Table of Content

15 January 2020, Volume 23 Issue 2

Previous Issue    Next Issue

Monographic Research

Research Progress of Related Assessment Tools for Patient Medication Experience　

WANG Yongli，GUO Yawen，FU Bo，QI Bei，ZHANG Zhenxiang

2020, 23(2):  125-129.  DOI: 10.12114/j.issn.1007-9572.2019.00.262

Asbtract ( )   PDF (1383KB) ( )  

References | Related Articles | Metrics

The medication experience of patients has much influence on their belief in taking medicine，behaviors and disease outcomes，while there are currently many kinds of assessment tools for patient medication experience that have not been unified.Therefore，this paper sorts out the related concepts of patient medication experience and the development process，content，reliability and validity，advantages and disadvantages of these assessment tools，in order to provide a scientific reference for the rational evaluation of patient medication experience.


New Progress in the Application of Bibliotherapy in Patients with Schizophrenia　

XUE Man，YAO Guizhong，CHENG Jia

2020, 23(2):  130-135.  DOI: 10.12114/j.issn.1007-9572.2019.00.124

Asbtract ( )   PDF (1380KB) ( )  

References | Related Articles | Metrics

The cognitive and social function of schizophrenics are severely damaged.Though drug treatment can effectively control positive symptoms，its effect on functional damage is not ideal.Bibliotherapy，as a non-drug treatment，can be used to improve the functional damage of patients with schizophrenia.And because of its low cost，easy implementation，and easy access，it has gradually attracted the attention of researchers.This paper further elaborated the overview，implementation process，research method of bibliotherapy and its application effect in patients with schizophrenia，in order to provide reference for future applications and research.


Research Progress of Early Biomarkers of Alzheimer's Disease in Peripheral Blood　

WANG Xuesong，KONG Lihong，YU Chaochao，WANG Yueshen

2020, 23(2):  136-140.  DOI: 10.12114/j.issn.1007-9572.2019.00.264

Asbtract ( )   PDF (1382KB) ( )  

References | Related Articles | Metrics

The onset of Alzheimer's disease is concealed，and a series of pathological changes have occurred in the body several decades before the onset of dementia symptoms.Once patients are in the dementia period，there are currently no ideal drugs and therapies to alleviate the condition.Alzheimer's disease is positively correlated with aging，and the older the patient，the higher the risk of this illness.Screening appropriate biomarkers of Alzheimer's disease for its early diagnosis，prevention，detection，and treatment is important for preventing and delaying the development of Alzheimer's disease.Peripheral blood biomarkers are easy and repeatable to collect and detect，which makes them the most ideal source of biomarkers.In this paper，based on the classical Aβ and Tau protein mechanisms of Alzheimer's disease，the potential biomarkers in peripheral blood were reviewed.


Community-based Management of Chronic Heart Failure Patients Using Heart Failure Inventory Project　

XU Xiaorong，PING Pengna，WANG Xin，WANG Hua，CHEN Pengxu，HAN Mengmeng，XU Lin，YU Liping，ZHAO Wenshu

2020, 23(2):  141-146.  DOI: 10.12114/j.issn.1007-9572.2019.00.751

Asbtract ( )   PDF (1145KB) ( )  

References | Related Articles | Metrics

Background　Active treatment and good management for patients with chronic heart failure（HF） can avoid exacerbation of the disease.But at present，there is no a unified，publicly recognized HF management model.Our research team used an HF inventory project to manage chronic HF patients in a unified way，aiming to provide a reference for the exploration of community-based management models of HF.Objective　To evaluate the effect of community-based management of chronic HF patients with an HF inventory project，hoping to offer a basis for the development of a simple chronic HF management model that can be easily carried out and promoted.Methods　We enrolled 200 HF inpatients from the Heart Center，Beijing Chaoyang Hospital，Capital Medical University during June 30，2016 to June 30，2017，and equally randomized them into the management group（n=100） and control group（n=100），treating with comprehensive management using an HF inventory project and follow-up once a month delivered by a general practitioner team，routine outpatient management without special interventions and follow-up once a month with recording of related data delivered by a general practitioner team，respectively.Intergroup comparisons were made in terms of baseline data obtained by searching the electronic medical record system，and NT-proBNP，left ventricular ejection fraction（LVEF），left ventricular end-diastolic diameter（LVEDD），left ventricular end-systolic diameter（LVESD），standard HF medication treatment，re-hospitalization rate and mortality rate at the end of 6-month follow-up.Results　A total of 176 cases completed the follow-up（89 in the management group and 87 in the control group）.At the end of 6-month follow-up，the management group showed lower mean NT-proBNP，NYHA class，LVEDD and LVESD，and higher mean LVEF compared with the control group（P<0.05）.The use rates of ACEI/ARB increased while the use rate of spironolactone decreased significantly in the management group after intervention（P<0.05）.After management，the utilization rate of ACEI/ARB in the management group was higher than that in the control group（P<0.05）.However，there was no significant difference in the utilization rates of beta-blockers and spironolactone between the two groups（P>0.05）.Furthermore，the management group showed a lower rehospitalization rate due to HF〔11.2%（10/89）〕vs〔29.9%（26/87）〕（χ2=9.404，P=0.002），but a similar mortality rate〔9.0%（8/89）vs 11.5%（10/87），χ2=0.301，P=0.583〕.Conclusion　By using our HF inventory project，the management effect of HF patients is increased significantly，suggesting that this simple project is feasible for community-based management of chronic HF.


Improvement Effects of Self-management Programs on Quality of Life and Negative Mood in Patients with Stroke：a Meta-analysis　

2020, 23(2):  147-155.  DOI: 10.12114/j.issn.1007-9572.2019.00.304

Asbtract ( )   PDF (1861KB) ( )  

References | Related Articles | Metrics

Background　Modern rehabilitation theory and practice have shown that effective rehabilitation training can alleviate the functional disability of stroke patients，accelerate the recovery and reduce medical costs.As a new type of health management method，self-management project has the advantage of “low input and wide coverage”，which provides a way for stroke survivors to promote rehabilitation.The rehabilitation basis of stroke patients depends on their health self-management abilities.Objective　To systematically assess the improvement effects of self-management interventions on the quality of life and negative mood in patients with stroke.Methods　We searched the databases such as PubMed，Web of Science，EBSCO，Cochrane Register of Controlled Trials （CENTRAL），EMBase，China National Knowledge Infrastructure （CNKI），Wanfang Data Knowledge Service Platform，CBM，and VIP from inception to May 2018 for RCTs conducted in adults with stroke receiving organized，systematic self-management interventions（experimental group） and those receiving usual care or receiving no interventions（control group） with outcome evaluation indicators consisting of changes in quality of life，negative mood，self efficacy and activities of daily living （ADL）．Data were analyzed with RevMan 5.3.Results　Nine RCTs with 694 participants were included.The quality of all of them was evaluated as “B”，and the overall level of quality was intermedium.Meta-analysis showed that the overall QOL score in the experimental group was much higher than that of the control group 〔SMD=0.32，95%CI（0.15，0.49），P=0.000 2〕.Subgroup analyses showed that mean SSQOL score and SF-36 score of the experimental group were both higher than those of the control group 〔SMD=0.35，95%CI（0.13，0.57），P=0.002；SMD=0.29，95%CI（0.02，0.56），P=0.04〕.The experimental group showed much lower mean HADS score than the control group 〔MD=-1.01，95%CI（-2.00，-0.02），P=0.05〕.The mean self-efficacy score of the experimental group was higher than that of the control group 〔SMD=0.45，95%CI （0.21，0.69），P=0.000 3〕；there was no significant difference in the mean score of the Stroke Self-efficacy Questionnaire（SSEQ） between the two groups 〔SMD=0.31，95%CI（-0.11，0.73），P=0.15〕；the experimental group obtained much higher mean General Self-efficacy Scale （GSES） score than the control group 〔SMD=0.52，95%CI （0.22，0.81），P=0.000 6〕.The experimental achieved significantly higher mean ADL score than the control group 〔SMD=0.84，95%CI（0.07，1.61），P=0.03〕；there were no significant differences in mean ADL score between the two groups either after short-term interventions or long-term interventions 〔SMD=0.70，95%CI（-0.15，1.54），P=0.11；SMD=1.00，95%CI （-0.52，2.52），P=0.20〕.Conclusion　Self-management programs can effectively improve the quality of life and negative mood，as well as general self-efficacy and ADL in stroke patients.However，the effects on the SSEQ score and other health related behaviors need to be verified by further studies.


Translation and Reliability and Validity of Colorectal Cancer Health Belief Scale　

WU Xiaodan，ZHANG Meifen，ZHENG Meichun，PAN Zhizhong，CHEN Jingyu，JIA Shumin，QIN Huiying

2020, 23(2):  155-160.  DOI: 10.12114/j.issn.1007-9572.2019.00.335

Asbtract ( )   PDF (1094KB) ( )  

References | Related Articles | Metrics

Background　Accurate and effective evaluation of individual health belief characteristics is the premise of effective intervention.Mature scales for evaluating health belief of hypertension，breast cancer and other diseases has been developed in China.As a common malignant tumor，colorectal cancer is a national focus in terms of prevention and control.However，there is no reliable，valid and mature Chinese evaluation scale for health belief of colorectal cancer.Objective　To introduce and translate Colorectal Cancer Health Belief Scale and examine its reliability and validity in Chinese population in order to provide an effective scale for measuring the health belief in patients with colorectal cancer in China.Methods　According to Brislin translation model，we translated the English Colorectal Cancer Health Belief Scale into Chinese version following the forward-translation and back-translation and the Chinese version of Colorectal Cancer Health Belief Scale was cross-culturally adjusted by expert review and a pilot study.A total of 200 relatives of patients with colorectal cancer from the Department of Colorectal Surgery，Cancer Center of Sun Yat-sen University in 2017 completed the scale and we tested its reliability and validity.Results　Six dimensions （36 items），the severity of colorectal cancer，knowledge of the susceptibility to colorectal cancer，the benefits of colorectal cancer screening，the obstacles in colorectal cancer screening，health motivation and self-efficacy of colorectal cancer screening，were included in the Chinese version of Colorectal Cancer Health Belief Scale.The Pearson correlation between item and total score of the scale ranged from 0.349-0.726.The content validity index of the scale （S-CVI） was 0.98.Content validity index of each item （I-CVI） ranged from 0.84 to 1.00.Six common factors were abstracted by principal component analysis and they explained 66.645% of total variance，and each item had a high rotated component matrix （>0.400）． The test-retest reliability was 0.848.The Cronbach's α coefficient of the total scale and its dimensions were 0.881 and 0.801-0.944，respectively.Conclusion　The Chinese version of Colorectal Cancer Health Belief Scale has been proved to be reliable and valid.It is a valuable tool for evaluating health belief of colorectal cancer in mainland China.


Effects of Smoking on Adverse Events in Patients with Heart Failure with Preserved Ejection Fraction　

WANG Qi，LIN Zhen，ZHOU Yanhui，MA Tianyi

2020, 23(2):  161-165.  DOI: 10.12114/j.issn.1007-9572.2019.00.595

Asbtract ( )   PDF (1132KB) ( )  

References | Related Articles | Metrics

Background　Smoking is an important risk factor in the development of heart failure with preserved ejection fraction（HFpEF），and previous studies have identified that smoking is a significant predictor of death in HFpEF population.However，the relationship between smoking and adverse events of heart failure has not been examined in patients with HFpEF.Objective　To analyze the relationship between smoking and adverse events of heart failure in patients with HFpEF.Methods　Patients with HFpEF diagnosed in Department of Cardiovascular Medicine and Department of General Practice of Central South University Xiangya School of Medicine Affiliated Haikou Hospital from 2013 to 2018 were selected as study subjects，and their baseline data，previous medical history and drug treatment data were collected.According to the smoking situation，all patients were divided into never smoking group，former smoker group，and current smoking group，and differences among the three groups were compared.Kaplan-Meier analysis was used to analyze the unadjusted cumulative incidence and survival probability of patients with heart failure requiring hospitalization，and the difference was compared using the Log-rank test.Multivariate Cox proportional hazard regression was used to analyze the risk of hospitalization for heart failure，death，and cardiac death among patients in three groups.Results　A total of 1 717 patients aged 58-87 with HFpEF were enrolled with an average age of（72.2±10.3）．There were 116 ( 6.7% ) current smoking，872 ( 50.8% ) former smoking，729 ( 42.5% ) never smoking. The median follow-up time was 2.9 years.And 387 patients ( 22.5% )  suffered from hospitalization for heart failure.There were 374 ( 21.8% )  deaths and 218 ( 12.7% ) cardiac deaths.There was a statistically significant difference in the unadjusted cumulative incidence and survival probability of hospitalization for heart failure among patients in three groups（Log-rank P=0.003，0.044）．Multivariate Cox proportional hazard regression analysis showed that current smoking was an influencing factor for hospitalization for heart failure〔HR=1.680，95%CI（1.083，2.606）〕，death〔HR=1.820，95%CI（1.195，2.773）〕，and cardiac death 〔HR=1.850，95%CI（1.092，3.133）〕in patients with HFpEF（P<0.005）．Conclusion　Current smoking is associated with an increased risk of adverse clinical outcomes for HFpEF，especially the hospitalization for heart failure.Smoking cessation strategies possibly have a role in reducing the risk of adverse cardiovascular outcomes in patients with HFpEF.


Efficacy Analysis of Tenofovir on HBV-related Decompensated Liver Cirrhosis Patients Experiencing Antiviral Treatment Failure　

ZHAO Yang，LI Ye，ZHAO Chen

2020, 23(2):  165-169.  DOI: 10.12114/j.issn.1007-9572.2019.00.791

Asbtract ( )   PDF (1099KB) ( )  

References | Related Articles | Metrics

Background　Antiviral treatment is an important means of treating HBV-related liver cirrhosis.Classical antiviral drugs are prone to drug resistance.Tenofovir is a new antiviral drug that can be used to save HBV-related decompensated liver cirrhosis patients experiencing antiviral treatment failure.Objective　To evaluate the clinical efficacy of tenofovir on HBV-related decompensated liver cirrhosis patients experiencing treatment failure with lamivudine alone or combined with lamivudine and adefovir dipivoxil.Methods　37 decompensated HBV-related decompensated liver cirrhosis patients who experienced treatment failure with lamivudine alone or combined with lamivudine and adefovir dipivoxil were selected from No.965 Hospital of PLA Joint Logistic Support Force from December 2014 to October 2017.The treatment regimen was changed to a 48-week course of oral administration of adefovir dipivoxil（300 mg，once daily）.And they were treated with oral TDF（300 mg/times/day） for 48 weeks.The level of HBV-DNA，HBV-DNA negative conversion rate，HBeAg negative conversion rate，liver functions，FibroScan values and incidence of complications were compared before and after the treatment.Results　The levels of HBV-DNA，ALT，total bilirubin（TBiL） and FibroScan values were lower，and levels of albumin（ALB），cholinesterase（CHE） and prothrombin activity（PTA） after 24-week and 48-week treatments were higher than those before the treatment（P<0.05）.And 48-week treatment further decreased HBV-DNA and FibroScan values，and increased ALB and CHE in comparison with 24-week treatment（P<0.05）.The negative conversion rates of HBV-DNA and HBeAg were 34.3%（12/35） and 11.4%（4/35），respectively after 24-week treatment，and were 60.0%（21/35） and 22.9%（8/35），respectively after 48-week treatment.Compared to baseline status，the incidence of peritoneal effusion and spontaneous peritonitis after 24-week treatment was lower（P<0.01），and further decreased after 48-week treatment（P<0.01）.There was no significant difference in the incidence of digestive tract hemorrhage，hepatic encephalopathy and hepatorenal syndrome before and after the treatment（P>0.05）.During the treatment, 1 case died of digestive tract hemorrhage, 1 case died of primary liver cancer.Conclusion　Tenofovir dipivoxil could continuously inhibit the replication of HBV，increase the negative conversion rate of HBV-DNA，improve liver function effectively，and lower the degree of hepatic fibrosis and incidence of complications.It may be an ideal alternative medicine for HBV-related decompensated liver cirrhosis patients experiencing antiviral treatment failure with lamivudine.


Risk Factors and Predictive Models for Intravenous Immunoglobulin Resistance in Kawasaki Disease　

PENG Yu，LIU Xiaohui，DUAN Zhao，ZOU Zheng

2020, 23(2):  170-176.  DOI: 10.12114/j.issn.1007-9572.2019.00.471

Asbtract ( )   PDF (1187KB) ( )  

References | Related Articles | Metrics

Background　At present Kawasaki disease （KD） has become the leading cause of acquired heart disease in children.Although intravenous immunoglobulin （IVIG） combined with aspirin were commonly adopted as the standard therapy protocol in KD which can effectively decrease the incidence of coronary artery lesions （CALs），some KD patients are resistant to IVIG therapy and they are at higher risk of developing CALs than patients who response to IVIG therapy.Therefore，it is very important to predict IVIG-resistance indicators in patients with KD.Objective　To analyze the risk factors of IVIG resistance in KD，develop a new predictive model to identify IVIG resistance，and evaluate the efficacy of the new predictive model compared with other four existing predictive models（Egami，Kobayashi，Fu and Lin）.Methods　A retrospective analysis was made on the clinical data of 173 KD children diagnosed，treated and followed up in Jiangxi Provincial Children's Hospital from January 2016 to June 2018.The patients were divided into IVIG resistant group and IVIG response group.Multivariate Logistic regression was used to analyze the independent risk factors of IVIG resistance.A new predictive model was established by assignment.Four other predictive models were used to evaluate the subjects.The predictive efficacy of the new model was compared with the other four predictive models through the receiver operating characteristic （ROC） curve.Results　Of the 173 cases with KD，31 cases（17.9%）were IVIG resistance and 142（82.1%）were IVIG response.Compared with the IVIG response group，IVIG resistance group had significantly higher percentage of male and higher white blood cell count （WBC），neutrophil count （N），percentage of neutrophils ，C-reactive protein （CRP） and ferritin （SF） levels and lower serum sodium level（P<0.05）.Multivariable Logistic regression analysis showed that male〔OR=5.151，95%CI（1.583，16.756）〕，CRP〔OR=1.166，95%CI（1.070，1.272）〕，sodium level〔OR=0.837，95%CI（0.719，0.914）〕 and SF〔OR=1.192，95%CI（1.079，1.318）〕 were independent risk factors of IVIG resistance in KD（P<0.05）.The cut-off values of each indicator were calculated by ROC curve.The results showed that the cut-off values of CRP，blood Na and SF were 94 mg/L，135 mmol/L and 148 μg/L，respectively.Taking 4 point as the cut off value，and the sensitivity and specificity were 79.9% and 53.3%.The sensitivity and specificity of the Egami model for the data were 38.7% and 73.8%，respectively.The sensitivity and specificity of the Kobayashi model were 35.5% and 88.7%，respectively.The sensitivity and specificity of the Fu model were 48.4% and 78.7%，respectively.The sensitivity and specificity of the Lin model are 77.4% and 55.3%，respectively.Conclusion　Male，sodium，CRP and SF are independent risk factors of IVIG resistance in KD.The new predictive model have a higher sensitivity and prediction efficacy than models of Egami，Kobayashi，Fu and Lin.


Application Effect of Transcranial Magnetic Stimulation Combined with Core Strength Training in Children with Spastic Cerebral Palsy　

BAI Yan，WANG Xiuxia，CHEN Haiying

2020, 23(2):  177-182.  DOI: 10.12114/j.issn.1007-9572.2019.00.307

Asbtract ( )   PDF (1107KB) ( )  

References | Supplementary Material | Related Articles | Metrics

Background　Rehabilitation treatment is of vital importance to both physical and mental health of children with spastic cerebral palsy.But responses to regular comprehensive training are not satisfactory in such patients.Transcranial magnetic stimulation can promote the recovery of brain functions by using magnetic fields to stimulate the central nervous system.Core strength training is a kind of rehabilitation targeting on resultant strength of core muscles，which can systematically improve the physical and mental state.Objective　To explore the application value of transcranial magnetic stimulation combined with core strength training in children with spastic cerebral palsy.Methods　448 children with spastic cerebral palsy were recruited from the Second Hospital of Hebei Medical University from 2016 to 2017，and were divided into routine group （148 cases），control group （150 cases） and study group （150 cases） by a random number table，receiving routine rehabilitation treatment，routine rehabilitation treatment with core strength training，routine rehabilitation treatment with core strength training and transcranial magnetic stimulation，respectively.Muscle spasticity measured by the Modified Tardieu Scale （MTS），and gross motor function measured by the Gross Motor Function Measure （GMFM） at baseline，at the end of 1-month and 3-month treatment were collected.And ankle joint motion and gait speed were evaluated at the end of the treatment.Results　Intervention method and time showed interactive effect on MTS score and GMFM score （P<0.001）．And both of them exerted significant main effects on MTS score and GMFM score（P<0.05）．Compared with baseline，MTS score decreased and GMFM score increased significantly at 1 and 3 months after treatment in all groups（P<0.05）．Moreover，MTS score decreased and GMFM score increased significantly at 3 months after treatment in all groups compared with at 1 month after treatment （P<0.05）．Intergroup comparisons indicated that at 1 and 3 months after treatment，higher MTS score and lower GMFM score were found in routine group than other two groups，and were also found in study group instead of control group（P<0.05）．At the end of treatment，ankle joint motion was found to be better than the baseline in all groups（P<0.001）．But it differed significantly across the groups（P<0.001）．In particular，it was improved less in routine group than in other groups（P<0.05），and improved less in control group compared with study group （P<0.05）．Post-treatment gait speed differed significantly across the groups（F=111.695，P<0.001）．Specifically，it was slower in routine group than in other groups（P<0.05），and was slower in control group than that of study group （P<0.05）．Conclusion　Routine rehabilitation training combined with transcranial magnetic stimulation and core strength training can improve the muscle spasticity and gross motor function，and increase the ankle motion and gait speed，so it is worthy of extensive use.


Value of Circulating Tumor Cells in Chemotherapy Efficacy Monitoring and Prognosis Prediction of Advanced Non-small Cell Lung Cancer　

ZHANG Xiaoqin，CHEN Xuanyi，WU Shengchang

2020, 23(2):  183-188.  DOI: 10.12114/j.issn.1007-9572.2019.00.733

Asbtract ( )   PDF (1328KB) ( )  

References | Related Articles | Metrics

Background　The evaluation of chemotherapy efficacy of advanced non-small cell lung cancer（NSCLC） relies on pre-and post-treatment comparison of CT lung lesions，lacking of effective short-term efficacy assessment methods.It is of great significance to find an index that can dynamically and real-timely monitor the efficacy of chemotherapy to guide the individualized treatment of lung cancer.Objective　To explore the value of circulating tumor cells（CTCs） in monitoring chemotherapeutic effect and predcitng prognosis in advanced NSCLC.Methods　Participants were selected from Zhejiang Provincial People's Hospital from December 2015 to December 2016，including 50 cases of advanced NSCLC（lung cancer group），and 50 healthy examinees who volunteered to be controls（control group）.The expression of CTCs in NSCLC patients before and after chemotherapy and in the control group were detected by immunomagnetic bead enrichment technique combined with fluorescence cytochemical staining.The follow-up ended by December 2018，during which the overall survival and progression-free survival of the lung cancer group were collected.The relationships of the expression of CTCs with clinical characteristics，therapeutic effect and prognosis of lung cancer group were analyzed.Results　The prevalence of positive CTCs was 78.0%（39/50），and 0 in lung cancer group，and the control group，respectively，showing a significant difference（χ2=63.934，P<0.001）.There were no significant differences in gender ratio，distributions of age，smoking prevalence，pathological type，differentiation degree and lymph node stage between NSCLC patients with positive CTCs and those with negative（P>0.05）.CTCs positive patients showed higher rate of distant metastasis，and advanced clinical stage than CTCs negative patients（P<0.05）.The prevalence of positive CTCs after one cycle of chemotherapy was lower than that before chemotherapy 〔36.0%（18/50） vs 78.0%（39/50），χ2=4.432，P=0.035〕.The evaluation of CTCs after 1-cycle chemotherapy was in good agreement with that assessed by RECIST 1.1 after 2-cycle chemotherapy（Kappa=0.528，P<0.001）.18 cases were assessed with disease progression by imaging after chemotherapy，including 14 with positive CTCs，and 4 with negative，and the rate of distant metastasis between these two subgroups was significant（12/14 vs 0，χ2=10.286，P=0.001）.The progression-free survival and overall survival of CTCs positive patients were both significantly shorter than those of CTCs negative patients（P<0.05）.Conclusion　It is feasible to detect CTCs by immunomagnetic bead enrichment combined with fluorescence cytochemical staining.The positive expression of CTCs is related to clinical stage and distant metastasis.CTCs are related to the chemotherapy effect and prognosis of advanced NSCLC，which can be used as a sensitive indicator for monitoring the curative effect of chemotherapy and predicting prognosis.


Effect of Intrauterine Transplantation of Bone Marrow Mesenchymal Stem Cells on the Expression of Bone Morphogenetic Protein 4 in Spinal Cord of Fetal Rats with Spina Bifida Aperta　

JIANG Mingyu*，ZHANG Jianbai，REN Mingyong，LIU Haichun

2020, 23(2):  189-193.  DOI: 10.12114/j.issn.1007-9572.2019.00.481

Asbtract ( )   PDF (1807KB) ( )  

References | Related Articles | Metrics

Background　Bone morphogenetic proteins-4 （BMP4） plays an important role in forming dorsal ventral axis pattern in neural tube，cell apoptosis as well as differentiation and transformation of stem cells.If BMP4 is transferred into bone marrow mesenchymal stem cells（MSCs）by transgenic method，whether it can secrete a certain level of BMP4，so that stem cells can replace damaged nerve cells as well as reconstruct collateral circulation and neuroprotection，is an urgent problem to be solved.Objective　To observe the expression of BMP4 in spinal cord of fetal rats with spina bifida aperta before and after MSCs transplantation.Methods　From November 2017 to October 2018，a total of 50 Wistar rats （8 males and 42 females） were purchased from the Laboratory Animal Center of the First Clinical College，Harbin Medical University.Five Wistar rats aged 10 days after birth were retained as stem cell sources.Feeding under normal conditions，cage closing at midnight and mating were confirmed.The rat fetuses with spina bifida were established by a teratogenic drug named as retinoic acid.MSCs were transplanted into rat fetuses by microsurgical injection.The fetuses from the same pregnant rat were divided into five groups:retinoic acid-free malformation group （n=10），spina bifida malformation group （n=12），stem cell transplantation group with retinoic acid-free malformation （n=10），stem cell transplantation group with spina bifida malformation （n=10） and blank transplantation group with spina bifida malformation （n=8）.Real-time polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of BMP4 and antagonist Noggin in each group.Results　The expression of BMP4 mRNA in spina bifida malformation group was higher than that in retinoic acid-free malformation group，and the expression of Noggin mRNA was lower than that in retinoic acid-free malformation group（P<0.05）.The comparisons of BMP4 and Noggin mRNA expression in spina bifida malformation group，stem cell transplantation group and blank transplantation group with spina bifida malformation also showed significant statistical differences（P<0.05）.The expression of BMP4 mRNA in stem cell transplantation group with spina bifida malformation was higher than that in spina bifida malformation group and blank transplantation group with spina bifida malformation.The expression of Noggin mRNA was lower than that in spina bifida malformation group and blank transplantation group with spina bifida malformation（P<0.05）.However，The comparisons of BMP4 and Noggin mRNA between retinoic acid-free malformation group and stem cell transplantation group with retinoic acid-free malformation confirmed no statistical differences （P>0.05）.Conclusion　BMP4 is related to the pathogenesis of spina bifida aperta.Furthermore，MSCs transplantation can up-regulate BMP4 mRNA expression to promote the recovery of neurological function so as to achieve therapeutic efficiency of congenital spina bifida malformation.


Responsibilities of General Practitioners in the Prevention and Treatment of Sudden Cardiac Death in China　

LIU Xiaoyu，ZHAO Jingyu，LI Bing，WANG Liuyi

2020, 23(2):  194-197.  DOI: 10.12114/j.issn.1007-9572.2019.00.652

Asbtract ( )   PDF (1062KB) ( )  

References | Related Articles | Metrics

Sudden cardiac death （SCD） is one of the most common causes of death with the rapid onset and extremely dangerous conditions.The incidence of SCD in China is on the rise and the number of deaths ranks first in the world.The general practitioner，as a gatekeeper，plays an increasingly important role in the healthcare system of China.This study focuses on the responsibilities of general practitioners may have in the SCD control system from the aspects of preventing risk factors，managing first aid treatment，referral，health education and patient management.


Current Status and Thinking of Helicobacter Pylori-negative Gastric Cancer　

WANG Jiong，GUO Qinghong，JI Rui，CHEN Zhaofeng，WANG Yuping，GUAN Quanlin，ZHOU Yongning

2020, 23(2):  198-203.  DOI: 10.12114/j.issn.1007-9572.2019.00.651

Asbtract ( )   PDF (1315KB) ( )  

References | Related Articles | Metrics

Helicobacter pylori-negative gastric cancer （HpNGC） is a disease entity that is different from Helicobacter pylori-positive gastric cancer （HpPGC），with its uniqueness in definition，diagnosis，clinicopathological features，and prognosis.The incidence of HpNGC is low，and its clinical case data is small.There is still no relevant research in China.Therefore，it is necessary to review researches on HpNGC and clarify its research status，in order to improve its understanding，draw more attention，and provide some reference for subsequent research.


The Influence and Thinking of Different Surgical Methods on Postoperative Pain of Anal Fistula　

LI Lei，YAN Guilin，FAN Wenbin，KANG Jian

2020, 23(2):  204-208.  DOI: 10.12114/j.issn.1007-9572.2019.00.159

Asbtract ( )   PDF (1108KB) ( )  

References | Supplementary Material | Related Articles | Metrics

Anal fistula surgery，like other surgical operations，is impossible to avoid postoperative pain，which seriously affects the quality of life of patients after surgery.As the most effective way to cure anal fistula，there are hundreds of clinical operations for anal fistula，and the pain degree of patients after each operation is also different.In addition to the patient's own tolerance to pain and the type of anal fistula，surgery is the most important factor affecting the patient's postoperative pain.By searching relevant domestic and foreign literatures，this paper analyzed the commonly used clinical procedures of anal fistula，explored the influence of different surgical methods on postoperative pain of patients with anal fistula to reflect and find the most suitable method and provide reference for the surgical treatment of anal fistula.


Effect of Sleep Duration and the Time of Falling Asleep on Yin-deficiency Constitution　

XIE Yisha1，ZHU Yanbo1*，XU Jia2，MENG Lingjie1，JIA Liyan3，LYU Xiaoying3

2020, 23(2):  209-214.  DOI: 10.12114/j.issn.1007-9572.2019.00.581

Asbtract ( )   PDF (1161KB) ( )  

References | Related Articles | Metrics

Background　Sleep is vital to people's health.Studies have shown that sleep time is related to traditional Chinese medicine（TCM） constitution.However，there is a lack of research on the influence of sleep time and time of falling asleep on Yin-deficiency constitution.Objective　To explore the effects of sleep time and the time of falling asleep on Yin-deficiency constitution.Methods　The cross-sectional survey method was adopted in people who took health examination in Beijing and Shijiazhuang，Hebei Province from March 2015 to December 2016.The Yin-deficiency subscale of TCM constitution scale was used to evaluate the degree of Yin-deficiency constitution，and the subjects were divided into high score group and low score group according to the mean score.The information on sleep time and time of falling asleep is collected by the investigator asking“How much do you sleep on average per day”and“When do you usually fall asleep”.The sleep time was divided into <6.0 h/d，6.0-6.9 h/d，7.0-7.9 h/d，8.0-8.9 h/d and ≥9.0 h/d.The time of falling asleep was divided into <23：00，23：00-23：59，≥24：00.Logistic regression analysis was used to explore the influence of sleep time and time of falling asleep on Yin-deficiency constitution.Results　A total of 2 170 questionnaires were distributed，2 170 questionnaires recovered，442 deleted，and 1 728 were included，with an effective recovery rate of 79.6%.The score of the Yin-deficiency subscale of 1 728 patients were（23.5±15.0），the score ≥23.5 was set as high，and the score <23.5 was classified as low.Among them，884 were in high score group and 844 were in low score group.Multivariate Logistic regression analysis showed that sleep time 7.0-7.9 h/d was taken as the reference group，sleep time <6.0 h/d〔OR=1.926，95%CI（1.014，3.658）〕，6.0-6.9 h/d〔OR=1.503，95%CI（1.115，2.027）〕，≥9.0 h/d〔OR =1.975，95%CI（1.087，3.589）〕were risk factors for Yin-deficiency（P<0.05）．The time to falling asleep≥24:00 was taken as the reference group，<23：00〔OR=0.576，95%CI（0.413，0.803）〕and 23：00-23：59〔OR=0.579，95%CI（0.438，0.765）〕were protective factors of Yin-deficiency（P<0.05）．Conclusion　Insufficient or too much sleep time，and falling asleep after early morning（24：00）will increase Yin-deficiency.


Effect of TCM-based Body Constitution on Sleep Quality：an Age-specific Analysis　

WANG Lerong，ZHU Yanbo，SHI Muran，MENG Lingjie，XIE Yisha，ZHENG Kun

2020, 23(2):  215-220.  DOI: 10.12114/j.issn.1007-9572.2018.00.431

Asbtract ( )   PDF (1139KB) ( )  

References | Related Articles | Metrics

Background　Nowadays，sleep problems are a common disease.Studies have shown that sleep quality is closely related to TCM-based body constitution.Sleep quality in people of different ages may vary by body constitution.But there is lack of studies about the influence of TCM-based body constitution on sleep quality in different age groups.Objective　To investigate the influence of TCM-based body constitution on sleep quality in different ages.Methods　The data were obtained from a cross-sectional survey conducted in a convenience sample of 1 029 Beijing's residents during March 2015 to May 2016.The Constitution in the Chinese Medicine Questionnaire （CCMQ） and Pittsburgh Sleep Quality Index （PSQI） were adopted in the survey.Scores of nine constitutional types，including gentleness type，Qi-deficiency type，Yang-deficiency type，Yin-deficiency type，phlegm-wetness type，wet-heat type，blood-stasis type，Qi-depression type and special diathesis type，were obtained by CCMQ.High score is associated with a more obvious tendency of constitution.The PSQI score is negatively correlated with sleep quality.Results　The scores of Qi-deficiency type，Yin-deficiency type，phlegm-wetness type，wet-heat type，blood-stasis type and Qi-depression type varied significantly among the respondents by age（P<0.05），but the scores of gentleness type，Yang-deficiency type and special diathesis type and total PSQI score did not （P>0.05）．There was a negative correlation between the score of gentleness type and the total PSQI score （P<0.001），indicating that sleep quality increased with the growth in gentleness of constitution.The scores of 8 types of pathological constitutions were positively correlated with the total PSQI score （P<0.001），showing that if body constitution was more pathologic，the quality of sleep would be worse.The results of multiple linear regression analysis showed that all the types of constitution had effects on the overall sleep quality of different age groups but with differences（P<0.001）．The top three types of constitutions influenced the sleep quality most were gentleness type，blood-stasis type and Qi-depression type in 18-30-year-old respondents，and gentleness type，Qi-deficiency type and Qi-depression type in 31-44-year-old respondents，and gentleness type，blood-stasis type and phlegm-wetness type in respondents aged ≥45.The sleep quality in 31-44-year-old respondents was affected more significantly by TCM-based body constitution compared with those aged 18-30 or those aged ≥45.Conclusion　The effects of gentleness type constitution on the sleep quality among people of different ages are the biggest.The influences of pathological constitutions on the sleep quality are different among people of different ages.To improve the sleep quality of people of different ages，targeted interventions based on age for ameliorating the pathological constitutions or enhancing the level of gentleness of constitution，may be an effective method.


Traditional Chinese Medicine Constitution Features of Different Obesity Phenotypes　

MENG Lingjie，ZHU Yanbo，XU jia，JIA Liyan，LYU Xiaoying，XIE Yisha，ZHENG Kun，ZHANG Hui，LIU Han

2020, 23(2):  221-226.  DOI: 10.12114/j.issn.1007-9572.2019.00.737

Asbtract ( )   PDF (1116KB) ( )  

References | Related Articles | Metrics

Background　Studies have shown that there are certain similarities in the types of TCM constitutions between obese people and those with metabolic disorders，but the risk of metabolically unhealthy in different obese people is not exactly the same.However，it is still unknown whether this difference is essentially related to TCM constitution.Objective　To explore the TCM constitution features of different obesity phenotypes.Methods　During June 2012 to January 2014，from the database of 1 814 physical examinees recruited from Preventive Treatment Center，Beijing Tongren Hospital，the First Affiliated Hospital of Anhui University of Chinese Medicine，and Zhuhai Branch，Guangdong Provincial Hospital of Traditional Chinese Medicine，1 267 normal-weight and obese cases were included after excluding those who were less than 18 years old，underweight，overweight，and had missing data.According to metabolic and obese phenotypes，they were divided into four groups:metabolically healthy normal weight（MHNW），metabolically unhealthy normal weight（MUNW），metabolically healthy obesity（MHO），and metabolically unhealthy obesity（MUO）.The TCM Constitution Questionnaire was used to investigate the TCM constitution.Partial least squares regression was used to calculate the scores of 9 types of TCM constitution for different obesity phenotypes after controlling sociodemographic and behavioral factors，including constitution of gentleness，Qi-deficiency，Yang-deficiency，Yin-deficiency，phlegm-dampness，damp-heat，blood stasis，Qi depression，and allergic.Results　The number of cases in groups of MHNW，MUNW，MHO，and MUO was 584（46.1%），207（16.3%），174（13.7%），and 302（23.9%），respectively.The mean scores of constitution of gentleness，Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype（P<0.05）.To be specific，MUO group showed higher mean score of gentleness constitution，and lower mean score of Yang-deficiency constitution compared with MHNW and MUNW groups（P<0.05）.MHO and MUO groups showed higher mean score of phlegm-dampness constitution compared with other two groups（P<0.05）.Sex-based analysis showed that，the mean scores of constitution of gentleness，Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype in males（P<0.05）.Specifically，males in MUO group demonstrated higher mean score of gentleness constitution，and lower mean score of Yang-deficiency constitution compared with those in MHNW and MUNW groups（P<0.05）.Moreover，males in MHNW group demonstrated lower mean score of phlegm-dampness constitution compared with those in other three groups（P<0.05）.The mean scores of constitution of Yang-deficiency and phlegm-dampness differed significantly by obesity phenotype in females（P<0.05）.Specifically，females in MUO group demonstrated lower mean score of Yang-deficiency constitution compared with those in MHNW group（P<0.05）.And they also showed higher mean score of phlegm-dampness constitution compared with those in MHNW and MUNW groups（P<0.05）.Conclusion　In the case of similar metabolic status，obese people have a higher tendency to develop phlegm-dampness constitution，and gentleness constitution，but the tendency of developing Yang-deficiency constitution is lower.When people's body weights are similar，metabolic status is not associated with significant differences in TCM constitution.However，conditions are different in males and females.Males who are obesity and metabolically unhealthy all showed higher tendency to have phlegm-dampness constitution，but in females，only the obese ones tend to show higher tendency of having phlegm-dampness constitution，those with unhealthy metabolism have no the tendency.


Efficacy of Chinese Medicine Therapies on Insomnia Associated with Coronary Heart Disease：a Network Meta-analysis　

ZHENG Yawei, WU Lifei, ZHANG Xingxing, GU Dongmei, ZHANG Siqi, LIU Ming, FANG Zhuyuan

2020, 23(2):  227-233.  DOI: 10.12114/j.issn.1007-9572.2019.00.255

Asbtract ( )   PDF (1381KB) ( )  

References | Related Articles | Metrics

Efficacy of Chinese Medicine Therapies on Insomnia Associated with Coronary Heart Disease：a Network Meta-analysis

 

ZHENG Yawei^1,2, WU Lifei², ZHANG Xingxing², GU Dongmei², ZHANG Siqi³, LIU Ming³, FANG Zhuyuan^1,3*1.Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

 

2.Nanjing University of Chinese Medicine, Nanjing 210023, China

 

3.Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China

 

*Corresponding author: FANG Zhuyuan, Professor, Chief TCM physician; E-mail: jsszyyfzy@163.com

 

 

 

【Abstract】BackgroundCoronary heart disease（CHD） with insomnia can be called a "psycho-cardiological disease", and the persistent existence of insomnia can induce the onset of CHD or aggravate the development of the condition. In recent years, there have been continuous reports on TCM treatment of CHD with insomnia, but the sample size is small and the relevant evidence-based evaluation is insufficient. ObjectiveTo systematically review the efficacy of Chinese medicine therapies and sedative hypnotic drugs on insomnia associated with CHD. MethodsDatabases including CNKI, CBM, Wanfang Data Knowledge Service Platform, VIP, PubMed, Web of Science, EMBase and Cochrane Library were searched from inception to September 2018 for randomized controlled trials （RCT） about insomnia associated with CHD treated with TCM therapies. RCT screening and enrollment, data extraction, and quality assessment were performed by two researchers independently. Meta-analysis was performed with Rev Man 5.3, Stata 15.1 and ADDIS （V.1.16.8）. ResultsA total of 21 studies with 2496 patients were included, involving 11 interventions（including 9 kinds of TCM therapies）. Traditional meta-analysis found that either Chinese patent medicine plus routine treatment or compound Chinese medicine plus routine treatment was associated with better efficacy compared sedative hypnotic drugs plus routine treatment（P<0.05）. Network meta-analysis demonstrated that for treating insomnia associated with CHD, massage plus five-tone therapy and routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, and compound Chinese medicine plus massage, five-tone therapy and routine treatment had better efficacy than sedative hypnotic drugs plus routine treatment（P<0.05）. Moreover, the efficacy of routine treatment was inferior to that of moxibustion with moxa plus routine treatment, baduanjin plus massage and routine treatment, massage plus five-tone therapy and routine treatment, finger-pressure therapy plus routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, compound Chinese medicine plus massage, five-tone therapy and routine treatment（P<0.05）. Of all the interventions, compound Chinese medicine plus massage, five-tone therapy and routine treatment showed best efficacy, while sedative hypnotic drugs plus routine treatment ranked 10th, only superior to routine treatment alone. ConclusionAvailable evidence shows that Chinese medicine therapies have certain effects on insomnia associated with CHD, and the regimen of compound Chinese medicine plus massage, five-tone therapy and routine treatment may be an optimal selection. However, due to limited number and quality of included studies, this conclusion needs to be confirmed by more high-quality multicenter RCT with larger sample sizes.

 

【Key words】Coronary disease; Sleep initiation and maintenance disorders; TCM therapy; Drug therapy（TCD）; Network Meta-analysis

 

 

 

Coronary heart disease (CHD) complicated with mental and psychological disorders such as insomnia is called ‘double heart disease’. The persistent existence of mental and psychological problems such as insomnia can induce the onset of CHD or aggravate the development of the disease, resulting in poor prognosis ^[1]. Insomnia is a kind of sleep disorder, which makes it difficult to fall asleep or wake up easily after sleeping, and makes it difficult to sleep all night. The initiation and maintenance of sleep are hindered, which seriously affects the quality of life of patients. At present, Western medicine still lacks reliable treatment methods, and sedatives and sleeping pills are the main treatment methods, but their addiction and adverse reactions are difficult to solve ^[2]. Traditional Chinese Medicine believes that this is caused by yangqi not entering yinqi, disharmony between yingqi and weiqi, and imbalance of viscera ^[3]. It is closely related to CHD like ‘xiongbi’ and ‘xintong’. Traditional Chinese Medicine has little adverse reaction and less dependence in treating insomnia. And the patients treated by Traditional Chinese Medicine(TCM) therapies have good compliance and remarkable clinical efficacy ^[4]. In recent years, there have been literature reports on treating CHD complicated with insomnia by TCM therapies, but the sample size was small and the relevant evidence-based evaluation was insufficient. At the same time, due to the wide variety of TCM therapies, different emphasis on efficacy and lack of direct comparative study between different TCM therapies, it is impossible to evaluate the efficacy of various TCM therapies for CHD complicated with insomnia. In this study, the efficacy of different TCM therapies and sedative-hypnotics in treating CHD complicated with insomnia was compared by the method of Network Meta-analysis, and intervention measures were sorted according to the efficacy, in order to provide evidence-based medicine evidence for clinical treatment plan. The report standard of this study refers to the report standard of International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Network Meta-analysis ^[5].

 

Methods

 

Inclusion criteria

 

(1) The study type is randomized clinical trial (RCT) or semi-RCT; (2) The subjects are patients with CHD complicated with insomnia, and the diagnosis of insomnia refers to Chinese Classification and Diagnostic Criteria for Mental Disorders ^[6]; (3) Interventions involve TCM therapy, such as traditional Chinese medicine compound, Chinese patent medicine, Chinese medicine fumigation, acupuncture, massage, five tones, acupoint application, traditional techniques, etc.

 

Exclusion criteria

 

(1) Repeated reporting of literature; (2) The outcome index does not contain the total effective rate of insomnia; (3) The key data is missing, and the complete data cannot be obtained after contacting the author.

 

Search Strategy

 

Databases including China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Wanfang data Information Site, VIP information resource integration service platform, PubMed, Web of Science, EMBase and the Cochrane Library were searched from inception to September 2018. The search terms used were as follows: Coronary heart disease, Insomnia, Traditional Chinese medicine, Acupuncture, Tuina, Qigong, etc.

 

Study Selection and Data Extraction

 

Two researchers independently screening articles, extracting data and cross-checking data combining the criteria of literature inclusion and exclusion. Differences were decided through discussion or arbitration by the third researcher. Data extraction includes: first author, publication time, age, sample size, treatment methods, outcome indicators, etc. The outcome index is expressed by the total effective rate of insomnia, and the calculation formula is: total effective rate = (Cured cases + Significant effective cases + Effective cases)/Total cases ×100%. The effect of insomnia was evaluated according to the Guiding Principles of Clinical Research on New Traditional Chinese Medicine: (1) Cured cases: the sleep time returned to normal or the night sleep time was > 6 h, and the sleep was deep and energetic after waking up; (2) Significant effective cases: sleep improved obviously, sleep time increased by more than 3h, and sleep depth increased; (3) Effective cases: the symptoms were relieved, and the sleep time was increased by < 3h; (4) Ineffective cases: Insomnia was not significantly improved or aggravated after treatment ^[7]. Other recognized evaluations of insomnia efficacy are consulted too. The quality evaluation was conducted by two researchers with reference to Cochrane risk assessment tool ^[8].

 

Data Analysis

 

Statistical analysis is performed with Rev Man 5.3, Stata 15.1 and ADDIS 1.16.8 software. Counting data are expressed by OR and its 95% confidence interval (CI), while the logOR and its 95%CI is used in the network meta-analysis with sedative hypnotic drugs plus routine treatment as common control. The χ2 test is used to analyze the heterogeneity, and I² is used to evaluate the heterogeneity ^[9]. When I² ≤ 50%, which means the heterogeneous less, the fixed effect model is selected for meta-analysis. Excluding the influence of significant clinical heterogeneity when I²>50%, which means the heterogeneity big. If the heterogeneity is still big, the random effect model is used for meta-analysis ^[10]. When there is a closed loop, the consistency between direct comparison and indirect comparison tested with the consistency test. When the inconsistency factor (IF) of consistency test is close to 0 or the odds ratio of hypothesis test (ROR) is close to 1, it is considered that the direct and indirect evidences are consistent ^[11]. Funnel diagram was used to identify whether there is small sample effect evaluation. Four Markov chains are used to set the initial value. The number of iterations of initial updating is 50000, and the number of iterations of continuous updating is 20000. The first 50000 anneals are used to eliminate the influence of the initial value. When the potential scale reduction factor (PSRF) tends to 1, it is considered that the convergence degree is satisfactory ^[12]. The probability of each intervention being the best one is presented by ranking probability. A P-value of < 0.05 is considered statistically significant.

 

Results

 

Search Results

 

A total of 498 related articles were obtained in the initial examination, and 21 RCT ^[13-33] were included after selected layer by layer in the end. A total of 2496 patients with CHD complicated with insomnia were included. Eleven kinds of intervention measures were involved specifically: 1) moxa plus routine treatment, 2) baduanjin plus massage and routine treatment, 3) massage plus five-tone therapy and routine treatment, 4) finger-pressure therapy plus routine treatment, 5) yangxinshi tablet plus acupuncture and routine treatment, 6) Chinese patent medicine plus routine treatment, 7) compound Chinese medicine plus routine treatment, 8) compound Chinese medicine plus massage, five-tone therapy and routine treatment, 9) fumigation and washing plus routine treatment, 10) routine treatment, 11) sedative hypnotic drugs plus routine treatment. The flow chart of literature screening and result was shown in Figure 1. General data of the included studies was shown in Table 1. The baseline situation of the 21 included studies had been statistically analyzed and comparable. Quality evaluation of the included studies was shown in Table 2. 


 

Table 1The general data of the included studies

Study	Age（year）		Sample（n）		Treatment		Outcome
	c	e	c	e	c	e
Zhou Meier 2015	51.7±12.7	51.4±13.0	73	73	J	A	▲
Yu Xuelian 2017	71.0± 5.1	71.0 ± 5.4	60	60	J	B	▲
Li Haiyan 2017	NA	NA	40	40	K	C	▲
Hu Yanning 2011	52.0±13.1	52.8±3.2	40	40	J	D	▲
Zhang Jun 2011	43.3±5.2	42.5±6.5	40	40	K	E	▲
Wang Lin 2016	53.8±6.8	51.2±5.2	60	59	J	F	▲
Ma Yan 2017	73.0±5.0	70.0±6.0	40	40	K	F	▲
Xu Yali 2015	64.2	63.2	100	100	K	F	▲
Zhai Shumin 2016	56.6±15.3	54.2±14.7	26	26	K	F	▲
Xue Zheng 2012	42~80	42~80	50	50	K	F	▲
Zhang Chunrong 2018	54.2±9.6	55.7±8.2	60	60	K	F	▲
Wang Zhuo 2011	53.0±5.0	52.0±6.0	100	100	K	F	▲
Zhang Xiangsu 2011	62.6±6.5	62.6±6.5	30	30	K	F	▲
Zhang Xiangrong 2016	67.3±6.8	70.5±8.1	160	160	K	G	▲
Wang Chuanfang 2018	67.7±10.0	68.4±8.4	53	53	J	G	▲
Wang Jian 2010	54.8±3.8	59.3±6.1	33	35	K	G	▲
Chen Xunshan 2018	73.2±11.2	72.8±12.2	45	45	K	G	▲
Ren Dewang 2011	66.9±10.2	65.2±11.8	39	39	K	G	▲
Yang Jiao 2015	NA	NA	40	80	K	G	▲
Liu Jinglu 2017	NA	NA	40	40	G	H	▲
Xu Yinli 2014	47.9±7.7	48.4±6.5	98	99	K	I	▲

NA, missing value; c, Control group; e, Experimental group; A, moxa plus routine treatment; B, baduanjin plus massage and routine treatment; C, massage plus five-tone therapy and routine treatment; D, finger-pressure therapy plus routine treatment; E, yangxinshi tablet plus acupuncture and routine treatment; F, Chinese patent medicine plus routine treatment; G, compound Chinese medicine plus routine treatment; H, compound Chinese medicine plus massage, five-tone therapy and routine treatment; I, fumigation and washing plus routine treatment; J, routine treatment; K, sedative hypnotic drugs plus routine treatment; ▲, total effective rate of insomnia.

 

Table 2Quality evaluation of the included studies

Study	Random sequence generation	Allocation concealment	Blind method	Quit or lose visit	Complete outcome data	Selective reporting	Other bias
Zhou Meier 2015	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Yu Xuelian 2017	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Li Haiyan 2017	High risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Hu Yanning 2011	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Zhang Jun 2011	Unclear risk of bias	Unclear risk of bias	High risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Wang Lin 2016	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Ma Yan 2017	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Xu Yali 2015	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Zhai Shumin 2016	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Xue Zheng 2012	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Zhang Chunrong 2018	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Wang Zhuo 2011	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Zhang Xiangsu 2011	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Zhang Xiangrong 2016	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Wang Chuanfang 2018	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Wang Jian 2010	Unclear risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Chen Xunshan 2018	High risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Ren Dewang 2011	High risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Yang Jiao 2015	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Liu Jinglu 2017	High risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias
Xu Yinli 2014	Low risk of bias	Unclear risk of bias	Unclear risk of bias	Low risk of bias	Low risk of bias	Low risk of bias	Unclear risk of bias

 

Table 3 Network meta-analysis of the overall efficacy of 11 intervetnions for insomnia in patients with coronary heart disease

OR	A	B	C	D	E	F	G	H	I	J	K
A	1.00	-	-	-	-	-	-	-	-	-	-
B	1.69 (0.15，20.14)	1.00	-	-	-	-	-	-	-	-	-
C	0.32 (0.01，7.56)	0.19 (0，5.04)	1.00	-	-	-	-	-	-	-	-
D	1.65 (0.18，19.29)	0.96 (0.09，11.66)	5.10 (0.23，213.00)	1.00	-	-	-	-	-	-	-
E	1.28 (0.07，21.50)	0.78 (0.04，15.58)	3.87 (0.17，150.34)	0.79 (0.04，12.48)	1.00	-	-	-	-	-	-
F	1.55 (0.21，12.94)	0.93 (0.11，8.83)	4.45 (0.44，120.74)	0.98 (0.13，6.59)	1.18 (0.16，12.01)	1.00	-	-	-	-	-
G	2.07 (0.29，15.42)	1.20 (0.16，12.15)	5.92 (0.59，172.50)	1.25 (0.18，9.01)	1.58 (0.21，16.59)	1.32 (0.58，3.28)	1.00	-	-	-	-
H	0.09 (0，1.73)	0.05 (0，1.44)	0.25 (0，21.61)	0.06 (0，1.00)	0.07 (0，1.92)	0.06 (0，0.66) a	0.05 (0，0.46) a	1.00	-	-	-
I	3.62 (0.29，36.10)	2.13 (0.17，28.92)	10.73 (0.72，367.56)	2.21 (0.20，20.78)	2.78 (0.27，35.65)	2.28 (0.54，9.95)	1.75 (0.38，7.21)	39.83 (2.51，1 603.66) a	1.00	-	-
J	9.98 (2.12，57.66) a	5.87 (1.11，39.05) a	30.00 (2.33，902.39) a	6.05 (1.22，30.95) a	7.58 (0.81，96.78)	6.21 (2.13，22.65) a	4.76 (1.61，16.01) a	108.22 (8.50，4 149.32) a	2.74 (0.52，17.52)	1.00	-
K	7.55 (1.00，60.65)	4.35 (0.50，45.33)	21.44 (2.24，564.61) a	4.59 (0.60，32.40)	5.69 (0.83，52.64)	4.74 (2.55，9.07) a	3.62 (1.77，6.96) a	80.32 (7.38，2 783.96) a	2.09 (0.56，7.76)	0.76 (0.21，2.26)	1.00

-, repeating data; ^aP<0.05 

 

Table 4Ranking of total effective rate of insomnia in patients with coronary heart disease

 

Rank	A	B	C	D	E	F	G	H	I	J	K
1	0.03	0.01	0.23	0.01	0.03	0.00	0.00	0.69 a	0.00	0.00	0.00
2	0.15	0.07	0.39 a	0.06	0.11	0.01	0.00	0.21	0.01	0.00	0.00
3	0.23 a	0.13	0.16	0.14 a	0.18 a	0.07	0.02	0.05	0.02	0.00	0.00
4	0.2	0.14*	0.08	0.14 a	0.15	0.18	0.07	0.02	0.03	0.00	0.00
5	0.12	0.12	0.05	0.13	0.11	0.25 a	0.15	0.01	0.05	0.00	0.00
6	0.09	0.1	0.03	0.13	0.09	0.25 a	0.23	0.00	0.07	0.00	0.00
7	0.07	0.12	0.02	0.13	0.09	0.16	0.27 a	0.00	0.11	0.00	0.01
8	0.06	0.14 a	0.02	0.12	0.11	0.07	0.21	0.00	0.21	0.02	0.04
9	0.03	0.1	0.01	0.09	0.08	0.01	0.05	0.00	0.39 a	0.08	0.16
10	0.01	0.05	0.00	0.04	0.03	0.00	0.00	0.00	0.08	0.26	0.53 a
11	0.00	0.01	0.00	0.01	0.02	0.00	0.00	0.00	0.05	0.64 a	0.26

^a, the most likely ranking of interventions

 

Traditional Meta-analysis

 

The results of traditional meta-analysis of total effective rate of insomnia showed that there were significant differences between Chinese patent medicine plus routine treatment and sedative hypnotic drugs plus routine treatment [OR = 4.47,95% CI (2.78,7.20)]. There were significant differences between compound Chinese medicine plus routine treatment and sedative hypnotic drugs plus routine treatment [OR = 4.28,95% CI (2.77,6.62)]. There was only one study in other each pairwise direct comparison items, so meta-analysis was not performed. Excluding each study one by one, the OR values of the combined effects were still within 95%CI of the total combined effects, with no directional change and no significant change in statistical heterogeneity, suggesting that the results of this study were relatively stable.

 

Network Meta-analysis

 

Network relationship

 

The network relationship of included intervention measures was shown in Figure2. Generally speaking, it is a star structure with 11 intervention nodes and no closed loop, centering on sedative hypnotic drugs plus routine treatment. One study ^[31] is a three-arm study with two experimental groups were both compound Chinese medicine plus routine treatment. So, we merged the two experimental groups into one group. As a result, the total number of arms in 21 articles was 42. There was a connection between nodes indicating that there was evidence of direct comparison between the two interventions. There were no connection nodes indicating that there was no direct comparison, which can be indirectly compared through network meta-analysis. There were 11 kinds of intervention measures involved in this study, among which the number of studies comparing Chinese patent medicine plus routine treatment with sedative hypnotic drugs plus routine treatment is the largest. The intervention measure with the largest total sample size was sedative hypnotic drugs plus routine treatment.

 

Consistency test

 

In this study, interventions did not form a closed loop, so consistency test was unnecessary.

 

Evaluation of small sample effect

 

The funnel chart was used to evaluate the publication bias of 21 included studies. We found one study ^[15] fell outside 95%CI, while the other 20 articles all fell within 95%CI. The included studies were distributed symmetrically on both sides of the vertical line X=0 and the regression line was relatively horizontal, which indicated that there was little possibility of small sample effect in the study (Figure 3).

 

Convergence diagnosis

 

Four Markov chains were used. The PSRF tends to 1 and reaches stability after 50000 simulation iterations, 20000 adjustment iterations and 10 refinement iterations, which indicates that the convergence degree of the model is satisfactory.

 

Network Meta-analysis results

 

All of 21 studies reported the total effective rate of insomnia. Firstly, the network meta-analysis was carried out with sedative hypnotic drugs plus routine treatment as common control. The results showed that massage plus five-tone therapy and routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, compound Chinese medicine plus massage, five-tone therapy and routine treatment were superior to sedative hypnotic drugs plus routine treatment. The differences were statistically significant (P<0.05, Figure 4). Then Bayesian network meta-analysis was performed. The results shown that moxa plus routine treatment, baduanjin plus massage and routine treatment, massage plus five-tone therapy and routine treatment, finger-pressure therapy plus routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, compound Chinese medicine plus massage, five-tone therapy and routine treatment were superior to routine treatment. At the same time, massage plus five-tone therapy and routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, compound Chinese medicine plus massage, five-tone therapy and routine treatment were superior to sedative hypnotic drugs plus routine treatment. The compound Chinese medicine plus massage, five-tone therapy and routine treatment was superior to Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, fumigation and washing plus routine treatment. The differences were statistically significant (P<0.05, Table 3).

 

Rank results

 

The total effective rate of insomnia of intervention was shown in Table 4. According to the results in Table 3, the order from superior to inferior was: compound Chinese medicine plus massage, five-tone therapy and routine treatment; massage plus five-tone therapy and routine treatment; moxa plus routine treatment; yangxinshi tablet plus acupuncture and routine treatment; finger-pressure therapy plus routine treatment; Chinese patent medicine plus routine treatment; baduanjin plus massage and routine treatment; compound Chinese medicine plus routine treatment; fumigation and washing plus routine treatment; sedative hypnotic drugs plus routine treatment; routine treatment.

 

Discussion

 

A total of 21 studies were included in our research, involving 2496 patients with CHD complicated with insomnia. A total of 11 kinds of different interventions were included, including 9 kinds of TCM therapy. The results of traditional meta-analysis show that Chinese patent medicine plus routine treatment and compound Chinese medicine plus routine treatment were superior to sedative hypnotic drugs plus routine treatment. The effectiveness of different TCM therapies and sedative hypnotic drugs in treating CHD complicated with insomnia were compared with Bayesian network meta-analysis. The results showed that TCM therapy were superior to routine treatment except yangxinshi tablet plus acupuncture and routine treatment and fumigation and washing plus routine treatment. At the same time, massage plus five-tone therapy and routine treatment, Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, compound Chinese medicine plus massage, five-tone therapy and routine treatment were superior to sedative hypnotic drugs plus routine treatment. The top 3 interventions of ranks were compound Chinese medicine plus massage, five-tone therapy and routine treatment, massage plus five-tone therapy and routine treatment, moxa plus routine treatment. The compound Chinese medicine plus massage, five-tone therapy and routine treatment which was the first order was superior to Chinese patent medicine plus routine treatment, compound Chinese medicine plus routine treatment, fumigation and washing plus routine treatment. The last 2 interventions of ranks were sedative hypnotic drugs plus routine treatment, routine treatment. The specific rank from superior to inferior was as follows: compound Chinese medicine plus massage, five-tone therapy and routine treatment; massage plus five-tone therapy and routine treatment; moxa plus routine treatment; yangxinshi tablet plus acupuncture and routine treatment; finger-pressure therapy plus routine treatment; Chinese patent medicine plus routine treatment; baduanjin plus massage and routine treatment; compound Chinese medicine plus routine treatment; fumigation and washing plus routine treatment; sedative hypnotic drugs plus routine treatment; routine treatment. The interpretation of the rank should be combined with the results of meta-analysis.

 

Patients with CHD complicated with insomnia exist widely in clinic. It can be proved that insomnia is closely related to CHD from both TCM theory and modern medicine ^[34]. Insomnia complicated or secondary to CHD has become an independent risk factor of cardiovascular disease, which affects the recovery of cardiac function and has a bad prognosis for patients. CHD in modern medicine belongs to ‘xiongbi’, ‘xintong’ and ‘xinji’ in traditional Chinese medicine, while insomnia in modern medicine belongs to ‘bumei’, ‘budemei’ and ‘mubuming’ in traditional Chinese medicine. As early as ‘Huangdi Neijing’, the double-heart theory of ‘heart governing blood vessels’ and ‘heart governing gods’ were expounded. Therefore, CHD complicated with insomnia should be treated with the principle of ‘treating with both hearts’, and with the treatment of tonifying deficiency, purging excess and regulating the mind ^[35]. The ‘holistic concept’ of traditional Chinese medicine has unique advantages and status in the diagnosis and treatment of CHD complicated with insomnia, which has a good therapeutic effect on CHD complicated with insomnia. However, there still was lacking rigorous evidence-based medicine research and standardized experimental research. So, further studies need to be carried out ^[36]. In this study, through the method of network meta-analysis, the curative effects of TCM therapy and sedative hypnotics on CHD complicated with insomnia were preliminarily compared. Results confirmed that the total effective rate of Chinese medicine therapy on CHD complicated with insomnia was higher. This study provided new ideas and evidence for clinical treatment of CHD complicated with insomnia. However, due to the high risk of bias in the original study, the related results are not stable at present. It is impossible to form a standardized clinical guidance for the time being. Therefore, multi-center, large sample and high-quality researches should be organized in the later stage to further clarify the effectiveness and safety of TCM therapy for patients with CHD complicated with insomnia, and to clarify its clinical feasibility, so as to achieve the initial purpose of guiding clinical practice.

 

The effectiveness of TCM therapy for CHD complicated with insomnia was compared by the method of network meta-analysis. The results of small sample effect evaluation and sensitivity analysis indicate that the results were stable. However, the limitations of this study should not be ignored: (1) All the studies included were Chinese articles, which may lead to the language bias existed; (2) The number of studies involved was small and the sample sizes were insufficient, which may lead to the decrease of statistical efficiency; (3) The low quality of the included studies affected the authenticity and reliability of the results, which may lead to the reduction of inspection efficiency; (4) The long-term effect of TCM therapy on CHD with insomnia could not be evaluated due to the limitation of included studies; (5) There were few safety reports, which cannot form reliable safety evidence. Therefore, in the future, multi-center, large-sample, and high-quality researches can be organized to further clarify the effectiveness and safety of TCM therapies in the treatment of CHD complicated with insomnia and define its clinical feasibility, to achieve the initial purpose of guiding clinical practice.

 

Conclusion

 

In conclusion, the effectiveness of the 9 TCM therapies in CHD complicated with insomnia has shown certain advantages. Among the 9 TCM therapies, compound Chinese medicine plus massage, five-tone therapy and routine treatment may be the most effective treatment. In addition, the conclusions of this study still need to be verified by more high-quality, multi-center and large-sample RCTs. Given the limitations of this study, the application of the conclusions of this study should be carefully selected.

 

Author contributions

 

ZHENG Yawei carried out research implementation and feasibility analysis, statistical processing, analysis and interpretation of results. ZHENG Yawei, WU Lifei and GU Dongmei collected data. ZHENG Yawei, WU Lifei and ZHANG Xingxing carried out data collation. ZHENG Yawei and WU Lifei wrote the paper. ZHENG Yawei and ZHANG Xingxing revised the paper. ZHANG Siqi and LIU Ming took charge of the quality control and revision of articles. ZHENG Yawei and FANG Zhuyuan took charge of the article and supervised the article.

 

Conflicts of Interest

 

The authors declare no conflicts of interest in any aspects.

 

References

 

[1] YANG X M，CHEN X H，SHI H B.Treatment of coronary heart disease with the theory of “simultaneously treatment on psycho-cardiology”[J].Journal of Emergency in Traditional Chinese Medicine，2018，27(1)：97-100.DOI：10.3969/j.issn.1004-745X.2018.01.030.

 

[2] TANG C Y，GUO J，WANG L P.Overview of treatment of primary insomnia with traditional Chinese and Western medicine［J］.World Journal of Integrated Traditional and Western Medicine，2015，10（6）：869-873.DOI：10.13935/j.cnki.sjzx.150640.

 

[3] JIA Y，JIA Y J，ZHENG X L.Discussion and prospect on the knowledge of insomnia from traditional Chinese medicine［J］.China Journal of Traditional Chinese Medicine and Pharmacy，2015，30（1）：163-166.DOI：10.3969/j.issn.1671-8313.2017.11.192.

 

[4] HU Q，LI Q Y.Litterature review TCM treatment for insomnia[J].International Journal of Traditional Chinese Medicine，2016，38(6)：573-576.DOI：10.3760/cma.j.issn.1673-4246.2016.06.027.

 

[5] JANSEN J P，FLEURENCE R，DEVINE B，et al.Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making：report of the ISPOR task force on indirect treatment comparisons good research practices：part 1[J].Value Health，2011，14(4)：417-428.DOI：10.1016/j.jval.2011.04.002.

 

[6] Chinese Society of Neurology.Classification and diagnostic criteria for mental disorders in China ［M］.Jinan：Shandong science & technology press，2001：87-88.

 

[7] ZHENG X Y. Guiding principles for clinical research of new Chinese medicines［M］.Beijing：China Medical Science Press，2002.

 

[8] HIGGINS J P T，GREEN S，Cochrane Collaboration：Cochrane handbook for systematic reviews of interventions [EB/OL].（2011-03-20）.http：//www.cochranehandbook.org．

 

[9] HIGGINS J P，THOMPSON S G，DEEKS J J，et al.Measuring inconsistency in meta-analyses[J].BMJ，2003，327(7414)：557-560.DOI：10.1136/bmj.327.7414.557.

 

[10] DERSIMONIAN R，LAIRD N.Meta-analysis in clinical trials[J].Control Clin Trials，1986，7(3)：177-188.

 

[11] ZHANG C，YAN J Z，SUN F.Differentiation and handling of homogeneity in network meta-analysis［J］. Chinese Journal of Evidence-Based Medicine，2014，14（7）：884-888.DOI：10.7507/1672-2531.20140146.

 

[12] YI Y X，ZHANG W，LIU X Y，et al.Result interpretation of network meta-analysis［J］.Chinese Journal of Evidence-Based Medicine，2015，15（1）：103-109.DOI：10.7507/1672-2531.20140263.

 

[13] ZHOU M E，XIA X Q.Observation on the effect of moxibustion shenmen point on coronary heart disease and insomnia［J］.Chinese Journal of Rural Medicine and Pharmacy，2015，22（5）：47.DOI：10.19542/j.cnki.1006-5180.2015.05.027.

 

[14] YU X L，LI H H.The effect of Baduanjin combined with acupoint massage on the sleep quality in elderly patients with coronary heart disease［J］.Practical Journal of Clinical Medicine，2017，14（6）：220-222.DOI：10.3969/j.issn.1672-6170.2017.06.069.

 

[15] LI H Y，XIN Y R，LIU J L，et al.Clinical effect experience of five-sound music therapy in combination with acupressure in the treatment of patients with psycho-cardiology［J］.Journal of Liaoning University of Traditional Chinese Medicine，2017，19（6）：180-183.DOI：10.13194/j.issn.1673-842x.2017.06.056.

 

[16] HU Y N，LIU X F，LONG X H，et al.Effect of acu-pressure on sleep quality of coronary heart disease patients with insomnia［J］.Journal of Traditional Chinese Medicine，2011，52（4）：310-313.DOI：10.13288/j.11-2166/r.2011.04.004.

 

[17] ZHANG J，JIA X L，YAN X H.Clinical observation on 40 cases of insomnia due to coronary heart disease treated by yangxin tablets combined with acupuncture［J］.World Chinese Medicine，2011，6（6）：504-505.DOI：10.3969/j.issn.1673-7202.2011.06.030.

 

[18] WANG L，JIAN Y，PAN C Q.Observation on myocardial protection and clinical effect of shensong yangxin capsule in the treatment of angina pectoris with primary insomnia［J］.Chinese Archives of Traditional Chinese Medicine，2016，34（8）：2000-2002.DOI：10.13193/j.issn.1673-7717.2016.08.060.

 

[19] MA Y，CUI Z.Clinical effect of shensong yangxin capsule on stable angina pectoris with insomnia［J］.World Latest Medicine Information，2017，17（5）：80，241.DOI：10.3969/j.issn.1671-3141.2017.5.068.

 

[20] XU Y L，ZHANG H.Shensong Yangxin capsule treated 100 cases of coronary heart disease complicated with insomnia［J］.Shaanxi Journal of Traditional Chinese Medicine，2015，36（10）：1320-1321.DOI：10.3969/j.issn.100-7369.2015.10.027.

 

[21] ZHAI S M.Clinical observation of Sanwei Danxiang decoction in the treatment of insomnia caused by coronary heart disease［J］.Journal of Medicine & Pharmacy of Chinese Minorities，2016，22（4）：24-25.DOI：10.16041/j.cnki.cn15-1175.2016.04.016.

 

[22] XUE Z.Buchang wenxin granule was used in 50 cases of insomnia with stable angina pectoris［J］.World Chinese Medicine，2012，7（2）：126-127.DOI：10.3969/j.issn.1673-7202.2012.02.020.

 

[23] ZHANG C R.Myocardial protection and sleep quality influence of shensong Yangxin capsules on patients with stable angina combined with insomnia[J].China Journal of Chinese Medicine，2018，33(2)：303-306.DOI：10.16368/j.issn.1674-8999.2018.02.073.

 

[24] WANG Z，CAI G，ZHANG H Q，et al.Linical observation “Shensong Yangxin capsule” in treating lnsomnia and coronary heart disease［J］.China Journal of Chinese Medicine，2011，26（11）：1363-1364.DOI：10.16368/j.issn.1674-8999.2011.11.020.

 

[25] ZHANG X S，SHI C P，RAO S G.Observation on therapeutic effect of nourishing serum brain granule on unstable angina pectoris with insomnia［J］.Journal of New Chinese Medicine，2011，43（10）：14-15.DOI：10.13457/j.cnki.jncm.2011.10.005.

 

[26] ZHANG C R.Curative observation of using self- made Yangxin Anshen decoction to treat unstable angina pectoris patients with insomnia[J].Journal of Sichuan of Traditional Chinese Medicine，2016，34(3)：125-128.

 

[27] WANG C F.Effect of Suanzaoren decoction on treating patients with coronary heart disease complicated with insomnia and its influence on quality of life[J].Journal of Liaoning University of Traditional Chinese Medicine，2018，20(9)：117-120.DOI：10.13194/j.issn.1673-842x.2018.09.033.

 

[28] WANG J.Clinical observation on the treatment of coronary heart disease angina pectoris and insomnia with revival decoction［J］.China Modern Medicine，2010，17（7）：100-101.DOI：10.3969/j.issn.1674-4721.2010.07.068.

 

[29] CHEN X S，YU T T.Clinical observation on warming heart Yang and nourishing liver blood in treating coronary heart disease with insomnia[J].Chinese Medicine Modern Distance Education of China，2018，16(16)：83-86.DOI：10.3969/j.issn.1672-2779.2018.16.036.

 

[30] REN D W，YANG C，REN Z Y，et al.Clinical observation on the treatment of coronary heart disease with insomnia by Jianling decoction［J］.Internal Medicine Department，2011，6（6）：563-564.DOI：10.3969/j.issn.1673-7768.2011.06.017.

 

[31] YANG J.Clinical observation of Danshen decoction and Suanzaoren decocotionon coronary heart disease with insomnia［D］.Huhehot：Inner Mongolia Medical University，2015.

 

[32] LIU J L，LI H Y，XIN Y R，et al.Observation of Hewei Anshen decoction combined with acupoint massage therapy on the heart and had double effect on the treatment of insomnia[J].Journal of Liaoning University of Traditional Chinese Medicine，2017，19(6)：143-145.DOI：10.13194/j.issn.1673-842x.2017.06.043.

 

[33] XU Y L，HE W L，ZHONG X J.Effect of herbal fumigation combined with acupoint massage on patients with coronary heart disease and insomnia［J］.Chinese Journal of Modern Nursing，2014，20（6）：694-696.DOI：10.3760/j.issn.1674-2907.2014.06.030.

 

[34] LI Y R，YU J，ZHUANG H，et al.Preliminary study on the relationship between insomnia and coronary heart disease[J].Shandong Journal of Traditional Chinese Medicine，2014，33(1)：14-16.DOI：10.16295/j.cnki.0257-358x.2014.01.008.

 

[35] CHEN X H，ZHU X H，CHEN J D，et al.Expert consensus on the diagnosis and treatment of psycho-cardiological disease with integrated traditional Chinese and Western medicine［J］.Chinese General Practice，2017，20（14）：1659-1662.DOI：10.3969/j.issn.1007-9572.2017.03.y04.

 

[36] ZHU Y，XIA W，LIU W W，et al.Chinese medicine treatment of insomnia[J].Jilin Journal of Traditional Chinese Medicine，2016，36(3)：320-324.DOI：10.13463/j.cnki.jlzyy.2016.03.028.

 

 

 

Effects of Anxiety and Depression on Neuroendocrine Immune Network in Patients with Ulcerative Colitis　

ZHAO Changdong，ZHAO Hongyan，KE Xiquan，ZHANG Xiaojie，ZHANG Hui，WANG Shufang，LI Xue

2020, 23(2):  234-239.  DOI: 10.12114/j.issn.1007-9572.2019.00.318

Asbtract ( )   PDF (1182KB) ( )  

References | Related Articles | Metrics

Background　Ulcerative colitis （UC） is a common disease in the Department of Gastroenterology.At present，the etiology and pathogenesis of UC are not very clear.In recent years，many studies have shown that psycho-psychological factors are involved in the occurrence of UC.Therefore，it is worth exploring the mechanism of psycho-psychological factors in the onset of UC.Objective　To investigate the effect of anxiety and depression on neuroendocrine immune network in patients with UC.Methods　A total of 198 outpatients and inpatients with UC in the Department of Gastroenterology of the Second People's Hospital of Lianyungang，Affiliated Hospital of Bengbu Medical College and the First Affiliated Hospital of Bengbu Medical College from January 2013 to November 2018 were divided into remission stage group （group A，57 cases） and active stage group （group B，141 cases）．Group B was divided into mild active stage （subgroup B1，83 cases） and moderate-severe active stage （subgroup B2，58 cases） according to the severity of the disease.Sixty-two patients with anxiety and/or depression among 121 patients with mild-moderate active stage were divided into control group（n=31） and intervention group（n=31） by random number table method.The control group was treated with mesalazine enteric-coated tablets and the intervention group was treated with psychological intervention+Flupentixol and Melitracen Tablets+mesalazine enteric-coated tablets.Thirty-two healthy persons were selected as the health examination group in the same period.The Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） were used to determine the anxiety and depression of the subjects after 4 weeks of treatment.The levels of serotonin（5-HT），interleukin（IL）-6，IL-8 and IL-2 were measured by enzyme-linked immunosorbent assay （ELISA）．Results　The scores of HAMA，HAMD and levels of 5-HT，IL-6 and IL-8 in healthy examination group，group A and subgroup B1 were lower than those in case group，group B and subgroup B2，and the levels of IL-2 were higher than those in case group，group B and subgroup B2，respectively （P<0.01）．Pearson correlation analysis showed that HAMA and HAMD score were positively correlated with 5-HT，IL-6，IL-8 and negatively correlated with IL-2 （P<0.001）．After 4 weeks of treatment，HAMA and HAMD scores，5-HT，IL-6 and IL-8 levels in the intervention group were lower than those in the control group，and IL-2 level was higher than that in the control group （P<0.05）；HAMA and HAMD scores，5-HT，IL-6 and IL-8 levels in the control group and the intervention group after treatment were lower than those before treatment，and IL-2 levels were higher than those before treatment （P<0.05）．Conclusion　Anxiety and depression are closely correlated to the pathogenesis of UC，which may participate in the pathogenesis of UC by affecting related indicators of neuroendocrine immune network.


Gender Difference in Conditional Extinction of Disgust and Fear　

ZENG Qing

2020, 23(2):  240-244.  DOI: 10.12114/j.issn.1007-9572.2019.00.465

Asbtract ( )   PDF (1254KB) ( )  

References | Related Articles | Metrics

Background　Significant differences were found between male and female in affective disorders.The reason may be that the emotion regulation strategies that men and women cope with negative experiences are different.Existing studies have shown that men and women use different brain regions in negative emotion regulation，but there is a lack of research on the time process of the relevant neural activities of the two genders.Objective　To study gender differences in conditional extinction of disgust and fear by classical conditioned extinction model.Methods　From January to July 2015，38 college students in Guangzhou were selected by using the method of recruiting，and 3 were excluded. The event-related potentials （ERPs） technique was used to study the gender difference in EEG of 35 college students after acquiring conditioned disgust and fear.Results　The behavioral results showed that all subjects could successfully carry out conditioned regression.and compared with men，it was more difficult for women to extinct conditioned fear.The ERPs data indicated that in early brain ingredients，women's amplitude of P1，N1 and P2 were greater than those of men.For men，the amplitude differences of early ingredients caused by these three conditional stimuli were not significant（P>0.05）；but for women，the amplitudes of early ingredients induced by conditioned fear stimulus were smaller than those induced by conditioned disgust and conditioned neutral stimulus （P<0.05）．However，at the middle and late stage，the main effect of gender was not significant in ingredients，such as N2 and P3（P>0.05）．Conclusion　Women's conditional fear is more difficult to extinct than that of men，but both genders can reach successful extinction.


Investigation on Clinical Features and Drug Use of Hospitalized Patients with Bipolar Disorder　

CHEN Ce，ZHENG Lidan，XIE Zuoliang，HUANG Ziye，TU Wenzhen，LIN Chongguang

2020, 23(2):  245-250.  DOI: 10.12114/j.issn.1007-9572.2019.00.444

Asbtract ( )   PDF (1224KB) ( )  

References | Related Articles | Metrics

Background　Bipolar disorder（BPD）is a severe mental disorder with a wide incidence and difficulty in treatment.Currently，clinical diagnosis and treatment guidelines in China are based on clinical survey data from foreign countries.Relevant data in China is rare.Objective　To understand the diagnosis and medication situation of patients with BPD in Wenzhou in order to make up for the lack of regional data and provide references for the clinical guidelines based on China's national conditions.Methods　A cross-sectional random sampling method was used to distribute a self-made questionnaire to doctors on duty in neurological/psychiatric departments randomly selected in 10 hospitals in Wenzhou from May 15 to 19 in 2017.The questionnaire was a mixed form that includes patients' essential information，initial onset status，age at which the diagnosis was determined，the time from the first diagnosis，drug use，doses，current adverse reactions，and the next medication plan.Results　A total of 150 questionnaires were distributed and 127 valid questionnaires were returned.The effective recovery rate was 84.7%.The initial onset age was 8 to 56；the age at which the diagnosis was determined was 8 to 78；the time from the first diagnosis was 1 month to 33 years.The most commonly used pharmacological agent was quetiapine with 77 times.Obesity was the most common adverse reaction with 41 cases.There were 106 cases in the medication maintenance period.The average doses of quetiapine，magnesium valproate，and lithium carbonate in maintenance period were 0.50 g/d，1.00 g/d，and 0.85 g/d，respectively.Conclusion　The situation in Wenzhou is different from what reported in other regions at home and abroad.Based on different regional situation，deeper and larger-scale investigations should be started as soon as possible to better provide more information for clinical diagnosis and treatment of BPD.