Therapeutic Efficacy of Shexiang Baoxin Pill Combined with Exercise in Patients with Heart Failure with Preserved Ejection Fraction: A Single-Center, Double-Blind, Randomized Controlled Trial

Objective:To evaluate the therapeutic efficacy of Shexiang Baoxin Pill combined with exercise in heart failure patients with preserved ejection fraction(HFpEF).Methods:Sixty patients with HFpEF were randomly divided into group A(n=20),receiving Shexiang Baoxin Pill combined with home-based exercise training based on conventional drugs for 12 weeks;group B(n=20),receiving conventional drugs combined with home-based exercise training for 12 weeks;and group C(n=20),receiving conventional drug treatment only.Peak oxygen uptake(peakVO2),anaerobic threshold(AT),6-min walking test(6MWT),Pittsburgh Sleep Quality Index(PSQI),and SF-36 questionnaire(SF-36)results before and after treatment were compared among groups.Results:After the 12-week intervention,patients in group C showed significant declines in peakVO2,AT,6MWT,PSQI,and SF-36 compared with pre-treatment(P<0.01),while groups A and B both showed significant improvements in peakVO2,AT,6MWT,PSQI,and SF-36 results compared with pre-treatment(P<0.01).Compared with group C,patients in groups A and B showed significant improvements in peakVO2,AT,6MWT,PSQI,and SF-36(P<0.01).In addition,patients in group A showed more significant improvements in physical function,role-physical,vitality,and mental health scores on the SF-36 questionnaire,and PSQI scores than those in group B(P<0.01).Conclusions:Exercise training improved exercise tolerance,sleep quality and quality of life(QoL)in patients with HFpEF.Notably,Shexiang Baoxin Pill played an active role in sleep quality and QoL of patients with HFpEF.

Effectiveness and safety of Shexiang Baoxin Pill(MUSKARDIA)in patients with stable coronary artery disease and concomitant diabetes mellitus:a subgroup analysis of a randomized clinical trial

Background:Preliminary studies have indicated that Shexiang Baoxin Pill(MUSKARDIA)has a coronary artery dilation effect and increases the coronary blood flow,relieving the symptoms of angina.This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease(CAD)and diabetes mellitus(DM).Methods:This was a subgroup analysis of a multicenter,randomized,placebo-controlled phase IV trial.CAD patients with a medical history of DM or baseline fasting blood glucose(FBG)≥7.0 mmol/L were grouped according to the treatment(standard therapy plus MUSKARDIA or placebo).The primary outcome was major adverse cardiovascular events(MACEs),which was the composite outcome of cardiovascular death,non-fatal myocardial infarction,and non-fatal stroke.The secondary outcome was the composite outcome of all-cause death,non-fatal myocardial infarction,non-fatal stroke,hospitalization for unstable angina or heart failure,and coronary angioplasty.Results:MACEs occurred in 2.6%(9/340)and 4.8%(18/376)of patients in the MUSKARDIA and placebo groups,respectively(P=0.192).Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo(15.3%[52/340]vs.22.6%[85/376],P=0.017).Risk of MACEs(hazard ratio[HR]=0.69,95%confidence interval[CI]:0.31-1.57)was comparable between two groups.In patients with uncontrolled DM(≥4 measurements of FBG≥7 mmol/L in five times of follow-up),the risk of secondary outcome was significantly lower with MUSKARDIA(5/83,6.0%)than with placebo(15/91,16.5%)(HR=0.35,95%CI:0.13-0.95).Conclusion:As an add-on to standard therapy,MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM.Furthermore,MUSKARDIA may reduce the frequency of all-cause death,hospitalization,and coronary angioplasty in this population,especially in those with uncontrolled DM.Trial Registration:ChiCTR.org.cn,ChiCTR-TRC-12003513.

Effect of Shexiang Baoxin Pill(麝香保心丸) in Alleviating Early Hypertensive Renal Injury in Rats

Objective:To investigate the effect of Shexiang Baoxin Pill(麝香保心丸,SBP)on early hypertensive renal injury in rats and to explore the possible mechanism.Methods:Twelve-week-old spontaneous hypertensive rats(SHRs)with high-salt diet(dietary containing 8%NaCl)were randomized into the SBP group[40 mg/(kg·d)],losartan potassium group[20 mg/(kg·d)]and saline group by stratified random sampling method,12 in each group.Blood pressure and urea albumin creatinine ratio were measured.After 10 weeks,the expression levels of serum creatinine(Scr),hypersensitive C-reactive protein(hs-CRP),interleukin(IL)-1β,IL-6,tumor necrosis factorα(TNF-α),and transforming growth factorβ(TGF-β)in serum were assessed.Kidney pathology periodate-schiff staining was performed.Semi-quantitative count of macrophage infiltration was determined by immunochemistry of CD68 staining.Real-time quantitative polymerase chain reaction and Western blot were performed to examine the mRNA and protein expressions of Toll-like receptor 4(TLR4),nuclear factorκB(NF-κB),monocyte chemokine peptide(MCP-1),inducible nitric oxide synthase(iNOS),and arginase-1(Arg-1).Results:SBP did not affect the mortality of SHR(P<0.05).SBP significantly reduced the level of elevated blood pressure of SHRs,but the effect was less significantly than that of losartan potassium.SBP decreased urine protein(P<0.01)and the expression levels of IL-1β,IL-6,TNF-α,and TGF-βin serum.The 22-week-old SHRs showed mild proliferation of glomerular endothelial cells,glomerular ischemic lesions,inflammatory cell infiltration in renal tubular interstitium and arteriosclerosis.Both SBP and losartan potassium had alleviated renal pathological change,and significantly reduced the infiltration of macrophage(P<0.05,P<0.01).SBP and losartan potassium decreased the expressions of TLR4,NF-κB,MCP-1,iNOS,and Arg-1.Conclusion:SBP significantly modified the early hypertensive renal injury by reducing inflammation,and the effect was similar to losartan potassium.

Exploring the Pathways and Targets of Shexiang Baoxin Pill for Coronary Heart Disease through a Network Pharmacology Approach

Objective: To investigate the network pharmacology of Shexiang Baoxin pill(SBP) and systematically analyze the mechanisms of SBP.Methods: In this study, we excavated all the targets of 26 constituents of SBP which were identified in rat plasma though literature mining and target calculation(reverse docking and similarity search) and analyzed the multiple pharmacology actions of SBP comprehensively through a network pharmacology approach.Results: In the end, a total of 330 Homo sapiens targets were identified for 26 blood constituents of SBP.Moreover, the pathway enrichment analysis found that these targets mapped into 171 KEGG pathways and 31 of which were more enriched.Among these identified pathways, 3 pathways were selected for analyzing the mechanisms of SBP for treating coronary heart disease.Conclusion: This study systematically illustrated the mechanisms of the SBP by analyzing the corresponding "drug-target-pathway-disease" interaction network.

Shexiang Baoxin Pill Regulates Intimal Hyperplasia,Migration,and Apoptosis after Platelet-Derived Growth Factor-BB-Stimulation of Vascular Smooth Muscle Cells via miR-451

Objective:To investigate the regulatory roles of Shexiang Baoxin Pill(SXBXW)in neointimal formation and vascular smooth muscle cells(VSMCs)invasion and apoptosis as well as the potential molecular mechanisms using cultured VSMCs model of vascular injury(platelet-derived growth factor(PDGF)-BBstimulated)in vitro.Methods:VSMCs were randomly assigned to 5 groups:blank,PDGF-BB(20 ng/mL+0.1%DMSO),SXBXW-L(PDGF-BB 20 ng/mL+SXBXW low dose 0.625 g/L),SXBXW-M(PDGF-BB 20 ng/mL+SXBXW medium dose 1.25 g/L)and SXBXW-H(PDGF-BB 20 ng/mL+SXBXW high dose 2.5 g/L)group.Cell proliferation was assessed using cell counting kit-8(CCK-8)assay and bromodeoxyuridine(BrdU)incorporation assay,the migration effects were detected by Transwell assay,cell apoptosis rate was measured by the Annexin V/propidium iodide(PI)apoptosis kit.The markers of contractile phenotype of VSMCs were detected with immunofluorescent staining.To validate the effects of miR-451 in regulating proliferation,migration and apoptosis treated with SXBXW,miR-451 overexpression experiments were performed,the VSMCs were exposed to PDGF-BB 20 ng/mL+0.1%DMSO and later divided into 4 groups:mimic-NC(multiplicity of infection,MOI=50),SXBXW(1.25 g/L)+mimic-NC,mimic-miR451(MOI=50),and SXBXW(1.25 g/L)+mimic-miR451,and alterations of proteins related to the miR-451 pathway were analyzed using Western blot.Results:PDGF-BB induced VSMCs injury causes acceleration of proliferation and migration.SXBXW inhibited phenotypic switching,proliferation and migration and promoted cell apoptosis in PDGF-BB-induced VSMCs.In addition,miR-451 was shown to be down-regulated in the VSMCs following PDGF-BB stimulation.SXBXW treatment enhanced the expression of miR-451 in PDGF-BB-induced VSMCs(P<0.05).Compared with SXBXW+mimic-NC and mimicmiR451 groups,the expression of tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein zeta(Ywhaz)and p53 was further reduced in SXBXW+mimic-miR451 group,while activating transcription factor 2(ATF2)was increased in VSMCs(P<0.05).Conclusion:SXBXW regulated proliferation,migration and apoptosis via activation of miR-451 through ATF2,p53 and Ywhaz in PDGF-BB-stimulated VSMCs.

Assessment of Effect of Shexiang Baoxin Pill for Labour Angina Pectoris Patients with Computerized Tomography Myocardial Imaging

Objective:To assess the effect of Shexiang Baoxin Pill（SXBXP）for labour angina pectoris.Methods:Effect of 66 patientstreated withconven tional treatment or conventional treatment plus SXBXP were observed and compared with^(99m) TC-MIBI singlepho tonemissi on computerized tomography（SPECT）target cardiograph to estimate is chemia my ocardial area.Results:The total effectiverate was much higher in patients treated with SXBXP than that in patients treated with conventional treatment only（87.8%vs.56%,P＜0.05）.The effective rate on ECG in the two group swas 70.7% and 52%respectively,with out significant statistical difference between them（P＞0.05）.While significant difference was observed in is chemiaarea of my ocardiali mage between the two groups after treatment,18.2±8.2%vs23.8±9.8%,P<0.05.Moreover,there currence of anginapect or is and cardiaceven twerealsolessin the SXBXPgroup.Conclusion:the SXBXP was effective for labourangina pectoris.

麝香保心丸调节PINK1/Parkin信号通路对糖尿病视网膜病变大鼠的影响

[目的]探讨麝香保心丸(SBP)对糖尿病视网膜病变(DR)大鼠线粒体自噬及PTEN诱导激酶蛋白1(PINK1)/细胞质E3-泛素连接酶(Parkin)信号通路的影响。[方法]建立DR大鼠模型,将大鼠随机分为正常组(Control组)、模型组(DR组)、麝香保心丸低剂量组(SBP-L组)、麝香保心丸高剂量组(SBP-H组)、麝香保心丸高剂量+雷帕霉素组(SBP-H+RAP组)。检测各组大鼠空腹血糖(FPG)及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平;苏木精-伊红(HE)染色观察各组大鼠DR情况;酶联免疫吸附实验(ELISA)检测各组大鼠血管内皮生长因子(VEGF)、高迁移率族蛋白1(HMGB1)水平;透射电镜观察各组大鼠细胞线粒体形态;免疫组化检测线粒体自噬相关蛋白选择性自噬接头蛋白sequestosome-1(SQSTM1/P62)、微管相关蛋白轻链3Ⅱ(LC3-Ⅱ)的表达;蛋白免疫印迹法检测各组大鼠PINK1、Parkin蛋白表达。[结果]与Control组比较,DR组视网膜结构破坏严重,细胞排列紊乱,水肿明显,细胞间隙变宽,线粒体损伤、肿胀明显,形态异常,FPG、TC、TG、LDL-C、VEGF、HMGB1、LC3-Ⅱ、PINK1、Parkin表达水平显著升高,SQSTM1/P62表达水平显著降低(P<0.05);与DR组比较,SBP-L组、SBP-H组视网膜细胞结构改善,细胞排列逐渐整齐,细胞水肿减轻,细胞、线粒体形态均趋于正常,线粒体肿胀减轻,FPG、TC、TG、LDL-C、VEGF、HMGB1、LC3-Ⅱ、PINK1、Parkin表达水平显著降低,SQSTM1/P62表达水平显著升高(P<0.05);与SBP-H组相比,SBP-H+RAP组视网膜细胞结构破坏加重,细胞排列紊乱,水肿明显,线粒体肿胀加重,形态异常,FPG、TC、TG、LDL-C、VEGF、HMGB1、LC3-Ⅱ、PINK1、Parkin表达水平显著升高,SQSTM1/P62表达水平显著降低(P<0.05)。[结论]麝香保心丸通过抑制PINK1/Parkin信号通路抑制DR大鼠线粒体自噬。

麝香保心丸联合达格列净对老年射血分数降低性心力衰竭患者心功能及预后的影响

目的:分析麝香保心丸+达格列净治疗老年射血分数降低性心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者的临床价值。方法:选取赣南医学院第一附属医院2022年1月—2023年8月收治的60例老年HFrEF患者为研究对象,以随机数字表法将60例患者划分至观察组、对照组,每组30例。对照组采用达格列净治疗,观察组采用麝香保心丸+达格列净治疗。均治疗2个月。对比两组中医症候积分、不良反应、超声心动图检查结果、心功能及生活质量。结果:治疗后,观察组中医症候积分(身寒肢冷、气短乏力、动则气喘、心悸)均低于对照组,差异均有统计学意义(P<0.05)。两组不良反应比较,差异无统计学意义(P>0.05)。治疗后,观察组超声心动图检查结果[肺动脉搏动指数(pulmonary artery pulsitility index,PAPi)]高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end systolic diameter,LVESD)均低于对照组,左心室射血分数(left ventricular ejection fraction,LVEF)、每搏输出量(stroke volume,SV)均高于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组明尼苏达心力衰竭生活质量调查表(Minnesota living with heart failure questionnaire,MLHFQ)各维度评分均低于对照组,差异均有统计学意义(P<0.05)。结论:予以老年HFrEF患者麝香保心丸+达格列净治疗效果显著,可改善患者临床症状与心功能,提升生活质量,保障用药安全性,促进预后。

麝香保心丸联合普罗布考对老年冠心病合并糖尿病患者血脂代谢及血管内皮功能的影响

目的分析麝香保心丸联合普罗布考对老年冠心病合并糖尿病患者血脂代谢及血管内皮功能的影响。方法前瞻性选取北京市朝阳区双桥医院2021年1月至2022年10月收治的老年冠心病合并糖尿病患者102例,按照随机数字表法分为观察组与对照组,每组各51例,对照组采用常规疗法+普罗布考治疗,观察组在对照组基础上采用麝香保心丸治疗。治疗3个月后,统计分析两组临床疗效、血脂代谢指标[总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(Apo)A1和ApoB]、血管内皮功能指标(内皮素-1、血栓素B2、一氧化氮)、心功能指标[左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)和左室质量指数(LVMI)]、血糖指标[空腹血糖(FBG)、糖化血红蛋白(GHb)及餐后2 h血糖(2 h PBG)]水平。结果观察组临床总有效率为94.12%,高于对照组(78.43%),差异有统计学意义(P<0.05)。治疗3个月后,观察组的总胆固醇、甘油三酯、LDL-C及ApoB水平分别为(5.15±0.88)mmol/L、(1.71±0.23)mmol/L、(3.33±0.71)mmol/L、(0.81±0.17)g/L,均低于对照组[(5.86±0.91)mmol/L、(2.13±0.26)mmol/L、(3.97±0.85)mmol/L、(1.08±0.18)g/L],HDL-C和ApoA1水平分别为(1.18±0.25)mmol/L、(1.44±0.25)g/L,均高于对照组[(0.96±0.22)mmol/L、(1.21±0.22)g/L],差异均有统计学意义(P<0.05)。治疗3个月后,观察组的内皮素-1及血栓素B2水平分别为(58.31±4.13)、(163.11±10.06)ng/L,均低于对照组[(62.11±4.41)、(179.31±11.11)ng/L],一氧化氮水平为(71.22±6.55)μmol/L,高于对照组[(67.58±5.61)μmol/L],差异均有统计学意义(P<0.05)。治疗3个月后,观察组的LVESD及LVMI分别为(35.13±2.23)mm、(109.85±11.29)g/m^(2),均低于对照组[(38.42±2.47)mm、(121.31±12.84)g/m^(2)],LVEDD、LVEF分别为(55.84±4.36)mm、(60.05±6.14)%,均高于对照组[(51.21±4.43)mm、(55.25±5.38)%],差异均有统计学意义(P<0.05)。治疗3个月后,观察组的FBG、GHb及2 h PBG水平分别为(6.41±1.01)mmol/L、(5.37±0.74)%、(8.20±1.34)mmol/L,均低于对照组[(7.31±1.04)mmol/L、(6.12±0.57)%、(9.68±1.22)mmol/L],差异均有统计学意义(P<0.05)。结论麝香保心丸联合普罗布考可有效改善老年冠心病合并糖尿病患者血脂代谢、血管内皮功能、心功能、血糖水平,临床综合疗效显著,值得临床予以推广应用。

麝香保心丸治疗心肌梗死后心力衰竭的临床效果

目的 观察麝香保心丸治疗心肌梗死后心力衰竭的临床效果。方法 选取2020年6月—2023年1月潍坊医学院附属诸城市人民医院收治的心肌梗死后心力衰竭患者80例,采用随机数字表法分为研究组和对照组,每组40例。对照组给予常规药物治疗,研究组在对照组基础上加用麝香保心丸治疗,2组均治疗1个月。比较2组疗效、治疗前后心功能指标[6 min步行距离(6MWD)、左室射血分数(LVEF)、心排出量(CO)、N末端脑钠肽前体(NT-proBNP)]和血管内皮功能指标[一氧化氮(NO)、血管内皮素-1(ET-1)、超敏C反应蛋白(hs-CRP)]变化。结果 研究组总有效率为97.50%,高于对照组的80.00%(χ^(2)=4.507,P=0.034)。治疗1个月后,2组6MWD、LVEF、CO及NO高于治疗前,NT-proBNP、ET-1、hs-CRP水平低于治疗前,且研究组升高/降低幅度大于对照组(P<0.05或P<0.01)。结论 麝香保心丸治疗心肌梗死后心力衰竭疗效显著,能有效改善患者心功能和血管内皮功能。

麝香保心丸介导的内皮功能改变对心梗后心衰患者短期预后影响的临床研究

目的分析麝香保心丸介导的内皮功能改变对心肌梗死(心梗)后心力衰竭(心衰)患者短期预后的影响。方法纳入心梗后心衰患者43例为研究对象,以随机分组方式分为对照组(21例)与观察组(22例)。两组患者均接受常规冠心病及心衰二级预防西药用药,观察组患者在常规西药治疗基础上联合麝香保心丸口服用药治疗。比较两组心功能[心率(HR)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)]、血常规指标[凝血酶原时间(PT)、血浆纤维蛋白原(FIB)、血小板聚集试验(PAgT)]、流式细胞学指标[辅助性T淋巴细胞1(Th1)、辅助性T淋巴细胞17(Th17)及调节性T细胞(Treg)]、炎性因子[白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平。结果观察组患者治疗1年后LVEF(59.12±3.83)%高于对照组的(55.88±3.97)%,HR(76.14±6.69)次/min、LVEDD(54.47±2.91)mm低于对照组的(80.61±5.92)次/min、(57.63±2.16)mm,统计学意义成立(P<0.05)。治疗1年后,观察组PT(13.93±2.01)s长于对照组的(12.63±2.07)s,FIB(4.02±0.98)g/L、PAgT(59.63±7.31)%均低于对照组的(4.79±1.02)g/L、(67.56±6.91)%,统计学意义成立(P<0.05)。观察组治疗1年后Th1、Th17低于对照组,Treg高于对照组,统计学意义成立(P<0.05)。治疗1年后,观察组患者IL-10(36.67±6.38)pg/ml、IL-6(130.63±24.36)pg/ml、CRP(33.12±8.93)mg/L均低于对照组的(43.08±7.11)pg/ml、(169.67±29.61)pg/ml、(49.68±10.47)mg/L,统计学意义成立(P<0.05)。结论麝香保心丸介导的内皮功能改变能显著提升心梗后心衰患者的心功能水平,增强机体免疫功能,降低机体炎症因子水平,麝香保心丸综合应用价值较高,建议临床推广使用。

基于CiteSpace的麝香保心丸治疗冠心病的可视化分析

目的:基于CiteSpace工具,对麝香保心丸治疗冠心病的相关文献进行可视化分析,探索该领域的研究热点及发展趋势。方法:通过中国知网(CNKI)、万方(WanFang Data)、维普(VIP)中文数据库检索公开发表的麝香保心丸治疗冠心病的相关中文文献,检索时限为2013年1月1日-2023年1月1日,应用CiteSpace 6.2.R4软件对作者、机构和关键词绘制知识图谱并进行分析。结果:共纳入文献940篇;纳入作者263位,形成了分别以杨国亮、薛增明、王焕超、吴海霞为代表的4个研究团队;纳入机构255所,发文量排名前3位的机构分别是河北医科大学第三医院、河北省清河县中医院、长春中医药大学附属医院;形成9个关键词聚类,研究热点主要为不同中医证型的治疗、疗效及安全性、主要的评价指标;获取了10个突现词,心功能、美托洛尔、高血压及炎性因子是近5年来该领域的研究热点。结论:麝香保心丸治疗冠心病的研究正处在快速发展时期,但是研究者和机构之间均未形成广泛而深入的联系,因此需要加强沟通合作。

麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的心肌保护作用及对动脉血流参数、ST2和IL-33的影响

目的:探讨麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的心肌保护作用,以及对动脉血流参数、可溶性生长刺激表达基因2(ST2)和白细胞介素33(IL-33)的影响。方法:该前瞻性研究的研究时间为2021年3月至2023年3月,受试对象为105例急性ST段抬高型心肌梗死患者,共脱落5例,最后完成疗程并有完整记录的为100例。将100例患者采用随机数字表法分为研究组和对照组,每组50例。两组患者入院后均采取常规吸氧、心电监护等措施,立即建立静脉通路,并行经皮冠状动脉介入治疗;对照组患者采用注射人脑利钠肽进行治疗,研究组患者在对照组的基础上口服麝香保心丸,两组患者均连续治疗14 d。比较研究组与对照组患者治疗前后胸痛胸闷、心悸、气短、疲倦乏力、面肢浮肿和气喘等中医症状积分并比较疗效,比较研究组与对照组患者冠状动脉再通率,治疗前后心肌标志物水平、动脉血流参数以及血清ST2、IL-33、一氧化氮(NO)和内皮素-1(ET-1)水平变化。结果:治疗后,研究组患者胸痛胸闷、心悸、气短、疲倦乏力、面肢浮肿和气喘等各项中医症状积分较对照组更低,差异均有统计学意义(P<0.05)。研究组患者的治疗总有效率为96.00%(48/50),显著高于对照组的84.00%(42/50),差异有统计学意义(P<0.05)。治疗后,研究组患者血清N末端B型利钠肽前体、乳酸脱氢酶、心肌肌钙蛋白T和肌酸磷酸激酶含量较对照组更低;研究组患者冠状动脉再通率分级情况显著优于对照组;研究组患者左心室射血分数、左心室高峰充盈率、收缩期血流速度峰值、舒张期血流速度峰值和冠状动脉血流速度储备较对照组更高,左心室舒张末期内径较对照组更低;研究组患者血清ST2、IL-33和ET-1水平较对照组更低,血清NO水平较对照组更高,上述差异均有统计学意义(P<0.05)。结论:麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的疗效较好,有助于保护心肌细胞,改善动脉血流循环,其心肌保护作用机制可能与减少ST2和IL-33的表达以及减轻血管损伤有关。

麝香保心丸联合曲美他嗪治疗冠心病合并心力衰竭疗效与安全性的系统评价

目的:系统评价麝香保心丸联合曲美他嗪治疗冠心病合并心力衰竭的临床疗效与安全性。方法:计算机检索EMbase、the Cochrane Library、PubMed、维普中文期刊服务平台、万方数据库、中国知网、中国生物医学文献数据库,检索时限为建库至2022年3月11日,检索有关麝香保心丸联合曲美他嗪治疗冠心病合并心力衰竭的临床随机对照试验(RCT)。由2名研究者筛选获得符合要求文献后提取有效数据,采用RevMan 5.3软件进行Meta分析。采用Cochrane评价手册中的风险偏倚评估工具进行文献质量评估。结果:共纳入文献13篇,涉及病人1 366例,其中试验组683例,对照组683例。Meta分析结果显示,试验组临床有效率高于对照组[RR=1.22,95%CI(1.15,1.28),P<0.000 01],试验组治疗后B型钠尿肽水平低于对照组[SMD=-5.06,95%CI(-7.07,-3.05),P<0.000 01],左室射血分数高于对照组[SMD=1.70,95%CI(1.36,2.04),P<0.000 01],左室舒张末期内径[SMD=-1.31,95%CI(-1.74,-0.87),P<0.000 01]和左室收缩末期内径[SMD=-1.91,95%CI(-2.32,-1.51),P<0.000 01]小于对照组,6 min步行试验距离较对照组增加[MD=48.29,95%CI(37.06,59.52),P<0.000 01],且不良反应发生率低于对照组[RR=0.33,95%CI(0.18,0.61),P=0.000 3]。结论:现有证据表明,麝香保心丸联合曲美他嗪治疗冠心病合并心力衰竭有协同增效作用,能改善病人心功能,提高临床疗效,且可有效降低不良反应发生率。

麝香保心丸对缺血再灌注大鼠心肌损伤及细胞自噬的调节作用

目的观察麝香保心丸(Shexiang baoxin pill,SBP)对缺血/再灌注损伤(Ischemia/reperfusion injury,I/R)大鼠心肌组织的保护作用及与自噬的调节关系。方法采用左冠状动脉前降支缺血再灌注建立I/R模型。将Sprague-Dawley(SD)大鼠30只按随机数字表法分为对照组、模型组及SBP组,每组各10只。通过心脏超声多普勒检测大鼠不同时期左心室射血分数(Left ventricular ejection fraction,LVEF)、左室缩短分数(Fractional shortening,FS)、左室舒张末期内径(Left ventricular end diastolic diameter,LVIDd)和左心室收缩期内径(Left ventricular end systolic dimension,LVIDs)的变化,HE染色观察心肌组织病理改变,TUNEL染色检测细胞凋亡情况,采用qRT-PCR方法检测白细胞介素-1β(Interleukin-1β,IL-1β)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)和自噬相关基因(Autophagy-related genes,ATG)、BCL-2关联X蛋白(BCL-2 associated X protein,Bax)和B淋巴细胞瘤-2基因(B-cell lymphoma-2,Bcl-2)的表达水平。采用Western blot检测自噬特异性基因(Beclin-1)、泛素结合蛋白p62(p62)和微管相关蛋白质1轻链3(Microtubule-associated protein 1 light chain 3,LC3)的表达水平。结果与对照组比较,心肌缺血/再灌注损伤后,各组大鼠心脏LVEF、FS均下降,LVIDd、LVIDs均增大。术后随访发现SBP组大鼠心脏功能指标较模型组明显改善。HE染色见SBP减轻I/R大鼠心肌细胞水肿紊乱情况。TUNEL染色显示,与对照组比较,模型组心肌组织显示凋亡细胞增多,而经SBP处理的大鼠心肌组织中凋亡细胞减少,说明SBP可以减轻I/R导致的细胞损伤。通过qRT-PCR检测发现,与对照组比较,模型组大鼠ATG12表达水平明显上调。而SBP组大鼠在1个月随访时发现ATG12表达水平较模型组降低。说明SBP抑制I/R诱导的ATG12 mRNA表达上调。与对照组比较,模型组Bax表达增加,Bcl-2表达降低。与模型组比较,SBP处理后大鼠心肌组织中Bax表达降低,Bcl-2表达升高。表明SBP可以下调促凋亡蛋白,上调抗凋亡基因。与对照组比较,模型组Beclin-1、p62及LC3-II/LC3-I水平均明显升高。与模型组比较,SBP下调了心肌中Beclin-1、p62和LC3-II/LC3-I蛋白的表达水平。结论心肌缺血再灌注可增强自噬反应,促进细胞凋亡。麝香保心丸可能通过调节ATG12从而抑制自噬,对受损心肌发挥保护作用,改善心肌细胞凋亡。

麝香保心丸联合增强型体外反搏治疗冠状动脉微血管疾病的疗效及对血管内皮功能的影响

目的:观察麝香保心丸联合增强型体外反搏治疗冠状动脉微血管疾病的临床疗效及对血管内皮功能的影响。方法:选取2022年3月—2022年12月在山东第一医科大学附属聊城市第二人民医院就诊的冠状动脉微血管疾病病人78例,按照随机数字表法分为观察组和对照组,每组39例。对照组采用常规西药治疗,观察组在对照组基础上加用麝香保心丸及增强型体外反搏治疗。观察两组治疗前后中医证候评分变化、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)、血清血管紧张素Ⅱ(AngⅡ)]、心肌断层显像变化,比较两组临床疗效。结果:治疗后,观察组中医证候评分低于对照组(P<0.05)。观察组临床疗效总有效率为87.18%,高于对照组的64.10%(P<0.05)。观察组治疗后血清ET-1、AngⅡ水平低于对照组,血清NO水平高于对照组,左室放射性异常积分、靶心图缺损范围小于对照组,差异均有统计学意义(P<0.05)。结论:麝香保心丸联合增强型体外反搏治疗可改善冠状动脉微血管疾病病人临床症状,改善血管内皮功能,改善心肌供血不足,提高临床疗效。

分析达格列净片联合麝香保心丸治疗射血分数降低心力衰竭急性发作期的临床疗效

目的对射血分数降低心力衰竭急性发作期患者使用达格列净片联合麝香保心丸进行治疗的效果做出分析。方法选择160例心力衰竭患者,该类患者均处在急性发作期,且射血分数降低,在随机抽样法方式下将患者划分成常规组和研究组,各80例。常规组患者使用达格列净片治疗,研究组使用达格列净片联合麝香保心丸治疗。对比分析两组患者的治疗效果、心室功能水平、心力衰竭标志物、中医证候积分。结果研究组治疗总有效率为98.75%,高于常规组的90.00%(χ^(2)=5.768,P<0.05)。研究组左室收缩末期内径、左室射血分数、左室舒张末内径分别为(35.13±2.08)mm、(58.71±2.87)%、(52.85±2.56)mm,均优于常规组的(39.56±2.51)mm、(43.10±2.43)%、(56.81±3.13)mm(t=12.154、37.127、8.759,P<0.05)。研究组N末端脑钠肽前体、血浆内脑钠肽水平分别为(1510.36±160.35)、(601.40±98.87)ng/L,均优于常规组的(2219.63±152.58)、(829.53±121.36)ng/L(t=28.660、13.035,P<0.05)。研究组治疗1、2周的中医证候积分分别为(16.08±6.84)、(11.27±9.71)分,均低于常规组的(24.28±10.39)、(20.25±13.26)分(t=5.896、4.887,P<0.05)。结论为射血分数降低心力衰竭急性发作期患者使用达格列净片联合麝香保心丸进行治疗,能够改善患者心室功能,降低患者心力衰竭标志物水平,提升治疗效果,临床应用价值较高。

麝香保心丸干预动脉粥样硬化模型动物实验的系统评价

目的系统评价麝香保心丸对动脉粥样硬化动物模型的干预作用。方法计算机检索建库至2023年7月18日在PubMed、Web of Science、EMbase、Cochrane Library、中国知网、维普、万方知识服务平台、中国生物医学文献数据库上公开发表的与麝香保心丸干预动脉粥样硬化模型动物实验相关文献。由2名研究者独立对文献进行筛选及资料提取,建立文献信息库,采用SYRCLE动物实验偏倚风险评估工具对纳入文献进行偏倚风险评价,使用RevMan 5.4软件进行Meta分析。结果经过筛选共纳入7篇文献进行Meta分析,与模型空白组相比麝香保心丸组可缩小主动脉斑块与血管腔面积比(SMD=-3.94,95%CI:-6.53~-1.36),降低血清低密度脂蛋白胆固醇水平(SMD=-2.86,95%CI:-4.21~-1.52),降低血清总胆固醇水平(SMD=-2.83,95%CI:-4.18~-1.47),降低血清三酰甘油水平(SMD=-2.80,95%CI:-4.57~-1.03)。麝香保心丸组与模型空白组相比血清高密度脂蛋白胆固醇水平差异无统计学意义(SMD=0.93,95%CI:-0.34~2.19)。结论本研究结果提示麝香保心丸干预动脉粥样硬化动物模型可缩小主动脉斑块面积,降低血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平。其机制可能与抑制炎症反应、促进胆固醇流出调节脂代谢、保护血管内皮、缓解血管内皮凋亡、激活自噬等有关。上述结论仍需要纳入设计更为严谨的高质量文献不断补充验证。

替格瑞洛联合麝香保心丸对冠状动脉慢性完全 闭塞患者血管内皮再生作用的研究

目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者,按治疗方法分为两组,分别为常规组和观察组,每组30例。常规组给予常规治疗和替格瑞洛治疗,观察组在常规组基础上给予麝香保心丸治疗。比较两组治疗前和治疗12个月后血管炎症指数、血管内皮损伤和增殖标志物水平的变化,记录两组内皮舒张功能和侧支循环改善率。结果治疗前两组冠状动脉CTO患者的血管炎症指标、血管内皮损伤和增殖标志物比较差异均无统计学意义(P>0.05)。治疗后,观察组可溶性CD40配体(sCD40L)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、血管性血友病因子(vWF)显著下降,与常规组相比,差异具有统计学意义(P<0.05);而内皮一氧化氮合酶(eNOS)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和Jagged1蛋白均显著升高,与常规组相比,差异具有统计学意义(P<0.05);两组冠状动脉CTO患者的内皮舒张功能比较差异无统计学意义(P>0.05);观察组侧支循环良好率高于常规组(P<0.05)。结论替格瑞洛联合麝香保心丸治疗冠状动脉CTO患者可抑制血管炎症的表达,纠正其内皮功能障碍,促进内皮细胞增殖,改善冠状动脉CTO患者冠状动脉侧支循环。

麝香保心丸对冠心病心绞痛患者冠脉血流及心率变异性的影响

目的:探究麝香保心丸对冠心病心绞痛患者冠脉血流及心率变异性的影响。方法:选取2021年11月-2023年6月常州市第三人民医院收治的110例冠心病心绞痛患者。根据随机数表法将其分为对照组(55例)和观察组(55例)。对照组给予常规冠心病心绞痛治疗,观察组在对照组基础上给予麝香保心丸。比较两组治疗后临床疗效,不良反应,治疗前、治疗2周及4周后冠脉血流指标、心率变异性。结果:观察组治疗总有效率显著高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。治疗2周及4周后,观察组收缩期峰流速(SPV)、舒张期峰流速(DPV)及时间速度积分(CTVI)均显著高于对照组,治疗4周后,两组SPV、DPV及CTVI均显著高于治疗前及治疗2周后,治疗2周后,两组SPV、DPV及CTVI均显著高于治疗前,差异有统计学意义(P<0.05)。治疗2周及4周后,观察组全部正常窦性心搏间期的标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻的RR间期差值>50 ms者占分析总心搏数量的百分比(PNN50)及相邻RR间期差值的均方根(RMSSD)均显著高于对照组,治疗4周后,两组SDNN、SDANN、PNN50、RMSSD均显著高于治疗前及治疗2周后,治疗2周后,两组SDNN、SDANN、PNN50、RMSSD均显著高于治疗前,差异有统计学意义(P<0.05)。治疗2周及4周后,观察组低频功率(LF)及高频功率(HF)均显著高于对照组,治疗4周后,两组LF、HF均显著高于治疗前及治疗2周后,治疗2周后,两组LF、HF均显著高于治疗前,差异有统计学意义(P<0.05)。结论:麝香保心丸在冠心病心绞痛患者中的应用效果较好,且可显著改善患者的冠脉血流及心率变异性。