,對納入的研究進行質(zhì)量評價;并在符合納入標準的研究中提取所需信息,將數(shù)據(jù)錄入Revman5.3進行統(tǒng)計量匯總。2.動物實驗：分為空白組,生理鹽水組,越鞠丸低倍劑量組,越鞠丸高倍劑量組,黛力新組(西藥組)5組。對后4組施予壓力刺激,并予相應(yīng)藥物灌胃,每日1次,持續(xù)3周。之后,取大鼠血清檢測血清皮質(zhì)酮、IL-6、 hs-CRP、 sICAM-1,主動脈組織檢測E選凝素。結(jié)果：1.Meta分析共納入8項研究,8項研究中有1項的終點事件是冠心病確診與死亡之和,1項分別列出了確診與死亡的RR,3項終點事件為確診,3項為死亡；8項研究中,2項采用了通用的壓力測定量表,其余研究均讓受試者對自己感受的壓力進行評分,根據(jù)分數(shù)歸到不同的壓力組中；受試者的例數(shù)除1項研究為211外,其余均在1000人以上；除2項研究的RR未經(jīng)其他危險因素校正,其余均經(jīng)過常見的冠心病危險因素校正。經(jīng)QUADAS質(zhì)量評價,所選文獻總體質(zhì)量不錯。統(tǒng)計量合并后,壓力所致冠心病的RR是1.25(1.15-1.35)(95%可信區(qū)間),壓力與患冠心病的風險正向相關(guān)。 12=18%,研究基本無異質(zhì)性。2.動物實驗予壓力刺激的大鼠血清中皮質(zhì)酮、hs-CRP、 ICAM-1,主動脈中E-選凝素的含量增加,標志著炎癥反應(yīng)的發(fā)生；予越鞠丸干預(yù)后,炎癥標志物的含量下降,總體來看,下降幅度與黛力新的效果相似,越鞠丸的療效的劑量效應(yīng)只表現(xiàn)在hs-CRP含量的測定中。IL-6的含量在各組間無明顯的差異。結(jié)論：壓力可以增加冠心病發(fā)病的風險,可作為冠心病的潛在危險因素之一。壓力下的大鼠血清中皮質(zhì)酮、CRP和ICAM-1,主動脈中E-選凝素的含量增加,標志炎癥反應(yīng)的發(fā)生,增加冠心病發(fā)病的風險；予越鞠丸干預(yù)后,炎癥標志物的含量下降,總體療效與黛力新類似,越鞠丸的療效無明顯的劑量效應(yīng)。予壓力應(yīng)激的大鼠體內(nèi)IL-6的含量無明顯變化�？紤]建模時間較短,不足以表現(xiàn)出明顯的區(qū)別。
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259
[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.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259
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