芪苈强心胶囊治疗扩张型心肌病的抗心室重构作用
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摘要
目的:探讨芪苈强心胶囊对(阳气亏虚血瘀证)扩张型心肌病(DCM)患者心功能、心肌纤维化和心室重构的影响。方法:将107例DCM患者按随机数字表法分为对照组53例和观察组54例。对照组口服美托洛尔缓释片,47. 5 mg/次,1次/d;口服沙库巴曲缬沙坦钠片,50 mg/次,1次/d;口服氢氯噻嗪片,20 mg/次,1次/d;口服螺内酯片,20 mg/次,1次/d。观察组在对照组治疗的基础上,加用芪苈强心胶囊,4粒/次,3次/d,餐后服用。两组疗程均连续治疗6个月。采用超声心动图检查记录治疗前后左室舒张末期内径(LVEDd),左室射血分数(LVEF),左室收缩末期内径(LVESD),室间隔厚度(IVST),左室后壁厚度(LVPWT),左室心肌质量(LVM)和左室心肌质量指数(LVMI);进行治疗后美国纽约心脏病学会(NYHA)心功能分级;进行治疗前后Lee氏心衰评分和阳气亏虚血瘀证评分;检测治疗前后N末端B型利钠肽原(NT-proBNP),可溶性ST2(s ST2),半乳糖凝集素-3(galectin-3),血管紧张素Ⅱ(Ang-Ⅱ),基质金属蛋白酶-2(MMP-2),MMP-9,基质金属蛋白酶抑制因子-1(TIMP-1),Ⅰ型前胶原羧基端肽(PIP)和Ⅰ型胶原羧端交联肽(CITP)水平。结果:治疗后观察组患者LVEDd,LVESD,IVST,LVPWT,LVM和LVMI均低于对照组(P <0. 05),LVEF高于对照组(P <0. 05);经秩和检验,治疗后观察组NYHA心功能分级轻于对照组(Z=2. 031,P <0. 05);治疗后3～6个月,观察组血浆NT-proBNP水平均低于对照组(P <0. 01),Lee氏心衰评分和阳气亏虚血瘀证评分均低于对照组(P <0. 01);观察组血清s ST2,galectin-3,PIP和CITP水平均低于对照组(P <0. 01);观察组血清MMP-2,MMP-9和Ang-Ⅱ水平均低于对照组,TIMP-1水平高于对照组(P <0. 01)。结论:在西医常规治疗的基础上,加服芪苈强心胶囊治疗DCM阳气亏虚血瘀证,可减轻DCM患者临床症状和心衰程度,改善心功能,并能调节s ST2,galectin-3,MMPs和Ang-Ⅱ等因子表达,起到抑制心肌纤维化,减轻心室重构,延缓心衰的作用。
Objective: To discuss the effect of Qili Qiangxin capsules on cardiac function,myocardial fibrosis and ventricular remodeling of patients with dilated cardiomyopathy( DCM) and Yang Qi deficiency and blood stasis syndrome. Method: One hundred and seven patients were randomly divided into control group( 53 cases) and observation group( 54 cases) by random number table. Patients in control group got metoprolol succinate sustained-release tablet,47. 5 mg/time,1 time/day,sacubitril valsartan sodium tablets,50 mg/time,1 time/day,hydrochlorothiazide tablets,20 mg/time,1 time/day,and spironolactone tablets,20 mg/time,1 time/day. In addition to the therapy of control group,patients in observation group were also given Qili Qiangxin capsules,4 granules/time,3 times/days. A course of treatment was 6 months. Before and after treatment,levels of left ventricular end-diastolic diameter( LVEDd),left ventricular ejection fraction( LVEF),left ventricular end systolic diameter( LVESD),interventricular septal thickness( IVST),left ventricular posterior wall thickness( LVPWT),left ventricular myocardial mass( LVM) and left ventricular myocardial mass index( LVMI) were recorded by echocardiography. The classification of cardiac function was recorded by New York College of Cardiology( NYHA). Lee's heart failure and Yang Qi deficiency and blood stasis syndrome were scored. And levels of N-terminal B-type natriuretic peptide( NT-proBNP),soluble ST2( s ST2),galectin-3( galectin-3),angiotensin-Ⅱ( Ang-Ⅱ),matrix metalloproteinase-2( MMP-2),MMP-9,matrix metalloproteinase inhibitor-1( TIMP-1),type I procollagen carboxy-terminal peptide( PIP) and type I collagen carboxy-terminal cross-linking peptide( CITP) were detected. Result: After treatment,levels of LVEDd,LVESD,IVST,LVPWT,LVM and LVMI were lower than those in control group( P < 0. 05),while LVEF was higher than that in control group( P <0. 05). According to the rank sum test,NYHA cardiac function classification was lighter than that in control group( Z = 2. 031,P < 0. 05). After treatment,level of NT-proBNP was lower than that in control group( P < 0. 01),Lee's heart failure score and Yang Qi deficiency,blood stasis syndrome score s ST2,galectin-3,PIP,CITP,MMP-2,MMP-9 and Ang-Ⅱ were lower than those in control group( P < 0. 01). Conclusion: In addition to the routine western medicine,Qili Qiangxin capsules can relieve clinical symptoms,degree of heart failure of DCM patients and ventricular remodeling,ameliorate heart function,regulate levels of s ST2,galectin-3,MMPs and Ang-Ⅱ,inhibit myocardial fibrosis,and delay heart failure.
Objective: To discuss the effect of Qili Qiangxin capsules on cardiac function,myocardial fibrosis and ventricular remodeling of patients with dilated cardiomyopathy( DCM) and Yang Qi deficiency and blood stasis syndrome. Method: One hundred and seven patients were randomly divided into control group( 53 cases) and observation group( 54 cases) by random number table. Patients in control group got metoprolol succinate sustained-release tablet,47. 5 mg/time,1 time/day,sacubitril valsartan sodium tablets,50 mg/time,1 time/day,hydrochlorothiazide tablets,20 mg/time,1 time/day,and spironolactone tablets,20 mg/time,1 time/day. In addition to the therapy of control group,patients in observation group were also given Qili Qiangxin capsules,4 granules/time,3 times/days. A course of treatment was 6 months. Before and after treatment,levels of left ventricular end-diastolic diameter( LVEDd),left ventricular ejection fraction( LVEF),left ventricular end systolic diameter( LVESD),interventricular septal thickness( IVST),left ventricular posterior wall thickness( LVPWT),left ventricular myocardial mass( LVM) and left ventricular myocardial mass index( LVMI) were recorded by echocardiography. The classification of cardiac function was recorded by New York College of Cardiology( NYHA). Lee's heart failure and Yang Qi deficiency and blood stasis syndrome were scored. And levels of N-terminal B-type natriuretic peptide( NT-proBNP),soluble ST2( s ST2),galectin-3( galectin-3),angiotensin-Ⅱ( Ang-Ⅱ),matrix metalloproteinase-2( MMP-2),MMP-9,matrix metalloproteinase inhibitor-1( TIMP-1),type I procollagen carboxy-terminal peptide( PIP) and type I collagen carboxy-terminal cross-linking peptide( CITP) were detected. Result: After treatment,levels of LVEDd,LVESD,IVST,LVPWT,LVM and LVMI were lower than those in control group( P < 0. 05),while LVEF was higher than that in control group( P <0. 05). According to the rank sum test,NYHA cardiac function classification was lighter than that in control group( Z = 2. 031,P < 0. 05). After treatment,level of NT-proBNP was lower than that in control group( P < 0. 01),Lee's heart failure score and Yang Qi deficiency,blood stasis syndrome score s ST2,galectin-3,PIP,CITP,MMP-2,MMP-9 and Ang-Ⅱ were lower than those in control group( P < 0. 01). Conclusion: In addition to the routine western medicine,Qili Qiangxin capsules can relieve clinical symptoms,degree of heart failure of DCM patients and ventricular remodeling,ameliorate heart function,regulate levels of s ST2,galectin-3,MMPs and Ang-Ⅱ,inhibit myocardial fibrosis,and delay heart failure.
引文
[1]中华医学会心血管病学分会,中国心肌炎心肌病协作组.中国扩张型心肌病诊断和治疗指南[J].临床心血管病杂志,2018,34(5):421-434.
[2]高晓飞,许轶洲.扩张型心肌病治疗手段的进展[J].心脏杂志,2016,28(4):488-491.
[3]樊华,居励之,王佑华.扩张型心肌病的中医药治疗进展[J].中西医结合心脑血管病杂志,2017,15(9):1051-1054.
[4]卢磊,刘晓丹,张培影.扩张型心肌病的中西医研究进展[J].实用心脑肺血管病杂志,2017,25(9):1-6.
[5]张富赓,张瑜,傅家良,等.芪苈强心胶囊治疗心力衰竭的作用机制研究进展[J].现代药物与临床,2016,31(2):255-259.
[6] LI X,ZHANG J,HUANG J,et al. A Multicenter,randomized, double-Blind, parallel-group, placebocontrolled study of the effects of qili qiangxin capsules in patients with chronic heart failure[J]. J Am Coll Cardiol,2013,62(12):1065-1072.
[7]吴相君,赵保礼,韩硕龙,等.芪苈强心胶囊对扩张型心肌病患者心功能及血管内皮功能影响的临床研究[J].疑难病杂志,2018,17(4):329-333.
[8]李滔,孙中华,赵兵兵.芪苈强心胶囊治疗扩张型心肌病疗效和安全性的Meta分析[J].中国循证心血管医学杂志,2017,9(11):1305-1309.
[9]徐涛,李方江,陈立锋,等.芪苈强心胶囊对心力衰竭大鼠心室重构的作用及机制研究[J].山东医药,2012,52(32):38-40.
[10]中华医学会心血管病学分会.心肌病诊断与治疗建议[J].中华心血管病杂志,2007,35(1):5-16.
[11]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[12]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[13]黄正,张小玲,章超慧,等.芪苈强心胶囊治疗慢性心力衰竭对心室重构的抑制作用[J].安徽医药,2014,18(10):1961-1963.
[14]王晓景,吕仕超,张军平,等.以心肌纤维化为病理基础的高血压病伴左心室肥厚与扩张型心肌病证候学研究[J].中医杂志,2016,57(15):1317-1321.
[15]张军芳,王磊.芪苈强心胶囊防治心力衰竭多效性研究进展[J].中国社区医师,2012,28(14):9-12.
[16]张大程,张春雨,鹿梦溪.芪苈强心胶囊联合西药常规对慢性心力衰竭患者心室重构及相关免疫指标的影响[J].河北医药,2017,39(21):3209-3212.
[17]王赛,胡烨,包斯图.黄芩苷对扩张型心肌病大鼠心室重构、心室肌细胞凋亡及β1-AR/PKA/Ca MKⅡ信号通路的影响[J].中国实验方剂学杂志,2018,24(9):140-144.
[18]保永宏,马一铭,蔡红雁.可溶性ST2和半乳糖凝集素3在心力衰竭中的应用进展[J].中国心血管杂志,2018,23(5):425-428.
[19]童敏,董佳敏,刘静,等.扩张型心肌病患者血清半乳糖凝集素-3水平变化及其与胶原代谢标志物的相关性分析[J].疑难病杂志,2016,15(9):908-911.
[20]韩安邦,张健,路迎冬,等.芪苈强心胶囊对心肌梗死大鼠心肌纤维化及TGF-β1/Smad3信号通路的影响[J].北京中医药大学学报,2017,40(1):41-47.
[21]牟海萍,刘婷,马宏博.理气化痰祛瘀法对慢性心力衰竭气虚血瘀型患者心脏康复的观察[J].中国实验方剂学杂志,2018,22(4):144-148.
[22]梁逸强,潘朝锌,何新兵,等.心室重构发病机制的研究进展[J].河北医药,2013,35(24):3781-3784.
[2]高晓飞,许轶洲.扩张型心肌病治疗手段的进展[J].心脏杂志,2016,28(4):488-491.
[3]樊华,居励之,王佑华.扩张型心肌病的中医药治疗进展[J].中西医结合心脑血管病杂志,2017,15(9):1051-1054.
[4]卢磊,刘晓丹,张培影.扩张型心肌病的中西医研究进展[J].实用心脑肺血管病杂志,2017,25(9):1-6.
[5]张富赓,张瑜,傅家良,等.芪苈强心胶囊治疗心力衰竭的作用机制研究进展[J].现代药物与临床,2016,31(2):255-259.
[6] LI X,ZHANG J,HUANG J,et al. A Multicenter,randomized, double-Blind, parallel-group, placebocontrolled study of the effects of qili qiangxin capsules in patients with chronic heart failure[J]. J Am Coll Cardiol,2013,62(12):1065-1072.
[7]吴相君,赵保礼,韩硕龙,等.芪苈强心胶囊对扩张型心肌病患者心功能及血管内皮功能影响的临床研究[J].疑难病杂志,2018,17(4):329-333.
[8]李滔,孙中华,赵兵兵.芪苈强心胶囊治疗扩张型心肌病疗效和安全性的Meta分析[J].中国循证心血管医学杂志,2017,9(11):1305-1309.
[9]徐涛,李方江,陈立锋,等.芪苈强心胶囊对心力衰竭大鼠心室重构的作用及机制研究[J].山东医药,2012,52(32):38-40.
[10]中华医学会心血管病学分会.心肌病诊断与治疗建议[J].中华心血管病杂志,2007,35(1):5-16.
[11]冠心病中医临床研究联盟,中国中西医结合学会心血管疾病专业委员会,中华中医药学会心病分会.慢性心力衰竭中医诊疗专家共识[J].中医杂志,2014,55(14):1258-1260.
[12]中华医学会心血管病学分会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):3-10.
[13]黄正,张小玲,章超慧,等.芪苈强心胶囊治疗慢性心力衰竭对心室重构的抑制作用[J].安徽医药,2014,18(10):1961-1963.
[14]王晓景,吕仕超,张军平,等.以心肌纤维化为病理基础的高血压病伴左心室肥厚与扩张型心肌病证候学研究[J].中医杂志,2016,57(15):1317-1321.
[15]张军芳,王磊.芪苈强心胶囊防治心力衰竭多效性研究进展[J].中国社区医师,2012,28(14):9-12.
[16]张大程,张春雨,鹿梦溪.芪苈强心胶囊联合西药常规对慢性心力衰竭患者心室重构及相关免疫指标的影响[J].河北医药,2017,39(21):3209-3212.
[17]王赛,胡烨,包斯图.黄芩苷对扩张型心肌病大鼠心室重构、心室肌细胞凋亡及β1-AR/PKA/Ca MKⅡ信号通路的影响[J].中国实验方剂学杂志,2018,24(9):140-144.
[18]保永宏,马一铭,蔡红雁.可溶性ST2和半乳糖凝集素3在心力衰竭中的应用进展[J].中国心血管杂志,2018,23(5):425-428.
[19]童敏,董佳敏,刘静,等.扩张型心肌病患者血清半乳糖凝集素-3水平变化及其与胶原代谢标志物的相关性分析[J].疑难病杂志,2016,15(9):908-911.
[20]韩安邦,张健,路迎冬,等.芪苈强心胶囊对心肌梗死大鼠心肌纤维化及TGF-β1/Smad3信号通路的影响[J].北京中医药大学学报,2017,40(1):41-47.
[21]牟海萍,刘婷,马宏博.理气化痰祛瘀法对慢性心力衰竭气虚血瘀型患者心脏康复的观察[J].中国实验方剂学杂志,2018,22(4):144-148.
[22]梁逸强,潘朝锌,何新兵,等.心室重构发病机制的研究进展[J].河北医药,2013,35(24):3781-3784.