| 摘要: |
| 目的：观察蛭龙活血通瘀胶囊治疗气虚血瘀型慢性心力衰竭（CHF）的临床疗效，并探寻其与NLRP3炎症小体的相关性。方法：选取108 例气虚血瘀型CHF患者，采用随机数字表法以1∶1的比例分为治疗组与对照组，每组各54 例。2组均进行西医常规基础治疗，对照组在此基础上给予琥铂酸美托洛尔缓释片治疗，治疗组在对照组基础上加用蛭龙活血通瘀胶囊治疗，2组疗程均为30 d。比较2组临床疗效及治疗前后中医证候评分、左心功能NYHA评级、心脏彩超指标［射血分数(LVEF)、左室收缩末期内径(LVESD)和每搏输出量(SV)］、N末端B型脑钠肽前体（NT-ProBNP）、Nod样受体家族热蛋白3（NLRP3）、白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18），评价其安全性，并探讨CHF患者病情严重程度与 NLRP3、IL-1β、IL-18之间的关系。结果：研究期间2组均脱落3 例，最终共102 例纳入疗效统计，每组各51 例。综合疗效总有效率治疗组为94.12%（48/51），对照组为88.24%（45/51），2组比较，差异有统计学意义(P＜0.05)。2组中医证候评分、左心功能NYHA评级、心脏彩超指标、NT-ProBNP、NLRP3、IL-1β、IL-18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)。２组均未发生严重不良反应。Pearson 相关性分析显示，2组治疗前NLRP3、IL-1β、IL-18 表达水平与治疗前中医证候总积分、NT-ProBNP、LVESD水平呈正相关，与治疗前LVEF、SV水平呈负相关。结论：蛭龙活血通瘀胶囊可安全有效地改善气虚血瘀型CHF患者临床症状和心功能，疗效明确，其作用机制可能与抑制血清中NLRP3炎症小体及IL-1β、IL-18有关。 |
| 关键词: 慢性心力衰竭 气虚血瘀证 蛭龙活血通瘀胶囊 NLRP3炎症小体 |
| DOI： |
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| Clinical effect of Zhilong Huoxue Tongyu capsules in treatment of chronic heart failure with Qi deficiency and blood stasis：An analysis of 51 cases |
| ZHENG Yu,LIU Mengnan,LIU Ping |
| (The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University，Luzhou 646000，Sichuan，China) |
| Abstract: |
| Objective：To investigate the clinical effect of Zhilong Huoxue Tongyu capsules in the treatment of chronic heart failure (CHF) with Qi deficiency and blood stasis and its association with NOD-like receptor protein 3 (NLRP3) inflammasome.Methods：A total of 108 CHF patients with Qi deficiency and blood stasis were enrolled and divided into treatment group and control group using a random number table at a ratio of 1∶1，with 54 patients in each group.The patients in the control group received conventional Western medicine basic treatment and metoprolol succinate sustained-release tablets，while those in the treatment group received Zhilong Huoxue Tongyu capsules in addition to the treatment in the control group，and the course of treatment was 30 days for both groups.Clinical outcome was compared between the two groups，as well as traditional Chinese medicine (TCM) syndrome score，NYHA class of left heart function，echocardiography parameters (left ventricular ejection fraction ［LVEF］，left ventricular end-systolic diameter ［LVESD］，and stroke volume ［SV］)，and the levels of N-terminal pro-brain natriuretic peptide (NT-ProBNP)，NLRP3，interleukin-1β (IL-1β)，and interleukin-18 (IL-18) before and after treatment，and safety was assessed for both groups.The correlation of CHF severity with NLRP3，IL-1β，and IL-18 was analyzed.Results：During the study，3 patients in the treatment group and 3 in the control group were lost to follow-up，and finally 102 patients were included in the analysis of treatment outcome，with 51 patients in each group.There was a significant difference in overall response rate between the treatment group and the control group ［94.12% (48/51) vs 88.24% (45/51)，P＜0.05］.After treatment，both groups had significant changes in TCM syndrome score，NYHA class of left heart function，echocardiography parameters，and the levels of NT-ProBNP，NLRP3，IL-1β，and IL-18，and there were significant differences in these indicators between the two groups after treatment (P＜0.05）.No serious adverse event was observed in either group.The Pearson correlation analysis showed that for both groups，the expression levels of NLRP3，IL-1β，and IL-18 before treatment were positively correlated with TCM syndrome score，NT-ProBNP，and LVESD before treatment and were negatively correlated with LVEF and SV before treatment.Conclusion：Zhilong Huoxue Tongyu capsules can safely and effectively improve the clinical symptoms and cardiac function of CHF patients with Qi deficiency and blood stasis，with a marked clinical effect，possibly by inhibiting NLRP3 inflammasome，IL-1β，and IL-18 in serum. |
| Key words: chronic heart failure Qi deficiency and blood stasis syndrome Zhilong Huoxue Tongyu capsules NOD-like receptor protein 3 inflammasome |
