基于NF-κB/iNOS/NO信号通路探讨生脉散加减对老年心肌梗死患者心功能的保护作用

Protective Effect of Modified Shengmaisan on Cardiac Function in Elderly Patients with Myocardial Infarction Based on NF-κB/iNOS/NO Signaling Pathway

目的:探究生脉散加减对老年心肌梗死患者心功能的保护作用并探讨核转录因子-κB/诱导型一氧化氮合酶/一氧化氮(NF-κB/iNOS/NO)信号通路在其中的作用机制。方法:前瞻性对2019年12月至2021年12月青海省中医院老年心肌梗死患者136例进行研究,按照随机数字表法分为观察组、对照组,各68例。对照组实施常规西药治疗,观察组实施常规西药+生脉散加减治疗,两组患者均给予经皮冠状动脉介入治疗进行血运重建。比较两组患者心功能相关指标,血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及基质金属蛋白酶-9(MMP-9)水平,超声心动图指标,心功能分级,NF-κB/iNOS/NO信号通路变化,氧化应激指标变化及不良心血管事件(MACE)发生情况。结果:与本组治疗前比较,两组患者的N末端B型利钠肽原(NT-pro BNP)、血清炎症指标、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、NO、iNOS、NF-κB p65及丙二醛(MDA)水平均明显降低(P<0.05,P<0.01),左室射血分数(LVEF)及超氧化物歧化酶(SOD)均明显升高(P<0.05)。治疗后与对照组比较,观察组NT-pro BNP、血清炎症指标、LVESV、LVEDV、NO、iNOS、NF-κB p65及MDA水平均明显降低(P<0.05),LVEF及SOD均明显升高(P<0.05)。两组患者纽约心脏病协会(NYHA)心功能分级比较差异无统计学意义。观察组MACE发生率明显低于对照组(P<0.05)。结论:生脉散加减可明显降低老年心肌梗死患者NT-pro BNP、血清炎症指标水平,改善超声心动图指标,可调控NF-κB/iNOS/NO信号通路变化及降低氧化应激指标,减少不良心血管事件发生率,具有较好的心功能保护作用。

Objective:To explore the protective effect of modified Shengmaisan on cardiac function in elderly patients with myocardial infarction based on the nuclear factor-κB/induction nitric oxide synthase/nitric oxide(NF-κB/iNOS/NO)signaling pathway.Method:A total of 136 elderly patients with myocardial infarction treated in Qinghai Hospital of Traditional Chinese Medicine from december 2019 to december 2021 were included.They were randomly divided into an observation group and a control group,with 68 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with conventional western medicine+modified Shengmaisan.Both groups were treated with percutaneous coronary intervention for revascularization.The indexes related to cardiac function and levels of serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and matrix metalloproteinase-9(MMP-9)were analyzed and compared between the two groups.The echocardiographic index,cardiac function classification,changes in the NF-κB/iNOS/NO signaling pathway,oxidative stress indexes,and major adverse cardiovascular events(MACE)of the two groups were compared.Result:Compared with those before treatment,the levels of N-terminal B-type natriuretic peptide(NT-pro BNP),serum inflammatory indexes,left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),NO,iNOS,NF-κB p65,and methane dicarboxylic aldehyde(MDA)were significantly reduced(P<0.05,P<0.01),and the left ventricular ejection fraction(LVEF)and superoxide dismutase(SOD)were significantly increased(P<0.05).After treatment,as compared with the control group,the levels of NT-pro BNP,serum inflammatory indexes,LVESV,LVEDV,NO,iNOS,NF-κB p65,and MDA in the observation group were significantly reduced(P<0.05),and those of LVEF and SOD were significantly increased(P<0.05).There was no significant difference in the New York Heart Association(NYHA)cardiac function classification between two groups.The incidence of MACE in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:Modified Shengmaisan can significantly reduce NT-pro BNP and levels of serum inflammatory indexes in elderly patients with myocardial infarction,improve echocardiographic indexes,regulate the NF-κB/iNOS/NO signaling pathway,and reduce the oxidative stress index and the incidence of MACE,which has a good protective effect on cardiac function.