摘要
目的观察真武汤联合沙库巴曲缬沙坦钠对射血分数降低型心力衰竭(以下简称心衰)阳虚水泛型Toll样受体4/核因子κB(TLR4/NF-κB)信号通路的影响。方法将120例射血分数降低型心衰阳虚水泛型患者按照随机数字表法分为2组,2组均予常规抗心衰治疗。治疗组60例予真武汤联合沙库巴曲缬沙坦钠治疗,对照组60例予安慰剂联合沙库巴曲缬沙坦钠治疗,2组均治疗8周。比较2组临床疗效,并比较2组治疗前、治疗4周、治疗8周中医证候(心悸、气短、水肿、畏寒肢冷)评分、心功能相关指标[左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、血浆脑钠肽(BNP)]、外周血炎症相关指标[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]水平及TLR4、NF-κB p65蛋白表达情况。结果治疗组总有效率95.00%(57/60),对照组总有效率86.67%(52/60),2组总有效率比较差异无统计学意义(P>0.05)。治疗4、8周2组心悸、气短、水肿、畏寒肢冷评分均较本组治疗前降低(P<0.05),且治疗组均低于对照组同期(P<0.05)。治疗4、8周2组LVEF均较本组治疗前升高(P<0.05),LVEDD、LVESD、BNP均较本组治疗前降低(P<0.05),但2组组间比较差异均无统计学意义(P>0.05)。治疗4、8周2组CRP、IL-6、TNF-α水平均较本组治疗前降低(P<0.05),且治疗8周治疗组CRP、IL-6、TNF-α水平均低于对照组同期(P<0.05)。治疗4、8周2组外周血TLR4、NF-κB p65蛋白表达均较本组治疗前降低,且治疗组低于对照组,但比较差异均无统计学意义(P>0.05)。结论真武汤联合沙库巴曲缬沙坦钠治疗射血分数降低型心衰阳虚水泛型可有效改善患者中医证候和心功能,降低炎性反应,下调TLR4、NF-κB p65蛋白水平。
Objective To observe the effect of Zhenwu Decoction with sacubitril/valsartan(SV)on Toll-like receptor 4/nuclear factor-kappa B(TLR4/NF-κB)signaling pathway in patients with heart failure with reduced ejection fraction(HFrEF)of hydroretention with asthenic yang.Methods Totally 120 patients with HFrEF(hydroretention with asthenic yang)were randomly divided into equal group,in addition routine anti-heart failure treatment,treatment group received Zhenwu Decoction with SV,and control group received placebo with SV.A 8-week treatment were performed,and the aim was to compare weeks 0,4,8 traditional Chinese medicine(TCM)syndrome(Palpitation,shortness of breath,edema,cold limbs and chilly)scores,cardiac function indexes[left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),plasma brain natriuretic peptide(BNP)],peripheral inflammatory related index[creactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],TLR4 and NF-κB p65 expressions;the curative effect was counted.Results The total response rates in treatment group and control group were 95.00%(57/60)and 86.67%(52/60),respectively,the difference of two groups being not significant(P>0.05).On weeks 4,8,TCM syndrome scores in groups were decreased(P<0.05),which decreased in treatment group compared with concurrent control group(P<0.05);LVEF in groups was increased(P<0.05),while LVEDD,LVESD and BNP were decreased(P<0.05),and with no statistically significant difference between groups(P>0.05);CRP,IL-6,TNF-αin groups were decreased(P<0.05),CRP,IL-6,TNF-αon week 8 in treatment group were lower than that in concurrent control group(P<0.05);TLR4 and NF-κB p65 expressions in groups were decreased,treatment group was decreased in comparison with control group,the difference was not statistically significant(P>0.05).Conclusion For patients with HFrEF(hydroretention with asthenic yang),Zhenwu Decoction combined with SV is effectively capable of improving TCM syndromes and cardiac function,reducing inflammatory response,and down-regulating the protein expression levels of TLR4 and NF-κB p65.
作者
黄静
庄光彤
HUANG Jing;ZHUANG Guangtong(Department of Cardiovascular Medicine,The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu,Sichuan 611730)
出处
《河北中医》
2021年第12期1969-1973,1978,共6页
Hebei Journal of Traditional Chinese Medicine
基金
四川省中医药管理局科学技术科研专项课题(编号:2020LC0034)。
关键词
心力衰竭
阳虚水泛
真武汤
中西医结合疗法
Toll样受体
NF-κB
Heart failure
Hydroretention with asthenic yang
Zhenwu Decoction
Integrated traditional Chinese and Western medicine therapy
Toll-like receptor
NF-κB
