Differences in Heart Stroke Volume between Han and Korean-Chinese Nationalities and Correlative Factors

Objective To compare the differences in stroke volume （SV） and stroke volume index （Sl） between Han and Korean-Chinese and to investigate the correlated risk factors. Methods A total of 1 647 Han and 876 Korean-Chinese aged 10-80 years were investigated. SV, SI, cardiac output, cardiac output index, heart rate （HR）, systemic vascular resistance （SVR）, systemic vascular resistance index （SVRI）, and blood pressure were measured. Results SV/SI values in Korean-Chinese were lower than those in the Han of the same sex and age. Covariance analysis showed that, apart from the effect of sex, age and body mass index （BMI）, the differences in SV and SI between the two cohorts were still significant （P〈O.O01）. Multiple regression analysis revealed that the SV difference between the two ethnicities was affected （in descending order from a strong to weak correlation） by SVR, SVRI, HR, diastolic blood pressure, mean arterial pressure, BMI, and systolic blood pressure, while the SI difference was affected by SVR, SVRI, HR, mean arterial pressure, diastolic and systolic blood pressure, and BMI. Conclusion The Fact that SV and SI in Korean-Chinese are lower than those in Han is related with higher SVR, HR and blood pressure in the Korean-Chinese.

C-reactive Protein Level,Apolipoprotein B-to-apolipoprotein A-1 Ratio,and Risks of Ischemic Stroke and Coronary Heart Disease among Inner Mongolians in China

Objective We aimed to investigate the cumulative effect of high CRP level and apolipoprotein B-to-apolipoprotein A-1（ApoB/ApoA-1） ratio on the incidence of ischemic stroke（IS） or coronary heart disease（CHD） in a Mongolian population in China.Methods From June 2003 to July 2012,2589 Mongolian participants were followed up for IS and CHD events based on baseline investigation.All the participants were divided into four subgroups according to C-reactive protein（CRP） level and ApoB/ApoA-1 ratio.Cox proportional hazard models were used to estimate the hazard ratios（HRs） and 95% confidence intervals（CIs） for the IS and CHD events in all the subgroups.Results The HRs（95% CI） for IS and CHD were 1.33（0.84-2.12）,1.14（0.69-1.88）,and 1.91（1.17-3.11） in the ‘low CRP level with high ApoB/ApoA-1＇,‘high CRP level with low ApoB/ApoA-1＇,and ‘high CRP level with high ApoB/ApoA-1＇ subgroups,respectively,in comparison with the ‘low CRP level with low ApoB/ApoA-1＇ subgroup.The risks of IS and CHD events was highest in the ‘high CRP level with high ApoB/ApoA-1＇ subgroup,with statistical significance.Conclusion High CRP level with high ApoB/ApoA-1 ratio was associated with the highest risks of IS and CHD in the Mongolian population.This study suggests that the combination of high CRP and ApoB/ApoA-1 ratio may improve the assessment of future risk of developing IS and CHD in the general population.

Factors Influencing the Diferent Incidences between Coronary Heart Disease and Stroke

To search factors influencing morbidity between coronary heart disease(CHD) and stroke, a longitudinal prospective study was done in a cohort of 1 809 participants aged 3574 at entry of Jiangsu province, China. The average annual agedadjusted incidence of stroke was 142.3/\{100 000\}, being over 1315 years more than that of coronary event(CE)(49.1/100 000), the difference of the incidences between the two diseases was very significant(P<0.01). Multivariate regression analysis revealed that the main risk factors of CHD include increase of serum total cholecsterol, hypertension and mental stress, whereas the most important risk factors for stroke consist of elevation of systolic blood pressure(SBP) as well as smoking and alcohol drinking habit. It was noted that these participants in cohort usually had high salt intake, low animal protein diet, and low level of serum cholecsterol with high level of blood presure and smoking and alcohol habit. We suggest that rational dietary food, stopping smoking, limited alcohol and community control of hypertension are the preventive strategy against these diseases.

Effect of Heart Failure on Acute Ischemic Stroke Severity

Objectives: To assess the impact of heart failure diseases on stroke severity and short term (1 month mortality). Materials and Methods: Totally, 200 patients admitted to Ain Shams university specialized hospital, were diagnosed clinically to have acute ischemic stroke within 3 days. History taking about previous heart disease was taken, and full general and neurological examinations were done. Full metabolic profile, cardiac examination and investigations were done. Carotid duplex, MRI stroke protocol and lastly clinical reevaluation using NIH Stroke Scale (NIHSS) after 1 month from stroke onset were done. Results: Patients with systolic dysfunction (EF ≤ 40%) had lacunar infarction in 18.75% of cases, partial anterior circulation infarction in 62.5% of cases, posterior circulation infarction in 6.25% of cases and total anterior circulation infarction in 12.5% of cases. Leucoaraiosis was present in 87% of cases and significant intracranial vessel stenosis was showed in 87.5% who had done MRI. Their median NIHSS score at admission was 10.5 with IQR of 5 - 21 and at follow-up it was 5 with IQR of 2.5 - 10.5. At follow-up 22.7% (5 patients) were dead. Conclusion: Systolic dysfunction (EF < 40) i.e. heart failure has no significant effect on stroke severity and 1 month follow up prognosis.

Clinical Heart Failure Patients with Ischemic Stroke Have a High Incidence (>60%) of Atrial Fibrillation or Flutter Whether Systolic Function Is Preserved or Depressed

Clinical congestive heart failure (CHF) is a major risk factor for strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF), which is frequently associated with, may be a marker for, and may be the mechanism of, ischemic strokes. To determine whether stroke patients with CHF have a high incidence of AF (that may be intermittent and not diagnosed), we reviewed all the 12 lead ECGs in a fourteen year institutional ECG data base and the clinical records and the available echocardiograms of 985 patients who had an ischemic stroke over a 3-year period. We found that 31.3% of the stroke patients had evidence of AF. Clinical congestive heart failure was present in 168 stroke patients;61.9% of these stroke patients with CHF had evidence of AF. In the total stroke population, patients with other risk factors for stroke (hypertension, advanced age, diabetes, coronary artery disease) had an increased incidence of AF;but among stroke patients with CHF, only advanced age (≥75 years) in addition to CHF increased the incidence of AF. To determine whether only the CHF stroke pts with systolic dysfunction had a high incidence of AF, we compared the incidence of AF in the 41.5% of the CHF patients with a depressed ejection fraction with the AF incidence in the 58.5% of CHF stroke patients with a normal ejection fraction (≥50%). The incidence of AF was the same (63.4% vs. 60.2%, p = 0.741) whether the ejection fraction was depressed or normal. These findings suggest that AF is common in patients with CHF who have strokes whether the ejection fraction is normal or depressed. CHF patients who have strokes and who are in sinus rhythm should be meticulously investigated for intermittent AF, so anticoagulation can be administered to prevent a further stroke.

State level correlations between high heart attack and stroke symptomology knowledge scores and CVD risk factors and mortality rates

Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS) heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA) 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed public health education efforts.

Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation

BACKGROUND:Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients.In case of acute ischemic stroke in pediatric age group,management is different from that of adult ischemic stroke where thrombolysis is a good option.METHODS:We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry.The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously.He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke.RESULTS:The patient recovered from acute ischemic stroke without being thrombolyzed.CONCLUSION:In pediatric patients,acute ischemic stroke usually is evolving and may not require thrombolysis.

Hidden Markov Models to Estimate the Lagged Effects of Weather on Stroke and Ischemic Heart Disease

The links between low temperature and the incidence of disease have been studied by many researchers. What remains still unclear is the exact nature of the relation, especially the mechanism by which the change of weather effects on the onset of diseases. The existence of lag period between exposure to temperature and its effect on mortality may reflect the nature of the onset of diseases. Therefore, to assess lagged effects becomes potentially important. The most of studies on lags used the method by Lag-distributed Poisson Regression, and neglected extreme case as random noise to get correlations. In order to assess the lagged effect, we proposed a new approach, i.e., Hidden Markov Model by Self Organized Map (HMM by SOM) apart from well-known regression models. HMM by SOM includes the randomness in its nature and encompasses the extreme cases which were neglected by auto-regression models. The daily data of the number of patients transported by ambulance in Nagoya, Japan, were used. SOM was carried out to classify the meteorological elements into six classes. These classes were used as “states” of HMM. HMM was used to describe a background process which might produce the time series of the incidence of diseases. The background process was considered to change randomly weather states, classified by SOM. We estimated the lagged effects of weather change on the onset of both cerebral infarction and ischemic heart disease. This fact is potentially important in that if one could trace a path in the chain of events leading from temperature change to death, one might be able to prevent it and avert the fatal outcome.

Stroke and Left Ventricular Assist Device (LVAD)

Treatment of ischemic stroke for a patient on left ventricular assist device (LVAD) by neurointerventional means is rare and many anesthesia providers are unfamiliar with both LVAD and neurointerventional protocols. Examples of this include: 1) filling for continuous-flow LVAD depend on preload and the flow is inversely related to afterload;as mean arterial pressure (MAP) increases above 80 to90 mmHg, flow decreases;2) there may be no palpable pulse in patients with continuous flow LVADs;3) pulse oximetry may not work when pump flow is high and native myocardial function is minimal;4) increasing MAP above80 mmHg potentially will maintain ischemic brain tissue—the penumbra—until flow is restored. This latter example creates a paradoxical management goal: increasing the mean arterial pressure (MAP) above80 mmHg while maintaining ischemic brain tissue, may decrease flow to the LVAD. Finally, there is controversy regarding which type of anesthesia is most efficacious for neuro interventional procedures. We describe three patients on LVAD suffering ischemic stroke requiring anesthesia for embolectomy and angioplasty during neruointeventioal radiology procedures.

Bayés syndrome and acute cardioembolic ischemic stroke

Bayés syndrome is an under-recognized clinical condition characterized by advanced interatrial block.Bayés syndrome is a subclinical disease that manifests electrocardiographically as a prolonged P wave duration>120 ms with biphasic morphology±in the inferior leads.The clinical relevance of Bayés syndrome lies in the fact that is a clear arrhythmological syndrome and has a strong association with supraventricular arrhythmias,particularly atypical atrial flutter and atrial fibrillation.Likewise,Bayés syndrome has been recently identified as a novel risk factor for non-lacunar cardioembolic ischemic stroke and vascular dementia.Advanced interatrial block can be a risk for embolic stroke due to its known sequelae of left atrial dilation,left atrial electromechanical dysfunction or atrial tachyarrhythmia(paroxysmal or persistent atrial fibrillation),conditions predisposing to thromboembolism.Bayés syndrome may be responsible for some of the unexplained ischemic strokes and shall be considered and investigated as a possible cause for cryptogenetic stroke.In summary,Bayés syndrome is a poorly recognized cardiac rhythm disorder with important cardiologic and neurologic implications.

卒中及共患疾病诊疗模式探索与实践

近年来,虽然国内外学者对卒中及共患疾病的关注逐步提高,但由于多病共存的特殊性和异质性,针对此类患者的诊治仍存在诸多不足和挑战。卒中及共患疾病的诊疗能力很大程度上反映了医疗机构的神经系统专科技术水平和多学科协同救治能力。构建多学科协同诊疗模式是卒中救治和质量管理体系建设的重要内容之一。医疗机构应运用先进的质量管理工具,优化要素配置和运行机制,建立高效的多学科协同诊疗模式,从而实现卒中及共患疾病整体诊治水平的提升。

基于网络药理学和分子对接探讨丹参治疗冠心病和脑卒中的“异病同治”作用机制研究

目的:基于网络药理学及分子对接方法探讨丹参有效成分治疗冠心病和脑卒中“异病同治”的作用机制及关键靶点。方法:通过中药系统药理学数据库和分析平台(TCMSP)、在线人类孟德尔遗传数据库(OMIM)、DrugBank等数据库筛选丹参治疗冠心病及脑卒中的潜在靶点,并通过Metascape在线平台进行靶点蛋白-蛋白相互作用(PPI)、基因本体(GO)和京都基因与基因组百科全书(KEGG)通路分析,使用Cytoscape 3.9.1构建活性成分-关键靶点-核心通路网络,筛选出核心成分。采用分子对接模拟核心成分与关键靶点的结合程度。结果:筛选丹参治疗冠心病与脑卒中“异病同治”的潜在靶点52个,主要富集于糖基化终末产物/糖基化终末产物受体(AGE/RAGE)、血小板激活、脂质与动脉粥样硬化、流体剪应力与动脉粥样硬化等通路。核心药效成分与磷脂酰肌醇-3-激酶(PI3K)、蛋白激酶B(AKT)、一氧化氮合酶(NOS3,eNOS)、B淋巴细胞瘤相关蛋白-2(Bcl-2)、环氧合酶2(PTGS2)、整合素亚基α2b(ITGA2B)、基质金属蛋白酶9(MMP9)等靶点结合稳定。结论:丹参“异病同治”冠心病与脑卒中主要通过抗血小板活化与聚集、保护心脑血管细胞、稳定斑块、减轻炎症等机制改善动脉粥样硬化,并存在靶点竞争及协同疗效的潜在可能。

Assessment of Pericardium Volume by the Stroke Volume Variation in Patients with Off-Pump Cardiac Surgery

Objective: SVV is derived from the cardiopulmonary interaction, which is used to predict the responsiveness of cardiac preload guiding fluid therapy in patients under general anesthesia in non-opened chest surgery. From a clinical point of view, it is important to know how well SVV reflects preload and fluid responsiveness during cardiac surgery. This study was undertaken to assess the accuracy and reliability of SVV derived from the FloTrac/Vigileo system in monitoring changes in blood volume in patients undergoing off-pump coronary artery bypass grafting (OPCABG) under general anesthesia. Methods: After approval from the ethics committee and obtaining the permission of the patients, twenty-nine patients, ASA II-III and NYHA II-III, aged 44-7 yr, undergoing elective off-pump coronary artery bypass grafting, were randomly divided into 2 groups: the control group (group C, n = 8) and volume expansion group (group V, n = 21). After patients entered the operating room, veins were put in line, ECG, HR, SpO2, and PETCO2 were continuously monitored. Left radial arterial and right internal jugular vein catheters were inserted under local anesthesia. The FloTracTM/VigileoTM system was connected and MAP, CO, CI, SVV, SV, SVI, SVR, SVRI, CVP were continuously monitored. BIS values were kept at 45%-55.6% hydroxyethyl starch 130/0.4 sodium chloride solution 7 ml/kg was intravenously infused after completion of sternotomy and pericardiotomy at a rate of 0.25 ml/kg–1/min–1 in group V. MAP, HR, CVP, systemic vascular resistance (SVR), SVV, and stroke volume index (SVI) were determined 10 min before (T1) and after the infusion of finished (T2), and the change rate (ΔHR, ΔMAP, ΔCVP, ΔSVR, ΔSVV, ΔSVI) was calculated. Sodium chloride injection 3 ml/kg was infused in group C. Results: CVP, SVI, CO and CI were increased after volume expansion, SVRI and SVV significantly decreased in group V(P < 0.01), while MAP and HR were not changed. Changes in HR(r = –0.737, P and SVR(r = –0.480, P were significantly correlated to changes in SVI, but there was no correlation between ΔCVP, ΔMAP, ΔSVV and ΔSVI.

高龄老年男性射血分数保留的心力衰竭住院患者收缩压的目标及预后意义

目的 探讨高龄老年男性射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)住院患者收缩压的目标及预后意义。方法 纳入了2012年7月至2023年6月解放军总医院第二医学中心心血管内科年龄≥80岁男性HFpEF住院患者952例,根据出院时收缩压分为<100 mm Hg(1 mm Hg=0.133 kPa)组29例、收缩压100~150 mm Hg组677例和收缩压>150 mm Hg组246例。收集所有患者一般临床资料,将全因病死率作为终点事件。结果 收缩压<100 mm Hg组死亡24例(82.8%),收缩压100~150 mm Hg组死亡430例(63.5%),收缩压>150 mm Hg组死亡137例(55.7%),3组病死率比较,差异有统计学意义(P=0.006)。收缩压<100 mm Hg组生存率明显低于收缩压100~150 mm Hg组和收缩压>150 mm Hg组(χ^(2)=22.70,P_(log-rank)<0.01)。与收缩压<100 mm Hg组比较,收缩压100~150 mm Hg组与收缩压>150 mm Hg的死亡风险明显降低(P=0.015)。结论 男性高龄老年HFpEF住院患者的收缩压<100 mm Hg与全因死亡风险增加密切相关。

A cardioembolic stroke

A 76-year-old woman with unspecified congenital heart disease was admitted on April 25th for TIA. She had a possible history of atrial fibrillation. A slight fever was noted on admission. Her ECG was abnormal, as well as her transthoracic echocardiography (TTE). Troponin I was slightly increased. On May 11th, a stroke occurred, in relation with an occlusion of the basilar artery. The patient was transferred to our institution for an emergency desobstruction. A dramatic improvement allowed her to be discharged to a rehabilitation center on May 18th. However, she was re-hospitalized on June 5th, due to sepsis and neurological worsening. MRI showed new ischemic brain lesions. Several episodes of paroxysmal atrial fibrillation were documented, as well as pulmonary hypertension. Effective heparin therapy was initiated and transesophageal echocardiography (TEE) was requested this time. It revealed a congenital valvular heart disease (a subaortic membrane), complicated by infective endocarditis. Despite a monitoring of aPTT, a fatal hemorrhagic shock occurred. We report this unfortunately remarkable case to address the following important points: 1) In the setting of a neurological event, abnormal ECG and/or abnormal TTE and/or Troponin I elevation may indicate a cardioembolic mechanism and therefore seek a cardiac source of embolism. 2) When TTE fails to identify a cardiac source of embolism, TEE should be performed, especially when a preexisting heart disease is suspected or known. 3) The multiplicity in space (infarcts in both the anterior and posterior circulation, or bilateral) and/or the multiplicity in time (infarcts of different age) may indicate a cardioembolic stroke. 4) Congenital subaortic membrane predisposes to infective endocarditis. 5) When anticoagulant therapy is initiated on strong arguments in a septic patient (much discussed in infective endocarditis), aPTT monitoring alone may not be enough. An anti-Xa monitoring may be more appropriate.

血清尿酸与心脑血管疾病相关性研究进展

尿酸(UA)是机体代谢的关键物质,随着生活质量改善、饮食结构变化,高尿酸血症(HUA)发生率呈逐年上升趋势,并与高血压、冠心病(CAD)、心力衰竭、心律失常、脑卒中等心脑血管疾病发生密切相关。现就血清UA水平与心脑血管疾病相关性研究作一概述,以期为心血管病早期防治提供参考。

脑心健康管理师主导的认知功能筛查模式在卒中患者中的实践效果

于2022年在南通市某三级甲等医院成立以脑心健康管理师为主导的卒中患者认知功能筛查团队,对卒中患者开展病史、体格检查、量表测评等认知功能筛查,探讨以脑心健康管理师为主导的认知功能筛查模式在卒中患者中的应用效果。研究显示,以脑心健康管理师为主导的认知功能筛查模式可提高卒中患者住院期间及出院后6个月认知功能筛查和评估率,早期发现和诊断卒中后认知障碍患者,从而进一步提高患者的规范化诊治率,改善患者结局。

不同心房颤动类型患者合并缺血性卒中的危险因素分析

目的探讨不同心房颤动(房颤)类型患者合并缺血性卒中的危险因素。方法连续入选2016年1月至2021年4月于中国中医科学院广安门医院心内科住院的非瓣膜性房颤患者751例,分为阵发性房颤(367例)和持续性房颤(384例),将不同房颤类型患者分为缺血性卒中组和非缺血性卒中组,分析不同类型房颤合并缺血性卒中的危险因素。结果在房颤合并卒中患者中,持续性房颤患者比例大于阵发性房颤(P<0.05),在阵发性房颤患者中,卒中组合并高血压、冠心病、心力衰竭(心衰)、糖尿病比例高于无卒中组,CHA2DS2-VASc评分高于无卒中组[(5.92±1.41)分比(3.97±1.26)分,P<0.05]。多因素logistics回归分析显示,冠心病(OR=3.795,95%CI 1.011~14.241,P<0.05)、糖尿病(OR=2.121,95%CI 1.272~3.536,P<0.05)是阵发性房颤合并缺血性卒中的独立危险因素。持续性房颤患者中,卒中组女性(P<0.05)、合并高血压(P=0.012)比例高于无卒中组,年龄[(79.34±6.62)岁比(74.5±9.70)岁]、左心房内径(LAD)[(49.28±4.29)mm比(42.13±3.96)mm]、CHA2DS2-VASc评分[(3.97±1.38)分比(3.61±1.37)分]高于无卒中组(P<0.05),接受抗凝治疗患者比例低于无卒中组(P<0.05),多因素logistics回归分析显示,年龄(OR=1.062,95%CI 1.025~1.100,P<0.05)、女性(OR=2.917,95%CI 1.681~5.060,P<0.05)、LAD(OR=1.165,95%CI 1.105~1.230,P<0.05)是持续性房颤合并缺血性卒中的独立危险因素,接受抗凝治疗(OR=0.332,95%CI 0.194~0.566,P<0.05)是保护因素。结论冠心病、糖尿病是阵发性房颤患者合并缺血性卒中的独立危险因素,持续性房颤患者的年龄、女性、LAD、抗凝情况与缺血性卒中密切相关,抗凝治疗。因此,对于阵发性房颤制定相应的预防策略,或积极进行节律控制、抗凝治疗,以降低缺血性卒中风险。

归脾汤加味联合黛力新治疗心脾两虚型缺血性脑卒中后抑郁临床研究

目的:观察归脾汤加味联合黛力新治疗心脾两虚型缺血性脑卒中后抑郁患者的疗效。方法:选取心脾两虚型缺血性脑卒中后抑郁患者80例,随机分为2组,每组40例。对照组予口服黛力新片治疗,中药组在对照组基础上加服归脾汤加味,两组疗程均为4周,观察比较两组治疗前后美国国立卫生院卒中量表(NIHSS)评分、汉密尔顿抑郁量表(HAMD)评分、健康调查简表(SF-36)评分、血清5-羟色胺(5-HT)水平、血清同型半胱氨酸(Hcy)水平变化情况及临床疗效、不良反应发生率。结果:治疗后,两组患者HAMD评分、SF-36评分、NIHSS评分及5-HT、Hcy水平均较治疗前改善(P<0.05),且中药组较对照组改善明显,差异具有统计学意义(P<0.05)。中药组总有效率为95.00%,高于对照组的80.00%,差异具有统计学意义(P<0.05)。中药组不良反应总发生率为5.0%,低于对照组的17.5%(P<0.05)。结论:归脾汤加味联合黛力新可改善心脾两虚型缺血性脑卒中后抑郁患者抑郁状态,安全性较好。

基于网络药理学和分子对接技术探讨血府逐瘀汤“异病同治”治疗冠心病和缺血性脑卒中的作用机制

目的 通过网络药理学方法结合分子对接技术探讨血府逐瘀汤“异病同治”治疗冠心病和缺血性脑卒中的作用机制。方法 在TCMSP数据库检索并结合文献筛选血府逐瘀汤11味中药的活性成分和作用靶点,通过Uniprot数据库匹配靶点官方名称。从OMIM、DrugBank、DisGNET、TTD、GeneCards数据库获取冠心病和缺血性脑卒中相关疾病靶点,取交集靶点,构建“单味药—共有靶点—疾病”网络。建立蛋白间相互作用网络,利用Centiscape插件筛选关键靶点,利用MetaScape数据库进行GO功能分析和KEGG通路富集分析。通过AutoDockTools-1.5.6进行分子对接预测。结果 筛选后得到血府逐瘀汤活性成分192个,作用靶点394个;与冠心病和缺血性脑卒中相关且排序靠前的通路有脂质和动脉粥样硬化、缺氧诱导因子-1、松弛素、核因子-κB信号通路等,主要与脂质代谢、炎症反应、氧化应激、血管生成和细胞凋亡等生物学过程相关。本方中主要活性成分木犀草素、山柰酚、柚皮素与靶点蛋白蛋白激酶1、白蛋白、胰岛素结合较好。结论 基于网络药理学的方法发现血府逐瘀汤通过多靶点、多途径治疗冠心病和缺血性脑卒中,且多个成分表现出良好的活性;可能通过抗氧化、抗炎、抑制细胞凋亡、调节激素水平、促进血管生成等作用,改善局部缺血缺氧状态,发挥“异病同治”作用。