口服黄芪合剂治疗扩张型心肌病室性心律失常

Treatment of ventricular arrhythmia in dilated cardiomyopathy with Huangqi

目的:探讨黄芪合剂对扩张型心肌病(DCM)室性心律失常长期疗效及相关机制。方法:选择65例稳定性DCM室性心律失常患者,根据病毒学检查结果分为阳性组(36例)和阴性组(29例)。在常规治疗基础上,阳性组中有25例接受口服黄芪合剂治疗半年(即阳1亚组),11例拒绝而未接受黄芪口服治疗(即阳2亚组);阴性组中有18例接受黄芪治疗(即阴1亚组),11例未接受黄芪治疗(即阴2亚组)。治疗前后应用Holter检查观察患者室性心律失常变化、心脏彩色超声多普勒评估心脏左室舒末内径(LVEDd)和左室射血分数(LVEF)、ELISA法检测外周血细胞因子IFN-γ、白细胞介素-4(IL-4)与转化生长因子(TGF)-β1水平。结果:阳1亚组和阴1亚组中分别有3例和2例未坚持服用黄芪或失访而退出。与治疗前相比,阳1亚组、阳2亚组、阴1亚组、阴2亚组室性心律失常改善率分别为:54.5%(12/22)、18.2%(2/11)、43.8%(7/16)、27.3%(3/11),阳1亚组与阳2亚组比较,差异有统计学意义(P<0.05);阳1亚组和阴1亚组LVEDd均有缩小(P<0.05)、LVEF均有升高(P<0.05),血IFN-γ和TGF-β1水平显著下降(P<0.01),而IL-4变化无统计学意义;阳2亚组和阴2亚组也有相似表现,但是LVEDd、LVEF和IL-4变化均差异无统计学意义。结论:口服黄芪合剂可以有效控制DCM室性心律失常,其机制可能与降低患者IFN-γ和TGF-β水平、抑制心肌纤维化有关。

Objective：To explore the effect of Huangqi on ventricular arrhythmia in dilated cardiomyopathy（DCM） and the mechanisms involved in this process.Method：Sixty-five stable DCM patients with ventricular arrhythmias in our hospital from Feb 2009 to Oct 2010 were chosen for this study.According to the results of viral detection,all of patients were divided into 2 groups： Positive group（n=36） and Negative group（n=29）.On the basis of the regular therapy,25 cases from Positive group took Huangqi orally for six month（P1 group） while the other 11 cases did not take this medicine（P2 group）.And in Negative group,18 cases received the treatment of Huangqi（N1 group） and 11 cases did not（N2 group）.Before or after the study,Holter was used to monitor the changes of ventricular arrhythmias,ultrasoundcardiogram（UCG） was employed to investigate Left ventricular end diastolic diameter（LVEDd） and ejection fraction（LVEF）,and ELISA was taken to measure the levels of blood cytokines IFN-γ,IL-4 and TGF-β1.Result：There were 3 cases from P1 and 2 cases from N1 groups quit the study because of stopping taking Huangqi or loss of follow up.After the treatment of Huangqi for 6 months,the rates of improving the ventricular arrhythmias were 54.5%（12/22） in P1 group,18.2%（2/11） in P2 group,43.8%（7/16） in N1 group,and 27.3%（3/11） in N2 group,respectively and the difference was significant（P0.05）.Moreover,compared with those before the treatment,the sizes of LVEDd and the levels of serum IFN-γ,TGF-β1 were all decreased while LVEF increased significantly in P1 and N1 groups（P0.05）,with no changes of IL-4.In P2 and N2 groups,the similar changes as P1 and N1 groups were also found but with no statistic significances in LVEDd,LVEF and IL-4.Conclusion：Taking Huangqi orally could effectively control ventricular arrhythmia in DCM,and the mechanism might be related to reduction of serum IFN-γ and TGF-β1 and inhibition of myocardial fibrosis.