参芎葡萄糖注射液辅助治疗高血压急性左心衰及对血清代谢组学的影响研究

Clinical Study on the Adjunctive Treatment of Hypertension with Acute Left Heart Failure with Shenxiong Glucose Injection and Influence on Serum Metabolomics

目的:探讨参芎葡萄糖注射液辅助治疗原发性高血压所致的急性左心衰患者心功能疗效,并观察血清小分子代谢物变化。方法:原发性高血压并发急性左心衰竭患者68例随机分为对照组(n=30)和观察组(n=38),对照组患者给予吸氧、利尿、降血压、扩张血管治疗,观察组患者在常规组治疗基础上给予参芎葡萄糖注射液100 ml,ivd,qd;观察患者治疗前后纽约心脏病协会(NYHA)心功能分级情况、6 min步行距离、左心室射血分数(LVEF)变化;比较两组患者治疗前后血清中N端脑钠肽前体(NT-proBNP)、人基质裂解素2(ST2)含量;采用超高液相色谱-质谱联用技术比较治疗前后两组患者血清代谢组学变化。结果:与治疗前相比,两组患者治疗后心功能指标改善,血清心衰标记物NT-proBNP及ST2含量降低,血清小分子代谢物组氨酸、牛磺酸、磷酸胆碱、白三烯A4甲酸、柠檬酸含量升高,乳酸含量降低(P <0. 05)。与对照组相比,观察组治疗后心功能指标明显改善,血清NT-proBNP及ST2含量降低(P <0. 05),血清小分子代谢物组氨酸、牛磺酸、苯丙氨酸、柠檬酸含量升高,溶血磷脂、乳酸含量降低趋势更加明显(P <0. 05)。结论:参芎葡萄糖注射液辅助治疗高血压并发急性左心衰竭有较好临床疗效,其机制可能与抗炎、舒张血管、抗炎、改善三羧酸循环有关。

Objective: To investigate the effect of Shenxiong glucose injection on cardiac function in patients with acute left heart failure caused by essential hypertension,and to observe the changes of serum small molecule metabolites. Methods: Totally 68 patients with acute hypertension complicated with acute left heart failure were randomly divided into the control group (n = 30) and the observation group (n = 38). The patients in the conventional group were treated with oxygen absorbing,diuretic,blood pressure lowering and dilatation vasculature. The patients in the observation group were treated with Shenxiong glucose injection 100 ml,ivd,qd additionally. The changes of NYHA cardiac function,6-min walking distance and left ventricular ejection fraction (LVEF%) were observed before and after the treatment. The serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and human matrix lysin 2 (ST2) were compared before and after the treatment. The serum metabolomics changes of the two groups before and after the treatment were compared by ultra-high liquid chromatography-mass spectrometry. Results: Compared with that before the treatment,the heart function index of the two groups was improved after the treatment,and the serum contents of heart failure markers NT-proBNP and ST2 were decreased. The contents of serum small molecule metabolites histidine,taurine,phosphorylcholine,leukotriene A4 formic acid and citric acid were increased,and that of lactic acid was decreased (P < 0. 05). Compared with that in the control group,the cardiac function index of the observation group was significantly improved after the treatment,and the serum levels of NT-proBNP and ST2 were decreased (P < 0. 05). The contents of serum small molecule metabolites histidine,taurine,phenylalanine and citric acid were increased,and that of lysophospholipid and lactic acid were decreased more significantly (P < 0. 05). Conclusion: Shenxiong glucose injection has a good clinical effect in the treatment of hypertension complicated with acute left heart failure. The mechanism may be related to anti-inflammatory effect,relaxing blood vessels and improving tricarboxylic acid cycle.