摘要
目的探讨银杏叶片联合曲美他嗪治疗老年慢性心力衰竭(chronic heart failure,CHF)的临床疗效及其对外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)转化生长因子-β1(transforming growth factor-β1,TGF-β1)/Smad3信号通路分子mRNA表达的影响。方法选取2021年1月至2023年10月收治的96例老年CHF患者,随机分为联合组、曲美他嗪组和银杏叶片组,每组32例。比较3组患者的临床疗效、心功能指标(包括心脏指数、左室射血分数、左室收缩末期内径和左室舒张末期内径)、心力衰竭相关生物生物标志物(氨基末端B型利钠肽前体、可溶性基质裂解素2、血管紧张素Ⅱ)水平以及PBMCs中TGF-β1/Smad3通路关键分子(TGF-β1、Smad2、Smad3、Smad7)的mRNA相对表达量,并记录不良反应发生情况。结果联合组患者的心脏指数和左室射血分数高于曲美他嗪组和银杏叶片组,且曲美他嗪组高于银杏叶片组,差异有统计学意义(P<0.05);联合组患者的左室收缩末期内径和左室舒张末期内径低于曲美他嗪组和银杏叶片组,且曲美他嗪组低于银杏叶片组,差异有统计学意义(P<0.05)。联合组患者的氨基末端B型利钠肽前体、可溶性基质裂解素2、血管紧张素Ⅱ水平低于曲美他嗪组和银杏叶片组,且曲美他嗪组低于银杏叶片组,差异有统计学意义(P<0.05)。联合组患者的PBMCs中TGF-β1、Smad2、Smad3的mRNA相对表达量低于曲美他嗪组和银杏叶片组;Smad7 mRNA的相对表达量高于曲美他嗪组和银杏叶片组,差异均有统计学意义(P<0.05)。3组患者的不良反应发生率差异无统计学意义(P>0.05)。结论银杏叶片联合曲美他嗪可显著改善老年CHF患者的心功能并减轻心肌损伤,其机制与抑制TGF-β1/Smad3信号通路有关,为中西医联合治疗CHF提供了新策略。
Objective To investigate the clinical efficacy of ginkgo leaf tablets combined with trimetazidine in the treat-ment of elderly patients with chronic heart failure(CHF)and its impact on the mRNA expression of transforming growth factor-β1(TGF-β1)/Smad3 signaling pathway molecules in peripheral blood mononuclear cells(PBMCs).Methods Ninety-six elderly patients with CHF were selected from January 2021 to October 2023 and randomly assigned to a combination group,a trimetazidine group,and a ginkgo leaf tablet group,with 32 patients in each group.The clinical efficacy,cardiac function indicators(including cardiac index,left ventricular ejection fraction,left ventri-cular end-systolic diameter,and left ventricular end-diastolic diameter),levels of heart failure-related biomarkers(amino-terminal pro-B-type natriuretic peptide,soluble stromal derived factor 2,angiotensinⅡ),and mRNA relative expression levels of key molecules in the TGF-β1/Smad3 pathway(TGF-β1,Smad2,Smad3,Smad7)in PBMCs were compared among the three groups,and the occurrence of adverse reactions was recorded.Results The cardiac index and left ven-tricular ejection fraction in the combination group were higher than those in the trimetazidine group and ginkgo leaf tab-let group,and the trimetazidine group had higher values than the ginkgo leaf tablet group,with statistically significant differences(P<0.05).The left ventricular end-systolic diameter and left ventricular end-diastolic diameter in the combi-nation group were lower than those in the trimetazidine group and ginkgo leaf tablet group,and the trimetazidine group had lower values than the ginkgo leaf tablet group,with statistically significant differences(P<0.05).The levels of amino-terminal pro-brain natriuretic peptide,soluble stromal derived factor 2,and angiotensinⅡin the combination group were lower than those in the trimetazidine group and ginkgo leaf tablet group,and the trimetazidine group had lower values than the ginkgo leaf tablet group,with statistically significant differences(P<0.05).The relative mRNA expression levels of TGF-β1,Smad2,and Smad3 in PBMCs from the combination group were lower than those in the trimetazidine group and ginkgo leaf tablet group;the relative mRNA expression level of Smad7 was higher than that in the trimetazidine group and ginkgo leaf tablet group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusions The combination of Ginkgo leaf tablets and trimetazidine can significantly improve cardiac function and alleviate myo-cardial damage in elderly patients with CHF.The mechanism is related to the inhibition of the TGF-β1/Smad3 signaling pathway,providing a new strategy for the integrated traditional Chinese and Western medicine treatment of CHF.
作者
贾魁
李治国
程翠婷
李志娟
刘瑞卿
JIA Kui;LI Zhiguo;CHENG Cuiting;LI Zhijuan;LIU Ruiqing(Clinical Medicine School of Henan University of Science and Technology,Cardiovascular Department of the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,Henan,China)
出处
《山东大学学报(医学版)》
北大核心
2025年第6期19-26,共8页
Journal of Shandong University:Health Sciences
基金
河南省医学科技攻关计划联合共建项目(LHGJ20190556)。
关键词
老年慢性心力衰竭
银杏叶片
曲美他嗪
转化生长因子-Β1
左室射血分数
氨基末端B型利钠肽前体
Elderly chronic heart failure
Ginkgo leaf tablets
Trimetazidine
Transforming growth factor-βl
Left ventricular ejection fraction
N-terminal pro-brain natriuretic peptide
