TCM-HIN2Vec:A strategy for uncovering biological basis of heart qi deficiency pattern based on network embedding and transcriptomic experiment

Objective:To elucidate the biological basis of the heart qi deficiency(HQD)pattern,an in-depth understanding of which is essential for improving clinical herbal therapy.Methods: We predicted and characterized HQD pattern genes using the new strategy,TCM-HIN2Vec,which involves heterogeneous network embedding and transcriptomic experiments.First,a heterogeneous network of traditional Chinese medicine(TCM)patterns was constructed using public databases.Next,we predicted HQD pattern genes using a heterogeneous network-embedding algorithm.We then analyzed the functional characteristics of HQD pattern genes using gene enrichment analysis and examined gene expression levels using RNA-seq.Finally,we identified TCM herbs that demonstrated enriched interactions with HQD pattern genes via herbal enrichment analysis.Results: Our TCM-HIN2Vec strategy revealed that candidate genes associated with HQD pattern were significantly enriched in energy metabolism,signal transduction pathways,and immune processes.Moreover,we found that these candidate genes were significantly differentially expressed in the transcriptional profile of mice model with heart failure with a qi deficiency pattern.Furthermore,herbal enrichment analysis identified TCM herbs that demonstrated enriched interactions with the top 10 candidate genes and could potentially serve as drug candidates for treating HQD.Conclusion: Our results suggested that TCM-HIN2Vec is capable of not only accurately identifying HQD pattern genes,but also deciphering the basis of HQD pattern.Furthermore our finding indicated that TCM-HIN2Vec may be further expanded to develop other patterns,leading to a new approach aimed at elucidating general TCM patterns and developing precision medicine.

Energy metabolism,immune function,and intestinal flora in rats with kidney-yin deficiency treated with raw or saltwater-processed Phellodendron chinense Schneid

Objective:To clarify the specific mechanisms of action of raw Phellodendron chinense Schneid.(RPC)and saltwater-processed PC(SPC)in the treatment of rats with a kidney-yin deficiency pattern(KYDP).Methods:Healthy rats were administered hydrocortisone to establish a KYDP model.The rats were divided into seven groups:blank control,model,positive control(Liuwei Dihuang pills),high-dose RPC,low-dose RPC,high-dose SPC,and low-dose SPC.Enzyme-linked immunosorbent assay was used to measure the levels of cAMP,cGMP,TRH,TSH,T3,T4,IFN-g,TNF-a,and testosterone in the serum and the levels of Na^(+)-K^(+)-ATPase and Ca ^(2+)-Mg ^(2+)-ATPase in the liver.TRH mRNA expression in the rat hypo-thalamus was measured using RT-PCR.THRa1+2 protein expression in the hypothalamus of rats was measured using Western blot.Immunohistochemistry was performed to determine the expression levels of FAS,FasL,and TSHR.Flow cytometry was used to determine CD4^(+)and CD8^(+)T lymphocyte levels.Illumina MiSeq sequencing technology was used to evaluate the diversity of intestinal flora in KYDP rats.Results:The cAMP/cGMP ratio was significantly higher in the model group than in the blank control group(P=0.048).Compared with the model group,after administration,the levels of the above-mentioned serum and liver indexes decreased,except that of testosterone.The CD4^(+)/CD8^(+)ratio also decreased.Compared with the RPC group,the levels of T3,IFN-g,FAS,FasL,and TSHR in the SPC group decreased whereas that of testosterone increased.Additionally,immune function and intestinal flora diversity improved in the SPC group.SPC proved to be more effective in improving liver energy meta-bolism in KYDP rats than RPC.Conclusion:SPC had a better therapeutic effect on KYDP than RPC.The underlying mechanism of action may be related to improvements in liver energy metabolism,immune function,and intestinal flora diversity.

Network pharmacology-based exploration of molecular mechanisms underlying therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure with spleen Qi deficiency syndrome

BACKGROUND Chronic heart failure is a complex clinical syndrome.The Chinese herbal compound preparation Jianpi Huatan Quyu recipe has been used to treat chronic heart failure;however,the underlying molecular mechanism is still not clear.AIM To identify the effective active ingredients of Jianpi Huatan Quyu recipe and explore its molecular mechanism in the treatment of chronic heart failure.METHODS The effective active ingredients of eight herbs composing Jianpi Huatan Quyu recipe were identified using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform.The target genes of chronic heart failure were searched in the Genecards database.The target proteins of active ingredients were mapped to chronic heart failure target genes to obtain the common drugdisease targets,which were then used to construct a key chemical componenttarget network using Cytoscape 3.7.2 software.The protein-protein interaction network was constructed using the String database.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed through the Metascape database.Finally,our previously published relevant articles were searched to verify the results obtained via network pharmacology.RESULTS A total of 227 effective active ingredients for Jianpi Huatan Quyu recipe were identified,of which quercetin,kaempferol,7-methoxy-2-methyl isoflavone,formononetin,and isorhamnetin may be key active ingredients and involved in the therapeutic effects of TCM by acting on STAT3,MAPK3,AKT1,JUN,MAPK1,TP53,TNF,HSP90AA1,p65,MAPK8,MAPK14,IL6,EGFR,EDN1,FOS,and other proteins.The pathways identified by KEGG enrichment analysis include pathways in cancer,IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,calcium signaling pathway,cAMP signaling pathway,NF-kappaB signaling pathway,AMPK signaling pathway,etc.Previous studies on Jianpi Huatan Quyu recipe suggested that this Chinese compound preparation can regulate the TNF-α,IL-6,MAPK,cAMP,and AMPK pathways to affect the mitochondrial structure of myocardial cells,oxidative stress,and energy metabolism,thus achieving the therapeutic effects on chronic heart failure.CONCLUSION The Chinese medicine compound preparation Jianpi Huatan Quyu recipe exerts therapeutic effects on chronic heart failure possibly by influencing the mitochondrial structure of cardiomyocytes,oxidative stress,energy metabolism,and other processes.Future studies are warranted to investigate the role of the IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,and other pathways in mediating the therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure.

Observation on the Nursing Effect of Ginger Moxibustion on Gastrointestinal Symptoms in Patients with Heart Failure Due to Yang Qi Deficiency

Objective:To evaluate the nursing measures and effects of ginger moxibustion in the treatment of heart failure(yang qi deficiency type)with gastrointestinal symptoms.Methods:86 patients with heart failure(yang qi deficiency type)accompanied by gastrointestinal symptoms who were admitted to the hospital between January 2023 and January 2024 were selected and divided into 43 cases in each group by random number table grouping;Group I implemented integrated care,while Group II adopted conventional care.The indicators of care were compared between the two groups.Results:After the nursing care,the digestive symptom scores of Group I were lower than those of Group I,and the psychological scores were lower than those of Group II(P<0.05).Conclusion:Ginger moxibustion can improve gastrointestinal symptoms and enhance the psychological health of patients with heart failure(yang qi deficiency type)with gastrointestinal symptoms.

Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure

Objective: To investigate the electrophysiological changes of autonomic cells in left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with chronic heart failure.Methods: Guinea pigs model of iron deficiency anemia complicated with chronic heart failure in 10 guinea pigs of the experimental group was made by feeding a low iron diet,pure water and subcutaneous injection of isoproterenol. The control group consisting of 11 guinea pigs was given normal food, normal water and injected with normal saline. The left ventricular outflow tract model specimen was also prepared. The standard microelectrode technique was used to observe electrophysiological changes of autonomic cells in the outflow tract of left ventricular heart failure complicated with iron deficiency anemia in guinea pig model. The indicators of observation were maximal diastolic potential, action potential amplitude, 0 phase maximal depolarization velocity, 4 phase automatic depolarization velocity, repolarization 50% and 90%, and spontaneous discharge frequency.Results: Compared with the control group, 4 phase automatic depolarization velocity,spontaneous discharge frequency and 0 phase maximal depolarization velocity decreased significantly(P < 0.01) and action potential amplitude reduced(P < 0.01) in model group. Moreover, repolarization 50% and 90% increased(P < 0.01).Conclusions: There are electrophysiological abnormalities of the left ventricular outflow tract in guinea pigs with iron deficiency anemia complicated with heart failure.

High Density Lipoprotein Phospholipids as a Marker of Coronary Heart Disease of Shen-Yang Deficiency Syndrome

Objective: To seek a new biochemical index for diagnosis of coronary heart disease (CHD) of shen-Yang deficiency syndrom (CHD-SYD). Methods: Sixty-one patients with CHD were divided into 3 groups according to their TCM Syndrome type, 10 patients in the group without Xin-Qi deficiency (Group A), 25 in the group with Xin-Qi deficiency but without Shen-Yang deficiency (Group B) and 26 in the group both with Xin-Qi deficiency and Shen-Yang deficiency (Group C). Levels of 17-hydroxy-corticoste-roid in urine (urinary 17-OHCS) per 24 hrs, and serum level of high density lipoprotein cholesterol (HDL-C) and high density lipoprotein phospholipid (HDL-PL) in them were determined in synchrostep and compared with those in the control group of 23 healthy aged persons, urinary 17-OHCS per 24 hrs was taken as the diagnostic standard to screen a new index for diagnosis of Shen-Yang deficiency Syndrome, and preliminary appraisal to the index was made. Results: Serum HDL-PL in the CHD-SYD patients( Group C) was 616+157 mg/L, which was obviously lower than that in the patients of Group A and B. With low HDL-PL(<650 mg/L) used as the index to diagnose CHD-SYD, the sensitivity was 73%, the specificity 86% and the accuracy 80%. Conclusion: HDL-PL <650 mg/L could be adopted as an index for CHD-SYD diagnosis, which is simple and practical.

Diabetic Cardiovascular Risk and Carnitine Deficiency <br/>—Carnitine Deficiency in Clinical Diabetes Mellitus

Background: Type 1 diabetes mellitus increases the risk of coronary heart disease. The Pittsburgh IDDM morbidity and mortality study reported greater than 10 fold coronary heart disease mortality compared with US national data?[1]. Adults with diabetes have heart disease death rates 2 to 4 times higher than adults without diabetes [2]. Diabetic cardiomyopathy explains much of this survival difference and carnitine deficiency is a cause of cardiomyopathy. Research Design and Methods: Adult subjects (40) with type 1 diabetes mellitus were seen for a routine annual visit having no clinical complaints. Fasting serum samples were collected for annual chemistries and the measurement of carnitine. Results: The mean total (40.8 ± 8.8) [40 - 80 nmol/ml] and free (32.9 ± 7.9) [30 - 60 nmol/ml] carnitine levels for this group included 43% low total and 28% low free carnitine. The mean esterified/free (E/F) carnitine ratio (0.25 ± 0.09) for this group was elevated indicating carnitine insufficiency. Conclusions: Fatty acids are the primary energy source for diabetic heart muscle, and carnitine is essential for intracellular fatty acid transport and ATP production. Therefore, mild carnitine deficiency can compromise fatty acid energy production in a failing heart. Carnitine deficiency in subjects at high risk for cardiovascular failure is a possible unrecognized reason for the 4 fold increased death rate in patients with type 1 diabetes. Supplementation with oral carnitine could reduce that increased risk of heart failure, in patients with type 1 diabetes. Intravenous carnitine may be life saving when managing acute cardiac failure in patients with diabetes mellitus. Normal carnitine levels in patients with type 1 diabetes may provide a biochemical environment that prevents the long recognized idiopathic heart failure that occurs in insulin requiring diabetics as first reported in the 1974 Framingham Study.

Physical Performance of Migrant Schoolchildren with Marginal and Severe Iron Deficiency in the Suburbs of Beijing

Objectives To investigate relationship between iron deficiency of different degrees and physical performance and habitual activity of migrant schoolchildren at the age of 11-14 years. Methods Ninety one randomly selected schoolchildren were divided into three groups according to their iron status. Iron status including hemoglobin （Hb）, serum ferritin （SF）, serum iron （SI） and sTfR was determined. Physical performance tests included maximum oxygen consumption （VO2max） and maximum work time. Energy expenditure （EE） and daily physical activity were estimated by recording 24-h heart rate （HR）. Dietary intake was assessed with frequency questionnaires, and physical activity level was estimated with frequency and physical activity questionnaires. Results Severe iron deficiency （IDA） impaired the aerobic capacity and habitual physical activity. When fat-free mass （FFM） was considered, VO2max （VO2max/FFM） was significantly lower in the iron-marginal group than in the iron-adequate groups among girls （P=0.02）, but such a deference was not found among boys （P=0.28）. Aerobic activity and EE at leisure were significantly lower in the severe iron deficient group than in the marginal iron deficient and iron adequate groups. Net HR at leisure time was correlated with lib, log SF, body weight, and FFM （P〈0.05）. Conclusion The functional effect of iron deficiency on physical performance and habitual physical activity rely on the degree of current iron deficiency. Severe iron deficiency significantly impairs both aerobic capacity and habitual physical activity. Iron-marginal deficiency impairs VO2max/FFM in girls, rather than in boys.

Prevalence of iron deficiency in patients aged 75 years or older with heart failure

Background The latest studies presented at the American Heart Association (AHA) meeting on heart failure and the update of the European Cardiology Society’s (ECS) recommendations on heart failure in 2016 recommend intravenous iron supplementation in patients with heart failure, reduced ejection fraction and iron deficiency for improves walking performance and quality of life, and reduces morbidity. In the present study, we investigated the prevalence of iron deficiency in heart failure patients aged 75 years or older, as there is currently no data on these patients. Methods We performed an observational study on hospitalized patients in Geriatric Cardiology Department. Among the 462 patients hospitalized during eight months, 176 were eligible for inclusion;22 patients was significant interference with an inflammatory syndrome (high ferritin with high C-reactive protein), and for 13 patients iron-related data were not available. For each patient included, a complete iron assessment and type of heart failure was available. Results A total of 141 patients were included, the mean age was 88 years (range: 75–101), and there were 52 (36.9%) of patients with reduced ejection fraction (EF), 37 (26.2%) with mid-range EF, and 52 (36.9%) with preserved EF. Irrespective of heart failure type, 73.8% had iron deficiency (95% CI: 65.7%–80.8%);this was found in 57.7%(95% CI: 43.2%–71.3%) of those with reduced EF, 78.4%(95% CI: 61.8%–90.2%) of those with mid-range EF, and 86.5%(95% CI: 74.2%–94.4%) of those with preserved EF (P = 0.003). Conclusion The prevalence of iron deficiency was very high in very elderly patients with heart failure, especially those with HF with mid-range EF or HF with preserved EF.

DIETARY MAGNESIUM DEFICIENCY INCREASES LEVELS AND FUNCTION OF Giα IN THE RAT HEART AFTER MYOCARDIAL INFARCTION

Magnesium(Mg) is crucial for the function of G proteins which play important roles in mediating the inotropic effects of β adrenergic agonists in the heart and are alteredin heart failure.This study was performed to determine whether or not dietary Mg deficiency alters functional activity and levels of the two major ventricular G proteins, Gia and Gsa in the heart after myocardial infarction(MI).Six week old rats were fed a Mg adequate or deficient diet for 6 weeks.At the end of week 3,MI was induced by coronary artery ligation.A sham operation was performed as control.After surgery,surviving animals were maintained on their assigned diets for another 3 weeks.Then,cardiac function was measured.Severe hypomagnesemia and increased plasma catecholamine level were observed in all animals fed the Mg deficient diet.A significant reduction of ruyocardial Mg concentration accompanied by elevated plasma and myocardial calcium concentrations was observed in MI animals with existing Mg deficiency vs.animals fed the Mg adequate diet.Cardiac function was impaired in MI rats and further reduced in MI rats with existing Mg deficiency. Gia level was not altered by either Mg deficiency or MI alone,but was dramatically elevated in animals with combined Mg deficiency and MI (9. 9±0.7 arbitrary unit.mg-1 protein) as compared to MI alone (5.8±0. 6,P<0.05 )and Mg deficiency alone(6.1± 0.8,P<0.05 ). Gsa level did not differ between groups.Bacal,GppNHp-and forskolin-but not fluoride-, stimulated adenylyl cyclase activity was signifcantly reduced in MI animals with existing Mg deficiency indicating increased functional activity of Gia.The findings suggest that dietary Mg deficiency increases the expression and functional ac tivity of Gia in the heart after MI, while levels and function of Gsa are not compromised during dietary Mg deficiency either with or without MI.

Efficacy and safety of Guipi Decoction combined with conventional Western medicine in the treatment of insomnia with deficiency of heart and spleen:a meta-analysis

Objective:To systematically evaluate the efficacy and safety of Guipi Decoction combined with Western medicine in the treatment of insomnia with deficiency of heart and spleen.Methods:English databases(PubMed,Web of Science,The Cochrane Library,EMBASE)and Chinese databases(CNKI,Wanfang database,China Biomedical Literature Service System,VIP database)were searched by computer.Randomized controlled trials of Guipi Decoction on insomnia with deficiency of heart and spleen were searched from the database construction to November 2021.After the first and second authors independently screened the literature,extracted the data and evaluated the risk of bias in the included studies,meta-analysis was performed using RevMan5.3 software.Results:A total of 9 RCTS were included after screening,including 914 patients.Meta-analysis results showed that:Total effective rate[RR=1.22,95%CI(1.16,1.30),P<0.00001],total PSQI score[MD=-3.05,95%CI(-3.96,-2.14),P=0.008],number of night awakening times[[MD=-1.18,95%CI(-1.42,-0.94),P<0.00001],adverse reaction rate[RR=0.32,95%CI(0.21,0.51),P<0.00001]were better than the control group,and the differences were statistically significant.Conclusion:The current evidence shows that,compared with pure using conventional western medicine,belongs to the spleen decoction combined western medicine therapy,cases both deficiency type of insomnia in the total effective rate,reducing the total PSQI score(improve sleep quality,sleep efficiency,sleep disorder,daytime function,etc.),reducing frequency of nighttime awakening,security,have more advantages.However,due to the limitation of the quality and quantity of articles included in the study,more randomized,double-blind,large-sample clinical studies are needed to confirm the above conclusions.

Iron Succinate Increased Ferritin and Transferrin Saturation in Non-Anaemic Patients with Heart Failure and Iron Deficiency—A Pilot Study

Introduction: Iron deficiency (ID) is often present (32% - 65%) in patients with heart failure (HF). Oral iron absorption in patients with HF is generally poor. This is the reason why oral treatment is not recommended. Aim: To test whether oral iron succinate significantly increases iron deposits in non-anaaemic patients with HF. Methods: ID was defined as ferritin < 100 μg/L or 100 - 299 μg/L with transferrin saturation (TSAT) < 20%. Forty-two patients were screened. Ferrous succinate was administered as one tablet (100 mg, including 32.48 mg Fe2+ plus 100 mg succinate) in the morning and one tablet at bedtime for at least 3 months. Hemoglobin, CRP, ferritin, iron, TSAT, and hepcidin were analyzed before starting treatment, at 6 weeks, and at 3 months end of study (EOS). Results: Five women and 15 men were included in the study. The level of ferritin increased significantly from baseline to 6 weeks (47 to 78 μg/L, p = 0.009) and baseline to EOS (47 to 85 μg/L, p = 0.001). TSAT increased significantly from baseline to 6 weeks (20% to 27%, p = 0.046) and baseline to EOS (20% to 25%, p = 0.043). Hepcidin increased significantly from baseline to 6 weeks (2.5 nmol/L to 4.8 nmol/L, p = 0.006) and baseline to EOS (2.5 to 4.2 nmol/L, p = 0.02). Conclusion: Oral iron succinate significantly increased iron uptake, almost doubling the ferritin levels and increasing the TSAT, in patients with HF. Our findings challenge the opinion that oral iron treatment cannot significantly increase iron deposits in non-anemic patients with ID and HF.

Serum proteomic approach in patients with Qi deficiency and blood stasis syndrome in coronary heart disease:to explore therapeutic mechanism of Yiqi Huoxue decoction

OBJECTIVE To explore the curative effect and mechanism of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome.METHODS The patients with coronary heart disease of Qi deficiency and blood stasis syndrome were treated with Yiqi Huoxue decoction for 3 months,and the changes of cardiac function were observed.61 serum samples(including 29 cases of disease group and 32 cases of Yiqi Huoxue expression group)were analyzed by non labeled proteomics.The disease group was used as the control group,and the protein with expression level difference of more than 1.2 folds(P<0.05)was screened.The molecular function,biological pathway and protein interaction of the different proteins were analyzed by bioinformatics,so as to identify the molecular and biological pathway of Yiqi Huoxue decoction in the treatment of coronary heart disease with Qi deficiency and blood stasis syndrome.RESULTS Clinical treatment found that Yiqi Huoxue decoction can improve TCM syndrome score and left ventricular ejection fraction,regulate blood glucose and blood lipid levels,prolong thrombin time,and improve heart function.The results of proteomic quantitative analysis showed that there were 69 proteins with different expression levels in the disease group.Bioinformatics analysis results showed that Yiqi Huoxue decoction may regulate ApoA1,alpha-2 and other proteins to act on HDL assembly,platelet degradation,PI3K Akt signaling pathway,and then play a therapeutic role in coronary heart disease with Qi deficiency and blood stasis syndrome.CONCLUSION Yiqi Huoxue decoction can effectively improved the heart function decline caused by Qi deficiency and blood stasis syndrome of coronary heart disease.It mainly act on energy metabolism and platelet activation pathway by activating HDL assembly and platelet degradation signal pathway proteins.This study can provide reference for the follow-up treatment mechanism of Qi deficiency and blood stasis syndrome of coronary heart disease.

Clinical Observation on the Treatment of Insomnia in Germany with Deficiency of Heart and Spleen by the Ear Bean Therapy

Objective: To observe the effect of insomnia patients with deficiency of heart and spleen in Germany by the therapy of ear points pressing with bean. Methods: A total of 80 cases of insomnia with deficiency of heart and spleen in Germany were divided into the observation group and the control group, with 40 cases in each group. The patients in the control group were treated with oral modified Guipi Decoction(归脾汤), while the patients in the observation group were treated with oral traditional Chinese medicine(TCM) and the therapy of ear points pressing with bean. The efficacy, sleep quality, the TCM syndromes score and the incidence of adverse reactions were compared between the two groups. Results: The effective rate in the observation group was higher than that in the control group, and there was statistical difference between the two group(P<0.05). After treatment, the Pittsburgh sleep quality index scale(PSQI) score, insomnia severity index(ISI) score and the TCM syndromes score in the two groups were decreased sharply(P<0.01), and those scores in the observation group were lower than that in the control group(P<0.05). There was no adverse reaction between the two groups. Conclusion: The therapy of ear points pressing with bean is effective on insomnia in Germany, which is worth further study and promotion.

基于“动则生阳”理论探讨鸢尾素与慢性心力衰竭心阳虚证本质的联系

慢性心力衰竭(chronic heart failure, CHF)是各种原因导致的心脏疾病终末阶段,心阳不足是导致CHF恶化的关键病因。鸢尾素是一种肌动蛋白糖基化蛋白激素,是纤维连接蛋白Ⅲ型结构域5(fibronectin typeⅢdomain containing 5, FNDC5)的多肽切割产物,同时也是一种依赖于过氧化物酶体增殖物激活受体γ共激活物-1α(peroxisome proliferator-activated receptor γ coactivator-1α, PGC-1α)的肌细胞因子。在肌肉运动时,PGC-1α通过刺激FNDC5表达,增加鸢尾素释放并介导运动相关的效应。在这一过程中产生的鸢尾素可以增加线粒体产能和脂肪褐变产热,促进葡萄糖代谢和脂肪酸氧化。“动则生阳”理论源于《易经》,其指出“动”是化生阴阳万物的起源。对于CHF心阳虚证患者,运动可振奋其心阳,促进人体气血通畅,改善CHF症状,促进疾病向愈。“动则生阳”的本质可能是运动改善了CHF心阳虚证患者的“气虚”和“寒象”状态,可能与机体运动时产生的鸢尾素调控了能量代谢及线粒体产能有关。因此,推测缺乏鸢尾素可能是CHF心阳虚证的生物学内涵。

Clinical Research of Zhenwu Decoction Combined with Tingli Dazao Xiefei Decoction in the Treatment of Chronic Heart Failure with Edema Syndrome due to Yang Deficiency

[Objectives]The paper was to investigate the clinical effects of Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction in the treatment of chronic heart failure with edema syndrome due to yang deficiency.[Methods]Eighty patients with chronic heart failure were randomly divided into 2 groups(control group and treatment group),with 40 cases in each group.The patients in the control group were treated with conventional western medicine for 14 d,and the patients in the treatment group were treated with Zhenwu Decoction and Tingli Dazhao Xiefeng Decoction on the basis of the control group for 14 d.The curative effect of traditional Chinese medicine(TCM)syndrome score,left ventricular ejection fraction(LVEF),plasma N-terminal brain natruretic peptide precursor(NT-proBNP)and New York Heart Association(NYHA)functional class were compared between the two groups before and after treatment.Minnesota living with heart failure questionnaire in the principle of Chinese civilization and traditional medicine characteristics(C-MLHF)at admission and 1 month after discharge were compared between the two groups.[Results]After treatment,the total effective rate of TCM syndrome score in the treatment group was 82.50%,and that in the control group was 67.50%.The curative effect of TCM syndrome score in the treatment group was better than that in the control group(P<0.05).After treatment the LVEF in both groups was increased compared with that before treatment,and the NT-proBNP level was decreased compared with that before treatment(P<0.05),and those in the treatment group were better than those in the control group.The total effective rate of cardiac function in the treatment group was 87.50%,and that in the control group was 65.00%.The improvement of cardiac function in the treatment group was better than that in the control group(P<0.05).One month after discharge,C-MLHF scores in both groups were decreased compared with those before treatment,and that in the treatment group was lower than in the control group(P<0.05).[Conclusions]Zhenwu Decoction combined with Tingli Dazao Xiefei Decoction based on traditional western medicine treatment could improve the clinical efficacy,symptoms and quality of life of patients in the treatment of chronic heart failure with edema syndrome due to yang deficiency.

益心泰颗粒对慢性心衰(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α的影响

目的观察益心泰颗粒对慢性心力衰竭(CHF)(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α的影响。方法采用丙硫氧嘧啶灌胃及阿霉素腹腔注射复制CHF(心气虚兼血瘀水停证)模型大鼠,将造模成功大鼠分为模型组与益心泰低、中、高剂量组和曲美他嗪组;另设正常对照组。灌胃4周后观察心肌组织病理结构,检测LVEF、血清NT-proBNP及心肌组织FFA、ATP/AMP、LAC、pAMPK、AMPK、PGC-1α水平。结果与模型组比较,益心泰颗粒低、中、高剂量组及曲美他嗪组LVEF、心肌组织ATP/AMP值、心肌组织p-AMPK、AMPK、PGC-1α相对灰度值均明显升高(P<0.05或P<0.01),血清NT-proBNP及心肌组织FFA、LAC明显降低(P<0.05或P<0.01)。结论益心泰颗粒能促进慢性心力衰竭(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α表达,改善心肌能量代谢。

Electrophysiological changes of Papillary Muscles in Guinea Pigs with iron deficiency anemia and heart failure

Objective:To investigate the changes of left ventricular papillary muscle action potentials in guinea pigs with iron deficiency anemia and heart failure.Methods:A total of 20 cases of iron deficiency anemia with heart failure were treated with experimental group and 10 normal guinea pigs as control group. Blood samples were collected to determine hemoglobin content, red blood cell number and whole blood iron index, and the changes of cardiac function and hemodynamics were detected by 6240 biological signal collection system to determine whether the model was successful or not, Intracellular microelectrode technique was used to determine the action potentials of the papillary muscles in the model group and the control group. the potential amplitudes (APA), overshoot values (APA), maximum depolarization rate (Vmax), 20 % of repolarization, 50 % and 90 % of repolarization (APD20, APD50 and APD90 ) and the average velocity of repolarization were measured. Compare statistical difference between the model group and the control group.Results: 14 cases of model group survived completely, compared with control group, APD50 and APD90 prolonged, and the average velocity decreased.Conclusions: the action potential repolarization duration in the guinea pig papillary muscle of iron deficiency anemia with heart failure is prolonged, and the average repolarization velocity is slow.

针刺联合安神定志汤加减治疗失眠心胆气虚证临床研究

目的:观察针刺联合安神定志汤加减治疗失眠心胆气虚证的临床疗效。方法:采用随机数字表法将94例失眠心胆气虚证患者分为观察组、对照组各47例。对照组给予安神定志汤加减治疗,观察组在对照组基础上配合针刺治疗,2组连续治疗4周。比较2组治疗前后中医证候积分、睡眠质量;比较2组治疗前后焦虑、抑郁评分及神经递质水平,并评估2组临床疗效及治疗安全性。结果:观察组总有效率91.49%,高于对照组76.60%(P<0.05)。治疗后,2组匹兹堡睡眠质量指数(PSQI)评分、睡眠状况自评量表(SRSS)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、中医证候积分及多巴胺(DA)水平均较治疗前降低(P<0.05),5-羟色胺(5-HT)水平升高(P<0.05);观察组治疗后PSQI评分、SRSS评分、SAS评分、SDS评分、中医证候积分及DA水平低于对照组(P<0.05),5-HT水平高于对照组(P<0.05)。2组均未发生严重不良反应。结论:针刺联合安神定志汤加减治疗失眠心胆气虚证效果显著,能改善患者睡眠质量,缓解焦虑、抑郁等负面情绪,平衡神经递质水平,安全性较高。