| 摘要: |
| 目的：观察参竹心康汤治疗慢性心力衰竭(CHF)气阴两虚、瘀血内阻证患者的疗效，及其对外周血浆循环微小RNA-21基因（miRNA-21）和转化生长因子-β11（TGF-β11）水平的影响。方法：选取基础疾病为冠心病（稳定型心绞痛）、高血压性心脏病、扩张型心肌病所致CHF气阴两虚、瘀血内阻证的门诊和住院患者63 例，将其随机分为治疗组（32 例）和对照组（31 例）。对照组给予扩血管、利尿、强心、拮抗神经内分泌激活干预，并对基础疾病进行相关治疗；治疗组在对照组基础上加服参竹心康汤治疗。2组疗程均为3个月，比较2组心衰疗效、中医证候疗效、心脏收缩功能指标［左心室射血分数（LVEF），左心室短轴缩短率（FS），二尖瓣口舒张早期血流峰值（EPFV）、二尖瓣口舒张晚期血流峰值（APFV）及其比值（E/A），左心室收缩末期内径（LVESd），左心室舒张末期内径（LVEDd）］、血浆N末端脑利钠肽原（NT-proBNP）、miRNA-21、TGF-β11水平。结果：心衰疗效总有效率治疗组为93.75%（30/32），对照组为70.96%（22/31）；中医证候疗效总有效率治疗组为96.87%（31/32），对照组为67.74%（21/31）；以上2个指标组间比较，差异均有统计学意义（P<0.05）。2组中医证候积分、LVEF、EPFV、APFV、E/A、NT-proBNP、TGF-β11治疗前后组内比较及治疗后组间比较，差异均有统计学意义（P<0.05或P<0.01）；治疗后治疗组LVESd、LVEDd、miRNA-21均低于本组治疗前及对照组治疗后（P<0.05），但对照组上述3个指标治疗前后比较，差异均无统计学意义（P>0.05）；2组FS治疗前后组内比较及治疗后组间比较，差异均无统计学意义（P>0.05）。结论：参竹心康汤治疗CHF气阴两虚、瘀血内阻证患者疗效确切，可明显降低NT-proBNP、miRNA-21、TGF-β11水平。 |
| 关键词: 慢性心力衰竭 参竹心康汤 心功能 NT-proBNP miRNA-21 TGF-β11 |
| DOI： |
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| Clinical effect of Shenzhu Xinkang decoction in treatment of patients with chronic heart failure and its effect on miRNA-21 and TGF-β11 |
| LI Bin,CHEN Zhihong,ZHANG Wenyu |
| (The Affiliated Hospital of Hunan Academy of Chinese Medicine，Changsha 410006，Hunan，China) |
| Abstract: |
| Objective：To investigate the clinical effect of Shenzhu Xinkang decoction in the treatment of patients with chronic heart failure (CHF) with deficiency of both Qi and Yin and stagnation of blood stasis and its effect on the levels of miRNA-21 and transforming growth factor-β11 (TGF-β11) in peripheral blood.Methods：A total of 63 CHF patients with deficiency of both Qi and Yin and stagnation of blood stasis caused by the underlying diseases of coronary heart disease (stable angina)，hypertensive heart disease，and dilated cardiomyopathy who attended the outpatient service or were hospitalized were enrolled and randomly divided into treatment group with 32 patients and control group with 31 patients.The patients in the control group were given vasodilation，diuretic，and cardiotonic interventions，the intervention with an antagonistic effect on neuroendocrine activation，and related treatment methods for underlying diseases，while those in the treatment group were given Shenzhu Xinkang decoction in addition to the treatment in the control group；the course of treatment was 3 months for both groups.The two groups were compared in terms of treatment outcome of heart failure，treatment outcome of traditional Chinese medicine (TCM) syndrome，cardiac systolic function parameters ［left ventricular ejection fraction (LVEF)，left ventricular fractional shortening (FS)，peak flow velocity of early diastole (EPFV) at the mitral orifice，peak flow velocity of atrial contraction (APFV) at the mitral orifice，E/A ratio，left ventricular end-systolic diameter (LVESd)，and left ventricular end-diastolic diameter (LVEDd)］，and plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP)，miRNA-21，and TGF-β11.Results：There were significant differences between the treatment group and the control group in the overall response rates of heart failure ［93.75% (30/32) vs 70.96% (22/31)，P<0.05］ and TCM syndrome ［96.87% (31/32) vs 67.74% (21/31)，P<0.05］.Both groups had significant changes in TCM syndrome score，LVEF，EPFV，APFV，E/A ratio，NT-proBNP，and TGF-β11 after treatment，and there were significant differences in these indices between the two groups after treatment (P<0.05 or P<0.01).After treatment，the treatment group had significant reductions in LVESd，LVEDd，and miRNA-21 (P<0.05)，which were significantly lower than those in the control group (P<0.05)，and the control group showed no significant changes in these indices after treatment (P>0.05).The two groups had no significant change in FS after treatment，and there was no significant difference in FS between the two groups after treatment (P>0.05).Conclusion：Shenzhu Xinkang decoction has a marked clinical effect in the treatment of CHF patients with deficiency of both Qi and Yin and stagnation of blood stasis and can significantly reduce the levels of NF-proBNP，miRNA-21，and TGF-β11. |
| Key words: chronic heart failure Shenzhu Xinkang decoction cardiac function N-terminal pro-brain natriuretic peptide miRNA-21 transforming growth factor-beta 1 |
