高血压心衰大鼠证候本质及药物干预研究
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摘要
目的研究参附注射液和参麦注射液对高血压心力衰竭大鼠的疗效差异,通过"以方测证"理论推测高血压心衰大鼠所属中医证型。方法将60只Dahl盐敏感性大鼠分为对照组、模型组、参附组和参麦组,每组15只,对照组使用低盐饲料,其余三组使用8%Na Cl高盐饲料喂养大鼠20周并予以相应干预,检测大鼠血清氨基末端脑钠肽前体(n-terminal pro-brain natriuretic peptide,NT-pro BNP),彩色超声多普勒检测大鼠左室射血分数(left ventricular ejection fraction,LVEF)和左室短轴缩短率(left ventricular fractional shortening,LVFS)及观察HE染色心肌细胞。结果与对照组比较,模型组LVEF和LVFS值均降低(P<0.05),NT-pro BNP值升高(P<0.01);与模型组比较,参附组LVEF和LVFS值明显降低(P<0.05),NT-pro BNP值升高(P<0.01);参麦组LVFS值升高(P<0.05),NT-pro BNP值降低(P<0.01);与参附组比较,参麦组LVEF和LVFS值均升高(P<0.05)。结论参麦注射液对高血压心衰大鼠的疗效显著,参附注射液对高血压心衰大鼠无效;高血压心衰大鼠模型不属于心阳虚证,最可能是心气阴虚证;LVEF值保留及血压升高可能是应用参附注射液的禁忌指标。
Objective To investigate the traditional Chinese medicine(TCM) syndrome types in rats with hypertensive heart failure based on the theory of "Syndrome Differentiation Through Formula" by investigating the clinical efficacy of Shenfu injection versus Shenmai injection in rats with hypertensive heart failure. Methods A total of 60 Dahl salt sensitive rats were equally and randomly divided into control group, model group, Shenfu injection group(Shenfu group), and Shenmai injection group(Shenmai group). The control group was fed with low-salt feed, while the other three groups were fed with high-salt(8% Na Cl) feed for 20 weeks and given respective interventions. The serum level of N-terminal-pro-brain natriuretic peptide(NT-pro BNP)was measured. The left ventricular ejection fraction(LVEF) and the left ventricular fractional shortening(LVFS) were determined by color Doppler ultrasound. And the myocardial cells with HE staining was observed under an electron microscope. Results Compared with the control group, the model group had significantly decreased LVEF and LVFS(P<0.05) and a significantly increased serum level of NT-pro BNP(P<0.01). Compared with the model group, the Shenfu group had significantly decreased LVEF and LVFS(P<0.05) and a significantly increased serum level of NT-pro BNP(P<0.01); the Shenmai group had a significantly increased LVFS(P<0.05) and a significantly decreased serum level of NT-pro BNP(P<0.01). Compared with the Shenfu group, the Shenmai group had significantly increased LVEF and LVFS(P <0.05). Conclusion In rats with hypertensive heart failure, Shenmai injection has significant clinical efficacy, while Shenfu injection has no effect. The rat model of hypertensive heart failure is not identified as heart-Yang deficiency syndrome and is most likely to be heart-Qi and Yin deficiency syndrome. The preserved LVEF and increased blood pressure may be the contraindications for Shenfu injection.
Objective To investigate the traditional Chinese medicine(TCM) syndrome types in rats with hypertensive heart failure based on the theory of "Syndrome Differentiation Through Formula" by investigating the clinical efficacy of Shenfu injection versus Shenmai injection in rats with hypertensive heart failure. Methods A total of 60 Dahl salt sensitive rats were equally and randomly divided into control group, model group, Shenfu injection group(Shenfu group), and Shenmai injection group(Shenmai group). The control group was fed with low-salt feed, while the other three groups were fed with high-salt(8% Na Cl) feed for 20 weeks and given respective interventions. The serum level of N-terminal-pro-brain natriuretic peptide(NT-pro BNP)was measured. The left ventricular ejection fraction(LVEF) and the left ventricular fractional shortening(LVFS) were determined by color Doppler ultrasound. And the myocardial cells with HE staining was observed under an electron microscope. Results Compared with the control group, the model group had significantly decreased LVEF and LVFS(P<0.05) and a significantly increased serum level of NT-pro BNP(P<0.01). Compared with the model group, the Shenfu group had significantly decreased LVEF and LVFS(P<0.05) and a significantly increased serum level of NT-pro BNP(P<0.01); the Shenmai group had a significantly increased LVFS(P<0.05) and a significantly decreased serum level of NT-pro BNP(P<0.01). Compared with the Shenfu group, the Shenmai group had significantly increased LVEF and LVFS(P <0.05). Conclusion In rats with hypertensive heart failure, Shenmai injection has significant clinical efficacy, while Shenfu injection has no effect. The rat model of hypertensive heart failure is not identified as heart-Yang deficiency syndrome and is most likely to be heart-Qi and Yin deficiency syndrome. The preserved LVEF and increased blood pressure may be the contraindications for Shenfu injection.
引文
[1]BUI A L,HORWICH T B,FONAROW G C.Epidemiology and risk profile of heart failure[J].Nat Rev Cardiol,2011,8(1):30-41.
[2]王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408-412.
[3]STEWART S,EKMAN I,EKMAN T,et al.Population Impact of Heart Failure and the Most Common Forms of Cancer A Study of 1162309 Hospital Cases in Sweden(1988 to 2004)[J].Circulation:Cardiovascular Quality and Outcomes,2010,3(6):573-580.
[4]ROSS J S,CHEN J,LIN Z,et al.Recent national trends in readmission rates after heart failure hospitalization[J].Circulation:Heart Failure,2010,3(1):97-103.
[5]杨萍,李华,章永南,等.参附注射液治疗舒张性心力衰竭的临床疗效及机制研究[J].中药药理与临床,2014,30(4):116-119.
[6]褚庆民,李荣,张瑶,等.参麦注射液治疗气阴两虚型舒张性心力衰竭疗效观察[J].山东中医药大学学报,2013,37(4):305-307.
[7]陈弘东,谢雁鸣,王连心,等.参麦注射液辅助治疗慢性心力衰竭的有效性及安全性系统评价[J].中国中药杂志,2014,39(18):3650-3661.
[8]侯雅竹,毛静远,王贤良,等.参附注射液治疗心力衰竭的系统评价[J].中国循证医学杂志,2011,11(3):292-299.
[9]李欣春,梁昊,胡志希,等.高血压心力衰竭大鼠动物模型的研制[J].湖南中医药大学学报,2017,37(3):245-248.
[10]严治涛,罗文利,黄金梅,等.不同剂量参附注射液治疗慢性心力衰竭的临床疗效观察[J].中华中医药杂志,2015,30(2):636-640.
[11]杨靖,李霖,谢雁鸣,等.参附注射液治疗冠心病临床用药方案实效研究[J].中国中药杂志,2013,38(18):3099-3103.
[12]张兰凤,王永炎.方证对应研究[J].中华中医药杂志,2005,20(1):8-10.
[13]卢林竹,胡志希,李琳,等.“以方测证”法在动物模型研究中的运用[J].湖南中医药大学学报,2017,37(5):570-573.
[14]贺泽龙,邹晓玲.参附注射液对充血性心力衰竭患者血流动力学的影响及机理探讨[J].中国中西医结合杂志,2001,21(5):386-387.
[15]王燕丽,刘捷,张光泰.999参麦注射液治疗左室舒张功能不全60例[J].辽宁中医杂志,1999(11):508-509.
[16]KLOTZ S,HAY I,ZHANG G,et al.Development of heart failure in chronic hypertensive Dahl rats:focus on heart failure with preserved ejection fraction[J].Hypertension,2006,47(5):901-911.
[17]KOKUBO M,UEMURA A,MATSUBARA T,et al.Noninvasive evaluation of the time course of change in cardiac function in spontaneously hypertensive rats by echocardiography[J].Hypertens Res,2005,28(7):601-609.
[18]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.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):98-122.
[19]GERGEI I,KR魧MER B K,SCHARNAGL H,et al.Propeptide bigendothelin,N-terminal-pro brain natriuretic peptide and mortality.The Ludwigshafen risk and cardiovascular health(LURIC)study[J].Biomarkers,2017,22(3/4):315-320.
[20]胡志希,吴涛,李欣春,等.基于中药制剂干预心肌梗死心衰大鼠的中医证型研究[A].中国中西医结合学会诊断专业委员会.中国中西医结合学会诊断专业委员会第十次全国学术会议论文集[C].河北秦皇岛:中国中西医结合学会,2016:107-114.
[21]胡思远,殷宏亮,李欣春,等.运动康复联合参附注射液对心肌病心衰大鼠血流动力学的影响[J].湖南中医药大学学报,2017,37(7):715-718.
[22]董文波,胡思远,吴涛,等.参附注射液与参麦注射液对阿霉素诱导慢性心衰大鼠血流动力学指标的影响[A].中国中西医结合学会诊断专业委员会.第九次全国中西医结合诊断学术研讨会论文集[C].北京:中国中西医结合学会,2015:4.
[23]NERBASS F B,PECOITS-FILHO R,MCINTYRE N J,et al.High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients[J].Eur J Clin Nutr,2015,69(7):786-790.
[24]洪汉利,陈统清,许玉燕,等.肾病综合征并发低位小肠梗阻1例报告[J].吉林医学,2014,35(2):444-445.
[2]王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408-412.
[3]STEWART S,EKMAN I,EKMAN T,et al.Population Impact of Heart Failure and the Most Common Forms of Cancer A Study of 1162309 Hospital Cases in Sweden(1988 to 2004)[J].Circulation:Cardiovascular Quality and Outcomes,2010,3(6):573-580.
[4]ROSS J S,CHEN J,LIN Z,et al.Recent national trends in readmission rates after heart failure hospitalization[J].Circulation:Heart Failure,2010,3(1):97-103.
[5]杨萍,李华,章永南,等.参附注射液治疗舒张性心力衰竭的临床疗效及机制研究[J].中药药理与临床,2014,30(4):116-119.
[6]褚庆民,李荣,张瑶,等.参麦注射液治疗气阴两虚型舒张性心力衰竭疗效观察[J].山东中医药大学学报,2013,37(4):305-307.
[7]陈弘东,谢雁鸣,王连心,等.参麦注射液辅助治疗慢性心力衰竭的有效性及安全性系统评价[J].中国中药杂志,2014,39(18):3650-3661.
[8]侯雅竹,毛静远,王贤良,等.参附注射液治疗心力衰竭的系统评价[J].中国循证医学杂志,2011,11(3):292-299.
[9]李欣春,梁昊,胡志希,等.高血压心力衰竭大鼠动物模型的研制[J].湖南中医药大学学报,2017,37(3):245-248.
[10]严治涛,罗文利,黄金梅,等.不同剂量参附注射液治疗慢性心力衰竭的临床疗效观察[J].中华中医药杂志,2015,30(2):636-640.
[11]杨靖,李霖,谢雁鸣,等.参附注射液治疗冠心病临床用药方案实效研究[J].中国中药杂志,2013,38(18):3099-3103.
[12]张兰凤,王永炎.方证对应研究[J].中华中医药杂志,2005,20(1):8-10.
[13]卢林竹,胡志希,李琳,等.“以方测证”法在动物模型研究中的运用[J].湖南中医药大学学报,2017,37(5):570-573.
[14]贺泽龙,邹晓玲.参附注射液对充血性心力衰竭患者血流动力学的影响及机理探讨[J].中国中西医结合杂志,2001,21(5):386-387.
[15]王燕丽,刘捷,张光泰.999参麦注射液治疗左室舒张功能不全60例[J].辽宁中医杂志,1999(11):508-509.
[16]KLOTZ S,HAY I,ZHANG G,et al.Development of heart failure in chronic hypertensive Dahl rats:focus on heart failure with preserved ejection fraction[J].Hypertension,2006,47(5):901-911.
[17]KOKUBO M,UEMURA A,MATSUBARA T,et al.Noninvasive evaluation of the time course of change in cardiac function in spontaneously hypertensive rats by echocardiography[J].Hypertens Res,2005,28(7):601-609.
[18]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.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):98-122.
[19]GERGEI I,KR魧MER B K,SCHARNAGL H,et al.Propeptide bigendothelin,N-terminal-pro brain natriuretic peptide and mortality.The Ludwigshafen risk and cardiovascular health(LURIC)study[J].Biomarkers,2017,22(3/4):315-320.
[20]胡志希,吴涛,李欣春,等.基于中药制剂干预心肌梗死心衰大鼠的中医证型研究[A].中国中西医结合学会诊断专业委员会.中国中西医结合学会诊断专业委员会第十次全国学术会议论文集[C].河北秦皇岛:中国中西医结合学会,2016:107-114.
[21]胡思远,殷宏亮,李欣春,等.运动康复联合参附注射液对心肌病心衰大鼠血流动力学的影响[J].湖南中医药大学学报,2017,37(7):715-718.
[22]董文波,胡思远,吴涛,等.参附注射液与参麦注射液对阿霉素诱导慢性心衰大鼠血流动力学指标的影响[A].中国中西医结合学会诊断专业委员会.第九次全国中西医结合诊断学术研讨会论文集[C].北京:中国中西医结合学会,2015:4.
[23]NERBASS F B,PECOITS-FILHO R,MCINTYRE N J,et al.High sodium intake is associated with important risk factors in a large cohort of chronic kidney disease patients[J].Eur J Clin Nutr,2015,69(7):786-790.
[24]洪汉利,陈统清,许玉燕,等.肾病综合征并发低位小肠梗阻1例报告[J].吉林医学,2014,35(2):444-445.