基于炎症-氧化应激-血管内皮功能探究补阳还五汤对急性心肌梗死早期心室重构的抑制作用

Buyang Huanwu Decoction Inhibits Early Ventricular Remodeling in the Patients with Acute Myocardial Infarction by Regulating Inflammation,Oxidative Stress,and Vascular Endothelial Function

目的基于炎症-氧化应激-血管内皮功能探究补阳还五汤对急性心肌梗死(Acute myocardial infarction,AMI)患者早期心室重构的抑制作用。方法选取2020年1月—2022年5月期间中国中医科学院望京医院收治的106例AMI患者作为研究对象,根据就诊顺序分为观察组53例和对照组53例。对照组给予经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)及术后常规药物治疗,观察组在对照组基础上加用补阳还五汤治疗。治疗4周后,观察比较两组患者临床疗效、随访情况,评价中医证候积分,测量并比较超声心动图指标[左室射血分数(Left ventricular ejection fraction,LVEF)、每搏输出量(Stroke volume,SV)、心排血量(Cardiac output,CO)、舒张早期速度峰值(Peak early diastolic velocity,E)/舒张末期速度峰值(Peak end diastolic velocity,A)比、左室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左室收缩末期内径(Left ventricular end systolic diameter,LVESD)、左室后壁厚度(Left ventricular posterior wall thickness,LVPWT)、室间隔厚度(Interventricular septal thickness,IVST)、左室重构指数(Left ventricular remodeling index,LVRI)],检测血清炎症因子[超敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、同型半胱氨酸(Homocysteine,Hcy)、白介素-6(Interleukin-6,IL-6)、肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)、干扰素-γ(Interferon-γ,IFN-γ)]、氧化应激指标[超氧化物歧化酶(Superoxide dismutase,SOD)、丙二醛(Malondialdehyde,MDA)、谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-Px)、氧化型低密度脂蛋白(Oxidized low density lipoprotein,ox-LDL)]、血管内皮功能指标[碱性成纤维生长因子(Basic fibroblast growth factor,bFGF)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、血管性血友病因子(Vascular hemophilia factor,vWF)、内皮素-1(Endothelin-1,ET-1)和一氧化氮(Nitric oxide,NO)]变化。结果治疗后观察组总有效率94.23%明显高于对照组82.35%,差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者主要心功能指标LVEF、SV、CO、E/A均较治疗前升高,且观察组高于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者心室重构相关指标LVEDD、LVESD、LVPWT、LMRI均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的血hs-CRP、Hcy、IL-6、TNF-α和IFN-γ水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者抗氧化物质SOD、GSH-Px水平较治疗前升高,氧化还原反应物质MDA、ox-LDL水平较治疗前降低,且观察组SOD、GSH-Px水平高于对照组,MDA、ox-LDL水平低于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者bFGF、VEGF和NO水平均较治疗前升高,vWF和ET-1水平较治疗前降低,且观察组bFGF、VEGF和NO水平高于对照组,vWF和ET-1水平低于对照组,差异均有统计学意义(P<0.05)。随访期间,观察组AMI后心衰等心血管事件(Major adverse cardiovascular events,MACE)发生率低于对照组,差异有统计学意义(P<0.05)。结论补阳还五汤治疗AMI可改善临床症状,改善心功能并抑制早期心室重构,其机制与调节炎症-氧化应激-血管内皮功能有关。

Objective To investigate the inhibitory effect of Buyang Huanwu Decoction on early ventricular remodeling in the patients with acute myocardial infarction(AMI)based on inflammation,oxidative stress,and vascular endothelial function.Methods A total of 106 patients with AMI admitted to the Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2020 to May 2022 were into an observation group(n=53)and a control group(n=53)according to the order of admission.The control group received percutaneous coronary intervention(PCI)and postoperative conventional medication,and the observation group was treated with Buyang Huanwu Decoction on the basis of the therapy in the control group.After four weeks of treatment,the clinical efficacy and follow-up results was compared between the two groups.Before and after treatment,both groups of patients were examined for the traditional Chinese medicine(TCM)syndrome score,echocardiographic parameters[left ventricular ejection fraction(LVEF),stroke volume(SV),cardiac output(CO),ratio of peak early diastolic velocity(E)to peak end diastolic velocity(A),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular posterior wall thickness(LVPWT),interventricular septal thickness(IVST),and left ventricular remodeling index(LVRI)],serum levels of inflammatory cytokines[hypersensitive C-reactive protein(hs-CRP),homocysteine(Hcy),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α),and interferon-γ(IFN-γ)],oxidative stress indicators[superoxide dismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),oxidized low density lipoprotein(ox-LDL)],and vascular endothelial function indicators[basic fibroblast growth factor(bFGF),vascular endothelial growth factor(VEGF),vascular hemophilia factor(vWF),endothelin-1(ET-1),and nitric oxide(NO)].Results The total response rate in the observation group was 94.23%,which was higher than that(82.35%)in the control group(P<0.05).After treatment,the TCM syndrome scores decreased in the two groups,and the decrease was more obvious in the observation group(P<0.05).After treatment,the LVEF,SV,CO,and E/A ratio in the two groups increased,and these indicators were higher in the observation group than in the control group(P<0.05).After treatment,LVEDD,LVESD,LVPWT,LVRI,and the serum levels of hs-CRP,Hcy,IL-6,TNF-α,and IFN-γdecreased and were lower in the observation group than in the control group(P<0.05).After treatment,the two groups showed elevated levels of SOD and GSH-Px and declined levels of MDA and ox-LDL,and the changes were more significant in the observation group than in the control group(P<0.05).The treatment elevated the levels of bFGF,VEGF,and NO and lowered the levels of vWF and ET-1,and the observation group had higher levels of bFGF,VEGF,and NO and lower levels of vWF and ET-1 than the control group after treatment(P<0.05).The total incidence of major adverse cardiovascular events(MACEs)such as heart failure post AMI in the observation group was lower than that in the control group during the follow-up period(P<0.05).Conclusion Buyang Huanwu Decoction can alleviate clinical symptoms,improve the cardiac function,and inhibit early ventricular remodeling in the patients with AMI by regulating inflammation,oxidative stress,and vascular endothelial function.