Investigation on the mechanism of Qiangxinhuoli prescription in the treatment of chronic heart failure based on p38-MAPK signaling pathway

Background:The aim of this study is to investigate the mechanism of action underlying the therapeutic effects of the national patent Chinese medicine compound“Qiangxinhuoli prescription(QXHLF)”on chronic heart failure(CHF).Methods:In vitro,the H_(9)C_(2) cell model was induced by ANGII,and cell proliferation and related protein expression were detected by Cell Counting Kit-8 and Western blot.In vivo,A rat model of CHF was prepared by ligation of the left anterior descending coronary artery.The effects of QXHLF on cardiac function in CHF rats were evaluated by cardiac index,hemodynamic changes,enzyme-linked immunosorbent assay,hematoxylin-eosin staining,immunohistochemistry,Western blot and RT-PCR.The expression of pro-apoptotic factors and anti-apoptotic factors,as well as TGFβ1,p-p38,TAK 1 mRNA,and protein,were detected.Results:In vitro,QXHLF has a significant inhibitory effect on the proliferation of H_(9)C_(2) cells.QXHLF can reduce the expression levels of TAK 1,TGFβ1,p-p38,Caspase3 and BAX proteins in H_(9)C_(2) cells,and increase the expression level of BCL_(2) protein.In vivo,QXHLF has the potential to increase left ventricular systolic pressure,m aximum rate of change in left ventricular pressure while decreasing left ventricular end diastolic pressure,and inhibiting the serum levels of brain natriuretic peptide.Moreover,QXHLF exhibits significant improvements in the pathological alterations of myocardial cells and fibers in CHF rats,leading to enhanced myocardial tissue morphology and notable advantages in combating myocardial fibrosis.QXHLF can reduce the levels of BAX and Caspase3 and up-regulate the expression of BCL_(2),thereby inhibiting cardiomyocyte apoptosis.Furthermore,QXHLF demonstrates inhibitory effects on the mRNA and protein expression levels of TGFβ_(1),TAK_(1),and p-p38 in the heart tissue of the CHF rat model.Conclusion:These findings indicate that QXHLF has a therapeutic effect on CHF by inhibiting the p38-MAPK signaling pathway,reducing myocardial fibrosis,preventing apoptosis,inhibiting cell proliferation,and restoring myocardial injury.

Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure

BACKGROUND Patients with chronic heart failure(CHF)have a progressive disease that is associated with poor quality of life and high mortality.Many patients experience anxiety and depression(A&D)symptoms,which can further accelerate disease progression.We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF.Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.AIM To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.METHODS We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital,Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores.We compared clinical data in the no-A&D,mild-A&D,moderate-A&D,and severe-A&D groups,the SAS and SDS scores with the New York Heart Association(NYHA)functional classification,and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups.Regression analysis was performed on the markers with P<0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve(AUROC)was used to evaluate their accuracy.RESULTS In the inter-group comparison,the following variables had an effect on A&D severity in patients with CHF:NYHA class,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,N-terminal pro-brain natriuretic peptide(NT-proBNP),interleukin-6(IL-6),and tumor necrosis factor-alpha(P<0.05).Other variables did not differ significantly between the A&D groups(P>0.05).In addition,we found that higher NYHA classes were associated with higher the SAS and SDS scores(P<0.05).Regression analysis showed that LVEF,NTproBNP,and IL-6 were independent risk factors for A&D severity(P<0.05).Among them,NT-proBNP had the best predictive ability as a single indicator(AUROC=0.781).Furthermore,the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients(AUROC=0.875).CONCLUSION Cardiac and inflammatory biomarkers,such as LVEF,NT-proBNP,and IL-6,are correlated with A&D severity in patients with CHF and have predictive value.

Clinical intervention effect of Xuefu Zhuyu decoction on chronic heart failure complicated with depression

BACKGROUND The diagnosis and treatment of depression in patients with chronic heart failure(CHF)is challenging,with no ideal treatment at present.AIM To analyze the clinical intervention effect of Xuefu Zhuyu decoction(XFZYD)on CHF complicated with depression.METHODS The study cohort comprised 116 patients with CHF complicated with depression who received treatment from July 2020 to July 2023,of which 55 received Western medicine(control group)and 61 received XFZYD(research group).Data on clinical effectiveness,traditional Chinese medicine(TCM)syndrome score,cardiac function,negative emotions,and serum inflammatory factors,were collected for comparative analyses.RESULTS Compared with the control group,the research group had an evidently higher total effective rate.Furthermore,there were marked reductions in TCM symptom score,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,Self-Rating Depression Scale,Hamilton Depression Scale,high-sensitivity C-reactive protein,monocyte chemoattractant protein-1,and matrix metalloproteinase-9 in the research group after treatment,and these were lower than the corresponding values in the control group.Left ventricular ejection fraction was increased and higher in the research group compared with the control group after treatment.CONCLUSION Our findings conclusively proved that XFZYD was considerably superior to Western medicine for treating CHF complicated with depression because it significantly alleviated patients’symptoms,improved cardiac function,relieved negative emotions,and reduced the levels of serum inflammatory factors.

Analysis of the mechanism of Radix Astragali-Radix Pseudostellariae in the treatment of chronic heart failure based on network pharmacology

Objective:To explore and analyze the effective component,target and mechanism of action of Radix Astragali-Radix Pseudostellariae in the treatment of chronic heart failure(CHF)by network pharmacological research methods.Methods:With the help of TCMSP database,the effective chemical constituents and targets of Radix Astragali-Radix Pseudostellariae were screened out,and CHF-related proteins were obtained by Gene Cards and OMIM database.The target protein interaction network(PPI)was constructed on the String database platform,and using DAVID database to conduct the GO function and KEGG pathway enrichment analysis on the target of the obtained astragalus-pseudostellariae for the treatment of CHF.Results:Radix Astragali-Radix Pseudostellariae were selected as 28 effective chemical components and 104 therapeutic targets for CHF.There were obtained 49 GO functional annotations and 86 KEGG signaling pathways.Conclusion:Radix Astragali-Radix Pseudostellariae can treat CHF through multi-target and multi-pathway.

Analysis of the Status and Factors Influencing Anxiety and Depression in Patients with Chronic Heart Failure and Their Primary Caregivers: Empirical Quantitative Research

Objective: This study examined the associations between anxiety, depression, and quality of life among hospitalized patients with chronic heart failure and their primary caregivers. Patients and Methods: Between May and September 2018, the data were collected from 61 patients and their caregivers. Demographic information of CHF patients was collected by questionnaires; the Hospital Anxiety and Depression Scale (HADS) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were used to assess CHF patient’s anxiety, depression and quality of life (QOL); the HADS, the Family Caregiver Quality of Life (FAMQOL) were used to assess primary caregivers’ anxiety, depression and QOL. Descriptive statistics, correlation analysis, independent-sample t-test, one-way analysis of variance and multiple stepwise regression were used in the statistical analysis. SPSS 17.0 was used to manage and perform statistical analyses. Results: Quality of life, anxiety, and depression of the patients and caregivers had significant positive correlations. Gender, quality of life, number of hospitalizations, duration of patients’ heart failure, and the quality of life of caregivers influenced patients’ anxiety. Gender, quality of life, relationship with the patient, and depression of caregivers influenced their anxiety. The quality of life and anxiety of patients influenced their depression. Daily caregiving time, anxiety, relationship with patients, and the patients’ heart function influenced caregivers’ depression. Conclusion: The patients and caregivers experienced anxiety and depression, which interacts and decreases their quality of life. It is important to regularly assess anxiety, depression, and quality of life in patients with chronic heart failure and their primary caregivers.

Network pharmacology study on mechanism of Zhen-Wu decoctionfor chronic heart failure treatment

Background:To explore and predict the mechanism of classic ancient prescription of Chinese medicine Zhen-Wu decoction for chronic heart failure treatment based on network pharmacology.Methods:Traditional Chinese medicine systems pharmacology database was used to search the effective components and targets of herbs in classic ancient prescription of Chinese medicine Zhen-Wu decoction.Relevant target genes of chronic heart failure were obtained from GeneCards and Online Mendelian Inheritance in Man databases.Then we obtained the intersection target genes of classic ancient prescription of Chinese medicine Zhen-Wu decoction in treating chronic heart failure,constructing the classic ancient prescription of Chinese medicine Zhen-Wu decoction-active ingredient-chronic heart failure-targets network using Cytoscape,and performing network analysis using a network ananlyzer plug-in to acquire hub compounds and key targets.Proton pump inhibitor network was constructed through STRING database.Gene ontology function and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis were carried out in Database for Annotation,Visualization and Integrated Discovery.Results:There are 61 active ingredients and 134 action targets in classic ancient prescription of Chinese medicine Zhen-Wu decoction,among which 49 target genes and 11 important compounds related to the chronic heart failure treatment.After network analysis,we obtained 12 key targets,77 gene ontology entries and 22 signal pathways,including tumor necrosis factor signaling pathway,NF-kappaB signal pathway,PI3K-Akt signal pathway,et al.Concludion:classic ancient prescription of Chinese medicine Zhen-Wu decoction was used for chronic heart failure treatment for the multi-component,multi-target and multi-channel interaction.The components such as kaempferol andβ-sitosterol were combined with target proteins such as CHRM1 and AChE,involving biological processes such as DNA transcription regulation,cholinergic synaptic transmission and apoptosis regulation,as well as signal pathways such as tumor necrosis factor signaling pathway,NF-kappaB signal pathway,PI3K-Akt signal pathway,et al.

Treatment of Chronic Heart Failure Complicated with Anxiety and Depression Using Traditional Chinese and Western Medicine

Chronic heart failure(CHF)is the terminal stage of various heart diseases,and is the main cause of death from cardiovascular disease.In recent years,the prevalence of CHF combined with anxiety and depressive state has shown an upward trend,and this paper was aimed to provide a reference for the diagnosis and treatment of CHF combined with anxiety and depression using Traditional Chinese medicine(TCM)and Western medicine.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

心理干预联合人文关怀对慢性心力衰竭患者心理状态、治疗依从性及睡眠质量的影响

目的:分析心理干预与人文关怀在慢性心力衰竭(CHF)患者中的应用效果。方法:选取2023年3月至2024年2月泉州市第一医院收治的CHF患者150例作为研究对象,按照随机数字表法分为观察组和对照组,每组75例。2组均接受常规治疗与护理,观察组在常规治疗、护理基础上接受心理干预与人文关怀。比较2组干预后焦虑与抑郁情绪、服药依从性、睡眠质量与生命质量。焦虑采用焦虑自评量表(SAS)评价,抑郁采用抑郁自评量表(SDS)评价,睡眠质量采用匹兹堡睡眠质量指数(PSQI)评价,生命质量采用明尼苏达心力衰竭生命质量量表(MLHFQ)评价。结果:观察组在干预后SAS、SDS评分低于对照组,服药依从率高,PSQI评分与睡眠障碍发生率较低,差异有统计学意义(P<0.05)。观察组在干预后MLHFQ评分显著低于对照组,差异有统计学意义(P<0.05)。结论:心理干预与人文关怀可改善CHF患者心理障碍与睡眠障碍,提升治疗依从性,改善生命质量。

基于网络药理学探讨益气复脉注射液治疗慢性心力衰竭的作用机制

目的:应用网络药理学探讨益气复脉注射液治疗慢性心力衰竭(CHF)的作用机制。方法:应用TCMSP、PubChem、BATMAN-TCM数据库获取药物的活性成分及靶点,运用GeneCards和OMIM数据库筛选CHF的靶点;Ven2.1.0软件筛选益气复脉注射液与CHF的交集靶点,构建药物-有效成分-关键靶点网络,使用STRING数据库构建蛋白-蛋白互作网络;通过Metascape数据库对交集靶点进行富集分析。结果:共筛选出益气复脉注射液的活性成分有人参皂苷Rh2、五味子乙素、五味子内酯E等;关键靶点包括丝裂原活化蛋白激酶3、基质金属蛋白酶9、胱天蛋白酶3等;主要包括肿瘤相关、缺氧诱导因子-1信号通路、糖尿病并发症中的AGE-RAGE信号通路等。结论:益气复脉注射液通过多成分-多靶点-多通路治疗CHF,为更加深入研究益气复脉注射液的药效物质奠定基础。

慢性心力衰竭患者衰弱变化轨迹及其影响因素

目的探索慢性心力衰竭患者衰弱变化轨迹及其影响因素,为针对性干预提供参考。方法采用方便抽样法选取住院治疗的105例慢性心力衰竭患者,对其入院至出院后6个月期间分为4个时间点进行衰弱评估,了解衰弱变化轨迹,分析影响因素。结果4个时间点患者衰弱评分分别为2(1,3)分、2(0.3)分、1(0,3)分、1(0,3)分;衰弱轨迹分为低水平缓降组(47.6%)、中水平下降组(18.1%)、中水平上升组(34.3%)3个潜类别;多分类logistic回归分析结果显示,年龄、身体质量指数、共病种数、血红蛋白、心功能分级、抑郁和体力活动是患者衰弱轨迹的影响因素(均P<0.05)。结论慢性心力衰竭患者经住院治疗护理,衰弱水平总体呈好转趋势,衰弱轨迹分为3个潜类别,轨迹具有异质性;护理人员可针对不同类别、不同阶段及影响因素制定干预计划,实现精准护理。

陈晓虎从“气、郁、瘀”论治慢性心力衰竭伴焦虑抑郁经验

本文介绍陈晓虎教授从“气、郁、瘀”论治慢性心力衰竭(慢性心衰)伴焦虑抑郁经验。陈晓虎教授认为,心气不足、肝气郁结、血脉瘀阻为该病核心病机。其主张从益气健脾、疏肝解郁、活血通脉等方面进行辨证论治,并认为其属于“双心疾病”范畴,将安神作为主要治疗大法,形神同治,且不忘心理疏导,动静结合,实现“双心同治”,从而获得更佳的疗效。附验案1则,以资佐证。

基于网络药理学与分子对接探讨温胆汤对心力衰竭合并抑郁共病同治机制

目的基于网络药理学探讨温胆汤对心力衰竭合并抑郁共病同治机制,并通过分子对接初步验证。方法通过TCMSP数据库与文献搜索得到温胆汤有效成分并预测作用靶点;在GeneCards、OMIM、DisGeNET以及TTD数据库搜索心力衰竭、抑郁症相关疾病靶点,与温胆汤作用靶点取交集。通过STRING平台完成交集靶点的蛋白质相互作用网络的构建并预测核心靶点,并对交集靶点进行基因本体注释及京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)通路富集分析,最后利用分子对接验证核心成分及核心靶点的结合能力。结果温胆汤治疗心力衰竭合并抑郁的核心成分为木犀草素、川陈皮素、β-谷甾醇、黄芩苷、豆甾醇等,核心靶点主要包括肿瘤坏死因子、白细胞介素-6、蛋白激酶B1、白细胞介素-1β、肿瘤蛋白p53等,通过KEGG主要富集在晚期糖基化终产物及其受体、磷脂酰肌醇-3激酶/蛋白激酶B、环磷酸腺苷、丝裂原活化蛋白激酶等信号通路。分子对接结果表明,木犀草素等核心成分与肿瘤坏死因子、白细胞介素-6等核心靶点的结合活性较好。结论温胆汤可能通过抑制炎症反应及氧化应激反应、调节神经递质的释放等方面来治疗心力衰竭合并抑郁。

中医药益气温阳、活血利水法治疗慢性心力衰竭作用机制的研究进展

综述中医药益气温阳、活血利水法治疗慢性心力衰竭作用机制的研究进展。慢性心力衰竭可依据阳气虚弱、心血瘀阻、水饮内停的病机,采用中医药益气温阳、活血利水法治疗。研究显示,该法治疗慢性心力衰竭的临床疗效显著,其机制主要与改善心肌纤维化及心室重构、调节氧化应激反应、改善血流动力学障碍与心肌能量代谢、干预相关信号通路、缓解利尿剂抵抗等有关。

基于数据挖掘探析中医药治疗慢性心力衰竭合并抑郁的用药规律

目的:基于数据挖掘探析中医药治疗慢性心力衰竭合并抑郁的用药规律。方法:收集并整理中国知网、维普、万方数据及中国生物医学文献数据库建库至2023年5月发表的关于中医药治疗慢性心力衰竭合并抑郁的文献,将方剂录入Excel表格,然后导入中医传承辅助平台(V2.5)软件,采用基本信息统计、频次分析、关联规则分析、层次聚类等数据挖掘技术,对医案进行分析并探究其用药规律、挖掘新方。结果:共纳入处方42首,涉及单味中药88味。频次分析结果显示,茯苓、白术、柴胡、白芍、炮附子、炙甘草、丹参、人参、黄芪、川芎居于用药频次前10位。药性以温、寒、平为主;药味以甘味为主,苦、辛次之;归经以心、肝、脾经为主。得到50组常用药物组合,31条药物关联规则和5个潜在新方。结论:中医药治疗慢性心力衰竭合并抑郁以益气温阳、疏肝解郁为基本治法,兼以活血化瘀、利水渗湿。

基于网络药理学和分子对接技术探讨芪参桃红颗粒治疗慢性心力衰竭的作用机制

目的:基于网络药理学探讨芪参桃红颗粒治疗慢性心力衰竭的作用机制。方法:运用TCMSP筛选芪参桃红颗粒的活性成分和靶点;运用UniProt获取靶点的标准基因名;运用GeneCards和OMIM获取慢性心力衰竭相关靶点;运用Evenn获取药物与疾病共同靶点;运用STRING绘制蛋白-蛋白互作(PPI)网络图;运用Metascape进行基因本体(GO)、京都基因和基因组百科全书(KEGG)富集分析;运用AutoDock进行分子对接验证。结果:芪参桃红颗粒作用于慢性心力衰竭主要涉及槲皮素、山柰酚等6个关键成分,缺氧诱导因子-1α(HIF1A)、肿瘤坏死因子(TNF)等34个关键靶点,核因子κB(NF-κB)通路、磷脂酰肌醇3-激酶/蛋白激酶B(PI3K/AKT)信号通路等20条关键通路。结论:芪参桃红颗粒主要通过PI3K/AKT通路、血管内皮生长因子(VEGF)通路、NF-κB通路、叉头框蛋白O(FoxO)通路、胰岛素抵抗、脂质和动脉粥样硬化6条通路对慢性心力衰竭发挥调节作用,主要机制包括细胞凋亡、炎症反应、氧化应激、心肌重构、胰岛素抵抗和脂质代谢等。

基于“元气”探讨心力衰竭的神经内分泌机制及治疗

慢性心力衰竭(chronic heart failure,CHF)是各种心血管疾病发展的终末期表现,神经内分泌是此病发生的重要机制之一,通过细致梳理近年来中医学对于CHF神经内分泌机制的研究进展,基于中医“元气”理论,从中、西医两个维度阐述此病的病因病机,探讨从“元气”角度干预其神经内分泌机制及应用中药治疗,丰富了中医学对CHF的认识,以期为临床中西医结合治疗慢性心力衰竭提供新的思路。

乌灵胶囊联合曲美他嗪对慢性心力衰竭合并抑郁患者心功能及心理状况的影响

目的分析乌灵胶囊联合曲美他嗪对慢性心力衰竭合并抑郁患者心功能及心理状况的影响。方法选取2021年1月至12月收治的100例慢性心力衰竭合并抑郁患者作为研究对象,以随机数字表法将其分为常规组和观察组,每组50例。常规组给予曲美他嗪+心理干预,观察组在常规组治疗基础上增加乌灵胶囊。比较两组的治疗效果。结果观察组的治疗总有效率高于常规组(P<0.05)。治疗后,观察组的左室射血分数(LVEF)大于常规组,左心室收缩末期内径(LVESD)、左心室收缩末期容积(LVESV)及左心室舒张末期容积(LVEDV)小于常规组,汉密尔顿抑郁量表(HAMD)评分低于常规组(P<0.05)。治疗后,观察组的B型利钠肽(BNP)、心肌肌钙蛋白T(cTnT)、可溶性ST2蛋白(sST2)水平低于常规组,脑源性神经营养因子(BDNF)、5-羟色胺(5-HT)水平高于常规组(P<0.05)。两组的不良反应总发生率无明显差异(P>0.05)。结论乌灵胶囊联合曲美他嗪治疗慢性心力衰竭合并抑郁患者,能够改善心功能,缓解抑郁情绪,且不会产生严重不良反应。

阿托伐他汀联合美托洛尔治疗CHF的效果及其治疗机制分析

目的 探讨阿托伐他汀联合美托洛尔治疗慢性心力衰竭(CHF)患者的效果及作用机制。方法 80例CHF患者随机分为两组各40例。对照组给予阿托伐他汀钙治疗,观察组在对照组基础上给予琥珀酸美托洛尔治疗。比较两组的治疗效果、血清指标以及不良反应。结果 观察组的总有效率为95.00%,高于对照组的70.00%(P <0.05)。治疗后,观察组的NT-proBNP、 CysC水平均低于对照组(P <0.05)。两组的恶心呕吐、失眠、头晕头痛、腹泻、口干发生率比较,差异均无统计学意义(P>0.05)。结论 阿托伐他汀联合美托洛尔治疗CHF的效果较好,安全性较高,其治疗机制可能与抑制NT-proBNP、 CysC的表达有关。

真武汤在慢性心力衰竭治疗中的应用与机制研究进展

慢性心力衰竭(CHF)作为心血管疾病的严重终末期表现,以其高患病率和病死率成为全球21世纪最关注的心血管疾病之一。近年来,中药真武汤以其温阳利水的独特功效,在临床治疗中显示出显著效果,并逐渐成为多途径、多靶点治疗CHF的研究热点。通过系统回顾已发表的文献,文章发现真武汤在缓解CHF患者临床体征、改善患者心功能、提高生存质量及改善预后等方面表现出色,且具备较高的安全性和较少的不良反应。动物实验进一步揭示了真武汤治疗CHF的作用机制,包括调节交感神经系统、肾素-血管紧张素-醛固酮系统,缓解氧化应激,改善水钠潴留,调节外周血管神经激素水平,纠正心衰细胞电异常,抑制左心室重塑和心肌细胞凋亡,调节心肌细胞自噬,调节心脏固有免疫系统,以及改善心肌细胞能量代谢等。文章旨在对真武汤及其加减方治疗CHF的临床疗效和分子生物学机制进行全面归纳和总结,为后续的深入研究提供参考和借鉴,推动中医药在心血管疾病领域的更广泛应用。