OBJECTIVE  To observe the clinical efficacy of Maitong Jun'an Decoction in treating coronary heart disease (CHD) angina of qi deficiency and blood stasis type, and preliminarily elucidate its possible mechanism of action through transcriptomics methods.

  METHODS  A total of 140 patients with CHD angina of qi deficiency and blood stasis type were included and randomly divided into a treatment group and a control group, with 70 cases in each group. During the treatment period, 3 patients in the control group dropped out. The control group received basic Western medicine treatment for secondary prevention of CHD, while the treatment group received Maitong Jun'an Decoction in addition to the treatment in the control group. The treatment period for both groups was 8 weeks. Before and after treatment, the patients in both groups were evaluated for the TCM syndrome score, Canadian Cardiovascular Society (CCS) angina grading, Seattle angina questionnaire (SAQ) score, self-rating anxiety scale (SAS), self-rating depression scale (SDS) score, and adverse reactions. The peripheral blood of 9 patients before and after treatment was selected for transcriptomic sequencing based on the principle of gender, age, and disease duration matching.

  RESULTS  After treatment, the TCM syndrome scores and total scores of the 2 groups were significantly reduced(P < 0.01). The treatment group was better than the control group in improving chest pain, chest tightness, shortness of breath, fatigue and total score (P < 0.05, P < 0.01); the overall improvement rate of CCS angina grading in the treatment group was better than that in the control group (P < 0.05); the SAQ, SAS and SDS scores of the 2 groups were significantly reduced before and after treatment (P < 0.01), and the SAQ score of the treatment group was improved better than that of the control group (P < 0.05, P < 0.01). The transcriptomics results showed that there were 862 significantly different mRNAs before and after treatment, including 509 up-regulated and 353 down-regulated. GO analysis showed that there were 666 biological processes in the differentially expressed mRNAs, mainly including viral gene expression, translation initiation, RNA catabolism, etc. There were 112 cell components, mainly including focal adhesion, ribosome subunit, nuclear spot, etc. There were 94 molecular functions, mainly including double-stranded RNA binding, cadherin binding, transcription co-regulatory factor activity, etc. KEGG analysis showed that the differentially expressed mRNAs enriched in 20 signaling pathways, mainly including glycerophospholipid metabolism pathway, AMPK signaling pathway, ribosome pathway, etc.

  CONCLUSION  Maitong Jun'an Decoction can improve clinical symptoms in patients with CHD angina of qi deficiency and blood stasis type. Its mechanism of action is multi-target and multi pathway, mainly related to the regulation of glycerophospholipid metabolism pathway, AMPK signaling pathway, ribosome pathway.